Public Reporting Helped Drive Quality Improvement In Outpatient Diabetes Care Among Wisconsin Physician Groups

Smith, Maureen A.; Wright, Alexandra; Queram, Christopher; Lamb, Geoffrey C.

doi:10.1377/hlthaff.2011.0853

Cited by 46 publications

(47 citation statements)

References 16 publications

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“…230 Despite its methodological flaws, this study's findings suggest the public reporting of performance data alone does not stimulate sustainable organisational change. The public reporting of performance data is more likely to lead to sustainable QI if it occurs alongside other, large, externally supported QI initiatives.…”

Section: Feedback Of Proms: Reviewing Contextsmentioning

confidence: 75%

“…230 Providers reported that considerable resources were required to enable them to respond to issues highlighted by the feedback of performance data. Those who are already engaged in QI activities may have been more likely to set up internal data processes that inform QI on an ongoing basis and, thus, were better able to respond when external data shone a light on poor performance.…”

Section: Theorymentioning

confidence: 99%

See 1 more Smart Citation

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

170

256

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BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Feedback Of Proms: Reviewing Contextsmentioning

confidence: 75%

Section: Theorymentioning

confidence: 99%

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

170

256

View full text Add to dashboard Cite

show abstract

“…In this vein, some evidence exists indicating that public reporting of performance measures alone can lead to performance improvements in hospitals. [12][13][14][15] Although a study that compared the performance effects of combining financial incentives and public reporting to public reporting alone found that incentives raise performance levels above those obtained from just public reporting, the added increase was quite modest. 16 As such, it is possible that the VA would have experienced similar patterns, though perhaps not at identical levels, of performance improvement and sustainability from reporting the performance of its facilities on the selected measures even without offering performance-based incentives.…”

Section: Discussionmentioning

confidence: 99%

Sustainability of Quality Improvement Following Removal of Pay-for-Performance Incentives

et al. 2013

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BACKGROUND: Although pay-for-performance (P4P) has become a central strategy for improving quality in US healthcare, questions persist about the effectiveness of these programs. A key question is whether quality improvement that occurs as a result of P4P programs is sustainable, particularly if incentives are removed. OBJECTIVE: To investigate sustainability of performance levels following removal of performance-based incentives. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study that capitalized on a P4P program within the Veterans Health Administration (VA) that included adoption and subsequent removal of performance-based incentives for selected inpatient quality measures. The study sample comprised 128 acute care VA hospitals where performance was assessed between 2004 and 2010. INTERVENTION: VA system managers set annual performance goals in consultation with clinical leaders, and report performance scores to medical centers on a quarterly basis. These scores inform performance-based incentives for facilities and their managers. Bonuses are distributed based on the attainment of these performance goals. MEASUREMENTS: Seven quality of care measures for acute coronary syndrome, heart failure, and pneumonia linked to performance-based incentives. RESULTS: Significant improvements in performance were observed for six of seven quality of care measures following adoption of performance-based incentives and were maintained up to the removal of the incentive; subsequently, the observed performance levels were sustained. LIMITATIONS: This is a quasi-experimental study without a comparison group; causal conclusions are limited. CONCLUSION: The maintenance of performance levels after removal of a performance-based incentive has implications for the implementation of Medicare's value-based purchasing initiative and other P4P programs. Additional research is needed to better understand human and system-level factors that mediate sustainability of performance-based incentives.KEY WORDS: inpatients; physician incentive plans; quality improvement; quality indicators; reimbursement; incentive; salaries ; fringe benefits.

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“…Public reporting of patient experience in combination with an array of interventions that take in to consideration the context of a healthcare system may have greater potential to stimulate providers to improve quality [51][52][53]. Although public reporting may encourage improvements through increased competition between health providers and professionals, a review exploring the impact of public reporting of patient experience, in combination with patient outcomes (such as mortality rates in hospital wards), found that some surgeons became more reluctant to care for highrisk patients (e.g.…”

Section: How Can Patient Experience Data Be Usedmentioning

confidence: 99%

Measuring Patient Experience: Concepts and Methods

Ahmed

Burt

Roland

2014

Patient

226

185

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Providing a good patient experience is a key part of providing high-quality medical care. This paper explains why patient experience is important in its own right, and its relationship to other domains of quality. We describe methods of measuring patient experience, including issues relating to validity, reliability and response bias. Differences in reported patient experience may sometimes reflect differences in expectations of different population groups and we describe the arguments for and against adjusting patient experience data for population characteristics. As with other quality improvement strategies, feeding back patient experience data on its own is unlikely to improve quality: sustained and multiple interventions are usually required to deliver sustained improvements in care. Key Points for Decision MakersQuality is a multi-dimensional concept, and a single indicator does not (and should not) reflect quality in other domains. Patient experience is important in its own right.Patient experience is consistently and positively associated with other quality outcomes including patient safety and clinical effectiveness across a wide range of studies, and healthcare facilities providing high-quality clinical care tend to have better experiences reported by patients. However, these associations are frequently modest in size. Clinical quality and patient experience should be considered as distinct but inter-related aspects of quality.Differences in patient experience scores between population (e.g. ethnic) groups may in part reflect differences in expectations.Adjusting patient experience scores for population characteristics (e.g. ethnicity, deprivation) increases the acceptability of the results to healthcare providers. Case-mix adjustment in general makes only small differences to scores, though the greatest positive effect is on providers serving vulnerable populations.Significant quality improvement in general requires multiple strategies which are sustained over time. The same is probably true when using patient experience measures as a quality improvement tool. Simple feedback is unlikely to produce significant improvements in care.

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Public Reporting Helped Drive Quality Improvement In Outpatient Diabetes Care Among Wisconsin Physician Groups

Cited by 46 publications

References 16 publications

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Sustainability of Quality Improvement Following Removal of Pay-for-Performance Incentives

Measuring Patient Experience: Concepts and Methods

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