Report Cards Get a Failing Grade

Reporting of health care delivered versus best-practice guidelines has been promoted for some time as a way to improve overall quality and potentially lower costs.  This approach has led to introduction of pay-for-performance programs as well, which either incent or punish providers who don’t meet the guidelines most of the time.  There are a number of issues with this approach, one of which is that there is little firm research evidence to support its ability to create care improvement.  A recent study reported in the Journal of the American Medical Association does little to assuage concerns about widespread adoption of such programs before we understand if they work and what makes them most effective.  (JAMA Article)

The researchers examined use of report cards for cardiac care in Ontario, Canada.  About 80 hospitals participated.  One group of hospitals received early feedback on their performance on the measures and another group of hospitals did not get feedback until later.  The early feedback group’s performance was also discussed in public press releases and through other media channels.   The primary analysis looked at whether performance in the early feedback hospitals improved vis a vis the delayed feedback group.

The researchers found that there was not significantly better improvement in the early feedback group, although there was somewhat better performance on a couple of individual measures.  In other words, generally the hospitals that knew how they were doing on the measures did not get better at meeting the measures than those hospitals who didn’t know how they were doing on the measures.   The early feedback hospitals did start more quality improvement programs than the delayed feedback group and there was a slight decrease in cardiac patient mortality rates in this early feedback group.

Overall the researchers concluded that public release of performance measures did not appear to be a particularly effective quality improvement strategy.  Further work is needed to help identify the best characteristics of programs to improve quality.  We also want to ensure that hospitals and other providers aren’t putting effort into programs just because they are mandated, but are directing resources toward those initiatives that have the highest likelihood of improving health outcomes.