Report Looks at Public Reporting and its Influence on the Quality of Health Care

As difficult as it is to believe in today's interconnected and open-sourced culture, concepts such as transparency are still in their infancy in the world of health care. With a growing national emphasis on quality improvement, accountability, and cost-effectiveness, with stakeholders such as government, purchaser and provider organizations, and consumers advocating for change, the need for more medical information in the public domain has reached a turning point.

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In a report published Feb. 5 in the Journal of the American College of Cardiology, Gregory Dehmer, MD, FACC, member of the ACC's Board of Trustees and professor of medicine at Texas A&M Health Science Center, and co-authors highlight the progress being made in publically reporting clinical quality data, and what it means for the health care system as a whole.

The authors look back at a few revisionist pioneers — including Florence Nightingale — whose progressive ideas were ultimately defeated by a resistant majority, and point out that it wasn't until the late 1980s that any kind of substantial action started taking place in public reporting. Detailing incremental steps with the establishment of the Health Care Financing Administration, the Centers for Medicare and Medicaid Services, the publication of coronary artery bypass grafts performances in Consumer Reports, and the passage of the Patient Protection and Affordable Care Act of 2010, the article attempts to illustrate the potential benefits of public reporting.

According to the authors, survey data from administrators, physicians and nurses already indicate that public reporting leads to greater involvement of leadership in performance improvement, creates a sense of accountability to internal and external customers, contributes to a heightened awareness of performance measure data throughout a given facility, re-focuses organizational priorities, raises concerns about data quality, and leads to questions about consumer understanding of performance reports. Addressing unintended consequences of public reporting, the authors state that physicians and facilities subject to its oversight are less inclined to develop adverse behavior.

For all its progress, the authors ultimately call for further research on the effects of public reporting, focusing on identifying which types of measures (process, outcome, safety, cost, access and patient experience) are most meaningful to consumers; defining the potential harm to facilities and providers; determining the balance of benefits and harms of reporting an individual physician's performance; determining the best formats for presentation of information to consumers; and assessing whether public reporting has resulting change in consumer behavior, health care quality, and cost savings.

"Data, information and knowledge are top priorities in the College's new strategic plan, and the College will continue to explore the reporting of transparent quality information," said William J. Oetgen, MD, MBA, FACC, ACC executive vice president of Science, Education and Quality. "This past year, the ACC initiated a pilot program in which hospital participants in the CathPCI Registry can voluntarily report their 30-day all-cause risk-standardized readmission rates following percutaneous coronary intervention on the Centers for Medicare and Medicaid Services' Hospital Compare website. The information provided allows hospitals to develop strategies to reduce readmissions. These efforts are tailored to the participating hospitals' patient populations. If the pilot program is a success, we plan to launch additional public reporting efforts in the future."

Keywords: Public Sector, Trustees, Social Responsibility, Cost Savings, Centers for Medicare and Medicaid Services, U.S., Patient Protection and Affordable Care Act, Awareness, Percutaneous Coronary Intervention, Quality Improvement, Registries, Quality of Health Care, Delivery of Health Care, Coronary Artery Bypass

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