The Impact of Information Disclosure on Quality of Care in HMO Markets

Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA 16802, USA.
International Journal for Quality in Health Care (Impact Factor: 1.76). 10/2010; 22(6):461-8. DOI: 10.1093/intqhc/mzq062
Source: PubMed


To examine the impact of voluntary information disclosure on quality of care in Health Maintenance Organization (HMO) markets in the USA.
Commercial HMOs that collected a set of standardized quality meausures, Health Plan Employer Data and Information Set (HEDIS), between 1997 and 2000 in the USA (1062 HMO-years). After collecting the HEDIS data, some HMOs disclosed their HEDIS-quality scores to the public (disclosing HMOs), whereas some HMOs declined to disclose the information (non-disclosing HMOs).
A secondary data analysis based on 4 years of quality scores of HMOs. The study uses non-disclosing plans as a control group. A treatment-effects model is used to address a potential bias associated with voluntary disclosure decisions by HMOs. MAIN OUTCOME MEASURE(s): The study focuses on 13 HEDIS clinical indicators. On the basis of these indicators, a plan-level composite score and four domain scores were constructed. The four domains are childhood immunizations, treatments/exams for chronic conditions, screening tests and maternity services.
Public disclosure leads to an increase of 0.72 composite score units, which corresponds to ∼7% points in original quality scale (0-100%). The degree of quality improvement differed by the type of services.
Public release of quality information had a significant and positive effect on quality in HMO markets during the earlier years of the voluntary disclosure program; however, the improvement was not universal across all quality measures.

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    • "In the field of healthcare, the public reporting of the performance data obtained from providers has been widely used to improve the quality of care. Almost all US states have implemented numerous reporting programs for hospitals, and the Center for Medicare and Medicaid Services has initiated public disclosure programs for hospitals , manages care plans, nursing homes, and home health agencies[5]. In South Korea, a national insurance review agency has been releasing information regarding antibiotics use rates among healthcare organizations publicly since 2006[6]. "
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    ABSTRACT: The public reporting of health outcomes has become one of the most popular topics and is accepted as a quality improvement method in the healthcare field. However, little research has been conducted on the transparency mechanism, and results are mixed with regard to the evaluation of the effect of public reporting on quality improvement. The objectives of this trial are to investigate the transparency mechanism and to evaluate the effect of public reporting on prescription at the level of individual participants. This study involves a cluster randomized controlled trial conducted in 20 primary-care facilities (clusters). Eligible clusters are those facilities with excellent hospital information systems and that have agreed to participate in the trial. The 20 clusters are matched into 10 pairs according to Technique for Order Preference by Similarity to Ideal Solution score. As the unit of randomization, each pair of facilities is assigned at random to a control or an intervention group through coin flipping. Prescribed ranking information is publicly reported in the intervention group. The public materials include the posters of individuals and of facilities, the ranking lists of general practitioners, and brochures of patients, which are updated monthly. The intervention began on 13th November 2013 and lasted for one year. Specifically, participants are surveyed at five points in time (baseline, quarterly following the intervention) through questionnaires, interviews, and observations. These participants include an average of 600 patients, 300 general practitioners, 15 directors, and 6 health bureau administrators. The primary outcomes are the transparency mechanism model and the changes in medicine-prescribe. Subsequently, the modifications in the transparency mechanism constructs are evaluated. The outcomes are measured at the individual participant level, and the professional who analyzes the data is blind to the randomization status. This study protocol outlines a design that aims to examine the transparency mechanism and to evaluate the effect of public reporting on prescription. The research design is significant in the field of public policy. Furthermore, this study intends to fill the gap of the investigation of the transparency mechanism and the evaluation of public reporting on prescription.
    Full-text · Article · Mar 2015 · BMC Public Health
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    • "The impact of these programs on the quality of health care for orthopedic patients compared with other Italian regions was evaluated in a recent study [16]. Overall, there is no clear evidence regarding an association between public reporting and improved quality of care, even though some studies suggest that public reporting may motivate quality improvement activities [24,25]. A previous study found little evidence of an association between the introduction of result-based payment and a change in the quality of care. "
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    ABSTRACT: A tariff modulation mechanisms has been introduced in some Italian regions with the aim of reducing inappropriate admissions and improving quality of care. In response to a regional act, hospitals in Lazio adopted a clinical pathway for elderly patients with hip fracture and introduced a compensation system based on the quality of health care, as in a pay-for-performance model. The objective of the present study was to compare the proportion of surgery for hip fracture performed within 48 hours of admission among Lazio hospitals according to different payment systems, before and after the implementation of the regional act. A retrospective cohort study of patients aged 65 years and over, residing in the Lazio region and admitted to an acute care hospital for hip fracture before (1 July 2008 - 30 June 2009) and after (1 July 2010 - 30 June 2011) the pay-for-performance act. The proportion of surgeries performed within 48 h of hospital arrival was calculated. An adjusted multivariate regression analysis was applied to assess the effect of hospital payment type on the likelihood of surgery within 48 h of hospital arrival. The share of patients with hip fracture that had surgery within 48 hours was 11.7% before the introduction of the pay-for-performance act and 22.2% after. The proportion of early hip fracture operations increased after the pay-for-performance act, regardless of hospital payment type. The largest increase of surgery within 48 h occurred in private hospitals (adjusted Relative Risk = 2.80, p < 0.001). The introduction of a compensation system based on health care quality is associated with improved quality of care for elderly patients with hip fracture, especially in hospitals that only use the Diagnosis Related Group system.
    Full-text · Article · Oct 2013 · BMC Health Services Research
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    • "Moreover, the improvement after public reporting is not universal across all quality measures. In particular , the disclosure has positive effects on the quality of chronic care services[28]. Tackling health inequalities is one of the priority areas of the health policy agenda for developed and developing coun- tries[29]. Though health behavioural risk factors and environmental exposures are the main causes of poor health among socially disadvantaged people, a role of health care systems in the widening health gap has been shown[30,31]. "
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    ABSTRACT: OBJECTIVE: INTERVENTIONS: that address inequalities in health care are a priority for public health research. We evaluated the impact of the Regional Health Care Evaluation Program in the Lazio region, which systematically calculates and publicly releases hospital performance data, on socioeconomic differences in the quality of healthcare for hip fracture. DESIGN: /st>Retrospective cohort study. SETTING: and participantsWe identified, in the hospital information system, elderly patients hospitalized for hip fracture between 01 January 2006 and 31 December 2007 (period 1) and between 01 January 2009 and 30 November 2010 (period 2). MAIN OUTCOME MEASURES: /st>We used multivariate regression models to test the association between socioeconomic position index (SEP, level I well-off to level III disadvantaged) and outcomes: mortality within 30 days of hospital arrival, median waiting time for surgery and proportion of interventions within 48 h. RESULTS: /st>We studied 11 581 admissions. Lower SEP was associated with a higher risk of 30-day mortality in period 1 (relative risk (RR) = 1.42, P = 0.027), but not in period 2. Disadvantaged people were less likely to undergo intervention within 48 h than well-off persons in period 1 (level II: RR = 0.72, P < 0.001; level III: RR = 0.46, P < 0.001) and period 2 (level II: RR = 0.88, P = 0.037; level III: RR = 0.63, P < 0.001). We observed a higher probability of undergoing intervention within 48 h in period 2 compared with the period 1 for each socioeconomic level. CONCLUSION: /st>This study suggests that a systematic evaluation of health outcome approach, including public disclosure of results, could reduce socioeconomic differences in healthcare through a general improvement in the quality of care.
    Full-text · Article · Jan 2013 · International Journal for Quality in Health Care
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