The use of public performance reporting by general practitioners: a study of perceptions and referral behaviours

Abstract

BackgroundPublic performance reporting (PPR) of hospital data aims to improve quality of care in hospitals and to inform consumer choice. In Australia, general practitioners (GPs) are gatekeepers to secondary care with patients requiring their referral for non-emergency access. Despite their intermediary role, GPs have been generally overlooked as potential users of PPR of hospital data, with the majority of the PPR research focussing on consumers, surgeons and hospitals.MethodsWe examined the use of PPR of hospital data by GPs when referring patients to hospitals. Semi-structured interviews were conducted with 40 GPs, recruited via the Victorian Primary Care Practice-Based Research Network and GP teaching practices in Victoria, Australia. The interviews were recorded, transcribed and analysed thematically.ResultsWe found that the majority of GPs did not use PPR when referring patients to hospitals. Instead, they relied mostly on informal sources of information such as their own or patients’ previous experiences. Barriers that prevented GPs’ use of PPR in their decision making included: lack of awareness and accessibility; perceived lack of data credibility; restrictive geographical catchments for certain hospitals; limited choices of public hospitals in regional and rural areas; and no mandatory PPR for private hospitals.ConclusionsOur findings suggest that lack of PPR awareness prevented GPs from using it in their referral practice. As gatekeepers to secondary care, GPs are in a position to guide patients in their treatment decisions and referrals using available PPR data. We suggest that there needs to be greater involvement by GPs in the development of hospital performance and quality indicators in Australia if GPs are to make greater use of them. The indicators require further development before GPs perceive them as valid, credible, and of use for informing their referral practices.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0719-4) contains supplementary material, which is available to authorized users.

Mechanisms and impact of public reporting on physicians and hospitals’ performance: A systematic review (2000–2020)

“…patient experience and satisfaction) reported at the individual physician level [ 77 – 79 ]; whereas providers and purchasers considered processes and outcomes measures (e.g. surgical complications and mortality ) to be important indicators that should be publicly reported [ 80 , 81 ]. Consumer-focused frameworks and best practice guidelines have also been developed for presenting, promoting and disseminating PPR data to improve their comprehensibility and usability [ 24 , 82 ].…”

“…Furthermore, in these countries and others European countries, general practitioners (GPs) are generally gatekeepers to secondary care with patients requiring their referral for access [ 100 ]. There have been few studies examining whether PPR of hospital data influences GPs referral behaviour [ 80 , 101 , 102 ]. Given the growth of PPR outside of the US, health policy makers must consider other potential users of PPR beyond patients such as the intermediate role that GPs play in connecting patients with hospitals.…”

Public performance reporting and hospital choice: a cross-sectional study of patients undergoing cancer surgery in the Australian private healthcare sector

“…However, past research shows that GPs rarely used PPR information when referring patients to hospitals because they were unaware of PPR data and they had concerns about its reliability and validity. 31 66 67 Addressing these barriers is essential if GPs are to be a viable source of PPR information for their patients.…”

“…Previous components of the research programme included interviews with healthcare consumer advocates, providers, purchasers (public and private funders of healthcare services), 28 senior hospital clinical administrators 29 30 and GPs. 31 This component of the research programme used a quantitative approach to understand the use of PPR information when selecting a hospital for surgery among patients with breast, bowel or lung cancer. A national cross-sectional study design of the private healthcare sector was conducted using postal questionnaires.…”

The impact of Australian healthcare reforms on emergency department time-based process outcomes: An interrupted time series study

“…This study is a component of a larger mixed-methods research program aimed at increasing understanding of how public reporting may improve quality of care in public and private hospitals in Australia. Previous components of the research program included examining the perspectives of multiple stakeholders including consumer advocates, providers, purchasers [28], public hospital medical directors[29, 30], general practitioners (GPs) [31] and patients [32]. This component used a quantitative approach to understand the effect of national healthcare reforms on various ED time-based process outcomes.…”