Public Reporting On Quality In The United States And The United Kingdom

Marshall, Martin; Shekelle, Paul G; Davies, H. T. O.; Smith, Peter

doi:10.1377/hlthaff.22.3.134

Cited by 180 publications

(175 citation statements)

References 33 publications

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“…Consistent with prior research, only a small minority reported comparing the quality of hospitals. 18 Employees who chose the lower-deductible CDHP in 2004 consistently reported the greatest use of health-related information in the prior year. They were more likely to have used a Web site or book for health information or how to handle a symptom or health problem.…”

Section: Study Findingsmentioning

confidence: 96%

Do Consumer-Directed Health Plans Drive Change In Enrollees’ Health Care Behavior?

Dixon¹,

Greene²,

Hibbard

2008

Health Affairs

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Using panel data from two surveys of employees at one large employer from 2004 and 2005, this paper examines consumer-directed health plans' (CDHPs') influence on the use of health-related information and health services. We compare enrollees in a high-deductible CDHP, a lower-deductible CDHP, and a preferred provider organization (PPO). Enrollees in the lower-deductible CDHP were more likely than enrollees in the other plans to start using information. Enrollees in the high-deductible CDHP were more likely than those in the PPO to start forgoing medical care to save money. [Health Affairs 27, no. 4 (2008): 1120-1131 10.1377/hlthaff.27.4.1120 T h e g r ow t h o f c o n s u m e r-directed health plans (CDHPs) has been rapid. 1 These plans usually combine a savings account, high-deductible insurance coverage, and information on the costs and quality of hospitals and doctors. Proponents of these plans believe that they give health care consumers more "skin in the game," through greater cost exposure, which will promote more cost-effective utilization decisions. Ultimately, the hope is that such decisions will result in lower costs and slower growth in health care spending. Critics have argued that these plans benefit only the "healthy, wealthy, and wise" segment of the insurance market and shift the burden of health care financing onto the poor and sick. 2 n Previous research findings. There has been much debate over the policy to promote CDHPs and their design, and some work has attempted to model CDHPs' impact. 3 Results from a telephone survey of the general population by the Commonwealth Fund and the Employee Benefit Research Institute (EBRI) suggest that enrollees in high-deductible plans are less satisfied with their health plan; are more likely to avoid, skip, or delay health care because of costs; and are more cost-conscious than those in comprehensive health plans. 4 Analysis of claims data from one large employer found lower physician visits and pharmacy use but higher hospital admission rates among CDHP enrollees. 5 n Objectives of our research. Our aim is to understand the impact of CDHPs on consumers' self-reported behavior, using survey data from a large single-employer population. We compared employees who enrolled in high-or lower-deductible CDHPs at the beginning of 2004 with employees who remained in a PPO. Specifically, we addressed the following research questions: (1) Does the provi-1 1 2 0 J u l y /A u g u s t 2 0 0 8 H e a l t h T r a c k i n g

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Section: Study Findingsmentioning

confidence: 96%

Do Consumer-Directed Health Plans Drive Change In Enrollees’ Health Care Behavior?

Dixon¹,

Greene²,

Hibbard

2008

Health Affairs

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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

243

212

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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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“…The goal is not an exhaustive review of the literature, but rather to demonstrate that both desired and unintended consequences have been observed following prior public-report release. [The reader is referred to recent reviews of the literature on public reporting for more detailed assessments of the history of positive and negative effects of public reports on overall quality by Marshall et al (26,27) and Werner & Asch (45).] Evidence of prior benefit and/or harm resulting from public reporting does not necessarily predict the magnitude of the impact of present and future reports, given current and expected progress in public-reporting design and implementation.…”

Section: Has Public Reporting Changed Hospital Quality Of Care?mentioning

confidence: 99%

PUBLIC REPORTING OF PROVIDER PERFORMANCE: Can Its Impact Be Made Greater?

Robinowitz

Dudley

2006

Annu. Rev. Public Health

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Key Words quality of care, report cards, incentives, sample size ■ Abstract Public reporting of provider performance is becoming increasingly commonplace. In this chapter, we first review studies of prior public reports (or report cards) that show real but small impact on provider attempts to improve quality, on consumers' impressions of providers, and even on consumer selection of providers. Among other factors, two potential explanations for the low level of impact are that, in most early reports, the large majority of providers have been labeled "average" and consumers may have had difficulty understanding the statistical assessments. In response, some current report card producers are using or considering a variety of methods to increase the number of distinctions among providers and the ease of comprehension of the labels used. Therefore, we also consider the advantages and disadvantages of several novel approaches to analyzing and reporting provider performance.

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Public Reporting On Quality In The United States And The United Kingdom

Cited by 180 publications

References 33 publications

Do Consumer-Directed Health Plans Drive Change In Enrollees’ Health Care Behavior?

Do Consumer-Directed Health Plans Drive Change In Enrollees’ Health Care Behavior?

Measuring Patient Experience: Concepts and Methods

PUBLIC REPORTING OF PROVIDER PERFORMANCE: Can Its Impact Be Made Greater?

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