Another week, another Agency for Healthcare Research and Quality report on one of the innovations which will supposedly improve quality and/or lower cost, this one looking at public quality measure performance reporting as a quality improvement strategy. (AHRQ Report) The authors reviewed about 200 research studies to determine the evidence that such public reporting would improve quality, and also whether it would affect the behavior of providers or patients. The theory of public reporting is that the exposure will encourage providers to improve performance so that they are viewed as high quality; with an associated theory that consumers will select providers on the basis of their quality scores. The report finds moderate evidence in regard to the effect of public reporting schemes, largely because of methodological challenges of designing effective research for these population-oriented interventions.
There was evidence to indicate that providers do improve their performance on the quality measures which are publicly reported. Becoming subject to a public reporting program also seems to lead providers to increase their involvement in quality improvement activities, at least for those measures. It is less clear that better performance on these quality measures actually leads to better health outcomes for the patients treated by the providers, and there is at least a possibility that focusing on the measures that are reported may mean that other quality areas that may be as or more important are neglected. There was only very weak evidence that patients are influenced by quality measure performance in their selection of providers. It is more likely that payers will use the information to incentivize patients to use higher quality providers.