Dying to Know

Public Release of Information about Quality of Health Care

by Martin Marshall, Paul G. Shekelle, Robert H. Brook, Sheila Leatherman

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Abstract

Long Abstract (a.k.a. Abstract Full): Public disclosure of the comparative performance of health care providers is seen as one mechanism for improving quality of care and controlling health care costs. This report, the result of a collaboration between the Nuffield Trust in London and RAND, assesses the U.S. experience with publicly releasing health care performance data and offers guidelines for establishing public disclosure policy in the United Kingdom. Because the United States leads the world in reporting clinical information by hospital and by physician name, this report will be of interest to any country considering public release of performance data. Principal findings: Despite a rapidly expanding report card industry, U.S. physicians are skeptical about report cards, and consumers and purchasers rarely use them. Hospitals may respond to performance data with internal changes, especially in a competitive environment. Publishing comparative mortality data seems to improve outcomes, but the mechanism by which this happens is unclear. Key recommendations: Public disclosure should be viewed as an evolutionary process, becoming more sophisticated and comprehensive over time. Disclosure should be a tool to support all quality initiatives in the U.K. National Health Service. Provider organizations should be a key audience for performance information. Health professionals should be fully involved in the public disclosure process. Both process and outcome measures of quality should be published. Public disclosure should be accompanied by possible explanations for the variations reported.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methodology

  • Chapter Three

    Public disclosure in the context of health care systems

  • Chapter Four

    The purpose of public release of performance data

  • Chapter Five

    Overview of publicly available performance data in the United States

  • Chapter Six

    Evaluation of the impact of public data

  • Chapter Seven

    Discussion: policy issues for the United Kingdom

  • Chapter Eight

    Recommendations

  • Appendix One

    Frequency of conditions/procedures studied in report cards

  • Appendix Two

    Evidence tables

  • Appendix Three

    Conceptual model of public disclosure

  • Appendix Four

    Summary of reporting systems that have been subject to evaluation

  • Appendix Five

    US Diagnosis Related Group frequency data

  • Appendix Six

    UK common causes of hospital bed occupancy

  • Appendix Seven

    Illustrative examples of performance indicators in the UK

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The study was conducted within RAND Health.

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