Publicly reported provider outcomes: The concerns of cardiac surgeons in a single-payer system

Guru, Veena; Naylor, C. David; Fremes, Stephen E.; Teoh, Kevin; Tu, Jack V.

doi:10.1016/s0828-282x(09)70020-0

Cited by 13 publications

(19 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may explain why Guru et al 193 found an increase in concerns about public reporting when it was introduced following a period of private reporting. They also indicate that media coverage which focused on 'controversies', such as when a well-regarded hospital had a poor public report card, was the means through which public reporting had the potential to damage a hospital's reputation.…”

Section: Feedback Of Proms: Reviewing Mechanismsmentioning

confidence: 99%

“…Evidence from surveys, interviews and ethnographic studies of providers' views and responses to the public reporting of hospital quality supports this idea and suggests that, although providers are more concerned about the consequences of public reporting on their reputation than on their market share, 118,179,192,193 they also perceive that damage to their reputation can have a subsequent impact on whether or not patients choose to attend their hospital. 18,194,195 One of the mechanisms through which providers perceive that report cards may damage their reputation is press or media coverage that either misrepresents the data or disproportionately focuses on reporting poor performance.…”

Section: Theorymentioning

confidence: 99%

“…193 It is not clear from the paper how widespread these concerns were among participants; in their discussion, the authors indicated that the responses to open-ended questions 'mainly focused on the negative implications of public reporting'. The respondents and questions in this survey are different from those included in Tu and Cameron's study 192 and differences in question wording can have a significant influence on responses.…”

mentioning

confidence: 99%

“…In responding to the open-ended questions, some surgeons expressed positive views about the role of the public disclosure of report cards in enabling public accountability and patient choice: 'Public [have the] right to know and choose improved quality so surgeons cannot hide behind false impressions.' 193 However some also expressed the opinion that surgeons, rather than the public, should receive feedback so that they can improve care, as the public do not understand report cards. As one respondent commented:…”

mentioning

confidence: 99%

“…Lay people see only a percentable mortality and assume that is either or good or bad without further understanding. 193 They also expressed concern that damage to an organisation's reputation can outlive problems with poor care; as one respondent commented:…”

mentioning

confidence: 99%

See 4 more Smart Citations

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

177

263

View full text Add to dashboard Cite

BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

Section: Feedback Of Proms: Reviewing Mechanismsmentioning

confidence: 99%

Section: Theorymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

177

263

View full text Add to dashboard Cite

show abstract

Provision of a surgeon's performance data for people considering elective surgery

Henderson

2015

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

We found no studies reporting the impact of the provision of a surgeon's performance data for people considering elective surgery. This is an important finding in itself. While the public reporting of a surgeon's performance is not a new concept, the efficacy of this data for individual patients has not been empirically tested. A review of qualitative studies or new primary qualitative research may be useful to determine what interventions are currently in use and explore the attitudes of consumers and professionals towards such interventions.

show abstract

Quality Control in Cardiac Surgery in the United States

Loebe

2017

Cardiac Surgery

View full text Add to dashboard Cite

Publicly reported provider outcomes: The concerns of cardiac surgeons in a single-payer system

Cited by 13 publications

References 26 publications

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Provision of a surgeon's performance data for people considering elective surgery

Quality Control in Cardiac Surgery in the United States

Contact Info

Product

Resources

About