Public Reporting of Performance Measures

There are so many initiatives under way in health care that it is very hard to track whether they really make sense or can work.  Most have some theoretical underpinnings, but those have seldom been tested with solid research designs.  Public reporting of quality of care and other measures relating to health care is one strategy which has become very widespread and which causes providers and health plans to incur significant expense in complying with the reporting requirements.  What is the theoretical mechanism by which these reporting programs will improve quality and does the evidence support that theory?  This topic is explored in a draft Agency for Healthcare Research and Quality report.  (AHRQ Report)

The researchers found about 174 studies relevant to the questions they were examining, but these studies provided generally low evidence, in part due to the methodological difficulty of designing and executing research in this area.  The fundamental premises about public reporting on quality measures are that when providers are measured they will undertake to improve their performance on the measures and that when information on performance is available, patients and payers will choose higher-performing payers.  Of course, the crucial first step is finding and using measures that actually bear a relationship to meaningful better health outcomes for patients.  While that wasn’t a focus of this report, in general there is little evidence that most public reporting measures have this underpinning.

The authors found that the research to date suggests that providers do attempt to improve their scores on measures they must report and that in fact those scores do improve, although what part of the improvement is due to the reporting program and what part might have occurred anyway is unclear.  However, the programs don’t seem to do lead to better actual health outcomes, like mortality, although they might improve care processes.  The authors also found the evidence to fairly strongly indicate that neither patients nor payers are using the data to select providers to any significant degree, in fact they generally seem to ignore performance reporting.  On the other hand, the researchers also found little evidence for harm to patients that some had suggested might occur as a result of these reporting programs.