Lifting the veil on stroke outcomes: revisiting stroke centers’ transparency through public reporting of metrics

Abstract

Public reporting of healthcare metrics provides transparency that allows patients and emergency medical providers to make informed decisions about where patients should receive care. Most previous reports about public reporting of health metrics have demonstrated significant improvements in outcome metrics after implementation. However, no mechanism exists, voluntary or otherwise, for the public reporting of outcomes of stroke care. We review the components of public reporting of health outcomes data and its limited history in stroke outcomes. We summarize the literature on public reporting in cardiovascular interventions, particularly percutaneous coronary interventions, as a close corollary to mechanical neurothrombectomy. The benefits, limitations, and controversies associated with reporting of cardiovascular outcomes are reviewed with a focus on the development of risk-avoidant behaviors. This article serves as a primer for discussion of the potential benefits, limitations, and unintended consequences of public reporting of stroke data.

Current trends in the acute treatment of ischemic stroke: analysis from the Paul Coverdell National Acute Stroke Program

“…Other studies have demonstrated that PCI centers may have developed risk avoidance behaviors, where treatment is withheld from higher-risk patients in order to avoid having to publicly report increased mortality rates. States with public reporting of outcomes have been found to perform fewer PCI procedures that disproportionately affect higher-risk patients 14. As we enter a new era for AIS intervention that includes IAT, the long-term implications of the trends we observed in our study remain unknown.…”

“…As we enter a new era for AIS intervention that includes IAT, the long-term implications of the trends we observed in our study remain unknown. We should define metrics that best reflect stroke quality of care in order to minimize risk avoidance behavior that could impact acute stroke treatment trends in the future 14…”

Effects of Public Reporting Legislation of Nurse Staffing: A Trend Analysis

“…The degree to which public reporting data are meaningful to patients has been extensively examined in the literature (Fargen, West, & Mocco, 2018). Of 203 patients with suspected or known cardiac disease, greater than 60% viewed publicly available mortality data as accurate, useful, and likely to improve care (Fernandez, Narins, Bruckel, Ayers, & Ling, 2017).…”

“…High-performing providers and hospitals will be rewarded for quality outcomes (Fargen et al., 2018). Evidence also suggests that public reporting for hospitals in conjunction with pay-for-performance requirements that financially reward hospitals for excellent care will result in modest improvements in hospital quality, compared with hospitals that only engaged in public reporting (Lindenauer et al., 2007).…”