Use of Public Performance Reports. A Survey of Patients Undergoing Surgery

Department of Health Policy and Management, Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA 02115, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/1998; 279(20):1638-42.
Source: PubMed


Publicly released performance reports ("report cards") are expected to foster competition on the basis of quality. Proponents frequently cite the need to inform patient choice of physicians and hospitals as a central element of this strategy.
To examine the awareness and use of a statewide consumer guide that provides risk-adjusted, in-hospital mortality ratings of hospitals that provide cardiac surgery.
Telephone survey conducted in 1996.
Pennsylvania, where since 1992, the Pennsylvania Consumer Guide to Coronary Artery Bypass Graft [CABG] Surgery has provided risk-adjusted mortality ratings of all cardiac surgeons and hospitals in the state.
A total of 474 (70%) of 673 eligible patients who had undergone CABG surgery during the previous year at 1 of 4 hospitals listed in the Consumer Guide as having average mortality rates between 1% and 5% were successfully contacted.
Patients' awareness of the Consumer Guide, their knowledge of its ratings, their degree of interest in the report, and barriers to its use.
Ninety-three patients (20%) were aware of the Consumer Guide, but only 56 (12%) knew about it before surgery. Among these 56 patients, 18 reported knowing the hospital rating and 7 reported knowing the surgeon rating, 11 said hospital and/or surgeon ratings had a moderate or major impact on their decision making, but only 4 were able to specify either or both correctly. When the Consumer Guide was described to all patients, 264 (56%) were "very" or "somewhat" interested in seeing a copy, and 273 (58%) reported that they probably or definitely would change surgeons if they learned that their surgeon had a higher than expected mortality rate in the previous year. A short time window for decision making and a limited awareness of alternative hospitals within a reasonable distance of home were identified as important barriers to use.
Only 12% of patients surveyed reported awareness of a prominent report on cardiac surgery mortality before undergoing cardiac surgery. Fewer than 1% knew the correct rating of their surgeon or hospital and reported that it had a moderate or major impact on their selection of provider. Efforts to aid patient decision making with performance reports are unlikely to succeed without a tailored and intensive program for dissemination and patient education.

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    • "Similarly, a previous study examining public release of cardiac surgery data suggested this resulted in only a modest impact on referral patterns by physicians [29]. Patient awareness or interest in these figures may also be low, with one study reporting less than 1% of patients undergoing cardiac surgery knew the correct rating of their surgeon or hospital beforehand [30]. Many assumptions surround the benefits of such public reporting, but overall little research examines the effects of public reporting on the delivery of health care [31]. "
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    ABSTRACT: Government-mandated publication of named surgeon-specific outcome data (SSD) has recently been introduced across nine surgical specialty areas in England. This move is the first time that such national data has been released in any country, and it promises to provide a significant advancement in health service transparency. Data is derived from nine preexisting national surgical audit databases. However, eight of these were not originally designed for this purpose, and there is considerable controversy surrounding data quality, risk adjustment, patient use and interpretation, and surgeons' subsequent case selection. Concerns also surround the degree to which these results truly reflect the individual consultant, or the wider hospital team and accompanying resources. The potential impact on surgical training has largely been overlooked. This paper investigated the background to SSD publication and controversies surrounding this, the potential impact on surgical training and the response to these concerns from medical and surgical leaders. As SSD collection continues to be refined, the most appropriate outcomes measurements need to be established, and risk adjustment requires ongoing improvement and validation. Prospective evaluation of changes in surgical training should be undertaken, as any degradation of will have both short and long-term consequences for patients and surgeons alike. It is important that the literature supporting the safety of supervised trainee practice is also promoted in order to counterbalance any potential concerns that might detract from trainee operating opportunities. Finally, it is important that outcomes data is communicated to patients in the most meaningful way in order to facilitate their understanding and interpretation given the complexities of the data and analysis involved. Copyright © 2014. Published by Elsevier Ltd.
    Full-text · Article · Dec 2014 · International Journal of Surgery (London, England)
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    • "We expect that awareness of PQI will be related to demographic and socio-economic characteristics of individuals, consistent with findings from the two previous studies of factors influencing awareness of PQI, studies of awareness of health plan and hospital comparative quality data (Kolstad & Chernew, 2009; Scanlon & Chernew, 1999; Harris & Buntin, 2008; Schneider & Epstein, 1998), and studies of the determinants of information searches for non-health care related goods (e.g., Klein & Ford, 2002). While our study focuses on people 65 years of age and older, some study participants received health insurance coverage through an employer or by purchasing supplemental Medicare insurance from private health insurers. "
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    ABSTRACT: Objective: Examine the factors that are associated with awareness of physician quality information (PQI) among older people with one or more chronic illnesses and the implications for Medicare. Data sources/study setting: Random digit-dial survey of adults with one or more chronic illnesses. Research design: Structural equation modeling to examine factors related to awareness of PQI. Results: Awareness of PQI is low (13 percent), but comparable to findings in general population surveys. Age, race, education, and self-reported health status are associated with PQI awareness. Trust in the Internet as a source of health care information and not trusting one's physician as a source of information both are associated with a greater likelihood of being aware of PQI. Patients with high levels of activation have greater trust in physicians as information sources, but this is not associated with awareness, nor is degree of satisfaction with their care experience. Conclusions: Awareness of PQI among older persons with chronic illnesses is relatively low across all socio-economic and demographic subgroups. Changes in population characteristics over time are unlikely to improve awareness in this population, nor are changes in patient activation or satisfaction with care. Medicare would need a broad-based effort if it wishes to raise PQI awareness among Medicare beneficiaries in the near term. Before undertaking resource-intensive efforts to increase awareness, Medicare may want to consider what level of awareness actually is needed to accomplish the overall objective for PQI transparency, which is raising the quality of care received by beneficiaries. It may be that relatively low levels of awareness are sufficient.
    Full-text · Article · Jun 2014 · Medicare and Medicaid Research Review
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    • "Reasons for not using it are that they encounter barriers to its use, e.g. the short time frame in which to select a provider and geographical barriers [62], unavailability of the right information [31,74,76,84,90,99], distrust of the information [49], information overload [31,60,100] and an insufficiently clear presentation of the information [30,31,60,92,100,101]. So, although patients indicate that they find comparative information important, research suggests that relatively few patients make use of comparative information, are aware of its existence or understand it [16,31,48,62,64,102]. This applies in both Europe and the USA. "
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    ABSTRACT: Background In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. Methods We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. Results Our review shows that patients’ choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. Conclusions There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research.
    Full-text · Article · Aug 2012 · BMC Health Services Research
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