Quality assessment by external bodies: intended and unintended impact on healthcare delivery

Riskin, Loren; Campagna, Jason

doi:10.1097/aco.0b013e3283244630

Cited by 9 publications

(9 citation statements)

References 38 publications

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“…These resources may be diverted to competing needs that include addressing improvement efforts for a large number of other publicly reported healthcare quality measures. Thus, an unintended consequence of quality improvement may be that improvement in 1 domain may be at the expense of quality of care in another domain . On the other hand, it is likely that hospitals in the lower quartile see a larger improvement in their scores for the same degree of investment as hospitals in the higher quartiles.…”

Section: Discussionmentioning

confidence: 99%

Effect of HCAHPS reporting on patient satisfaction with physician communication

Mann

Siddiqui

Kurbanova

et al. 2015

Journal of Hospital Medicine

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INTRODUCTION Prior studies, using limited data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, reported that public reporting increases satisfaction scores in all domains except physician communication. Our objective was to examine changes in patient satisfaction with physician communication using all available data. METHODS We used publicly accessible datasets: HCAHPS (2007–2013), socioeconomic datasets from the US Census Bureau, and hospital service area (HSA) dataset from the Dartmouth Atlas of Health Care. Satisfaction scores were determined by the percentage of responses to “doctors always communicated well.” Hospitals were grouped into quartiles based on 2007 scores. We used multilevel models to account for correlation between within‐hospital observations. RESULTS HCAHPS data were reported by 2273 hospitals in 2007. During the 7‐year period, overall satisfaction scores with physician communication increased by 2.8% (P < 0.001). The lowest quartile hospitals had significant increase in satisfaction scores, whereas the highest quartile scores decreased (0.87% per year vs −0.23% per year; P < 0.001). These differences remained significant after adjusting for hospital and local population characteristics. Survey response rate and the number of acute‐care beds and physicians in the HSA were positively associated, whereas HSA population size and being a teaching hospital were negatively associated with patient satisfaction scores (all P < 0.005). CONCLUSIONS Although there has been an improvement in patient satisfaction with physicians during the past 7 years, this improvement was not seen in all hospitals. The overall gap between hospitals has narrowed, which can be further improved through sharing best practices. Journal of Hospital Medicine 2016;11:105–110. © 2015 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Effect of HCAHPS reporting on patient satisfaction with physician communication

Mann

Siddiqui

Kurbanova

et al. 2015

Journal of Hospital Medicine

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“…Moreover, even the most well-meaning of policies can create perverse incentives. Indeed, there is now a considerable literature on how efforts to improve the quality of medical care can reward behavior that is not in patient’s best interests[8–10]. One well known paper is that of Boyd et al, who show that following guidelined care for an elderly patient with multiple comorbidities would result in the patient being subject to an unreasonably large number of different tests and treatments, including 12 different medicines taken in 19 doses at five different times during a typical day.…”

Section: Problems With Outcome Reporting 4: Unanticipated Consequencementioning

confidence: 99%

What has to happen before we report radical prostatectomy outcomes of individual surgeons to the public?

Vickers

Eastham

2011

Urologic Oncology: Seminars and Original Investigations

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SummaryIt would appear entirely uncontroversial to suggest that prostate cancer patients should have available information on surgeon outcomes so that they can make informed treatment decisions. We argue that release of surgeon-level data on radical prostatectomy outcomes would be premature at the current time. We point to a series of problems that would need to be addressed before we could be sure that a consumerist approach to surgeon selection would do more good than harm. These include non-standardized reporting of endpoints such as urinary and erectile function, statistically unreliable estimates from low volume surgeons and perverse incentives, such as referring of high risk patients to radiotherapy. We recommend an alternative to the "name-andshame" paradigm of public outcomes reporting: continuous quality improvement. Surgeons are given reports as to their own outcomes on a private basis, such that no-one else can see their data. This helps to build trust and to avoid perverse incentives. Such reports must be multi-dimensional and based on a comprehensive, patient-reported outcomes system. As outcomes data are meaningless for low volume surgeons, these surgeons would have to choose between focusing on radical prostatectomy and referring patients to higher volume colleagues. Systematic research is required to determine whether such an approach would do more good than harm.

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“…[2][3][4][5][6][7][8] However, the empirical study of denominator management, as well as methods for detecting it, has received far less attention. [9][10][11] In one recent study, Roth and colleagues studied changes in measured performance and denominator qualification for the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) measure on avoidance of antibiotics for the treatment of acute bronchitis.…”

Section: Introductionmentioning

confidence: 99%

Are Improvements in Measured Performance Driven by Better Treatment or “Denominator Management”?

et al. 2016

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BACKGROUND: Process measures of healthcare quality are usually formulated as the number of patients who receive evidence-based treatment (numerator) divided by the number of patients in the target population (denominator). When the systems being evaluated can influence which patients are included in the denominator, it is reasonable to wonder if improvements in measured quality are driven by expanding numerators or contracting denominators. OBJECTIVE: In 2003, the US Department of Veteran Affairs (VA) based executive compensation in part on performance on a substance use disorder (SUD) continuity-ofcare quality measure. The first goal of this study was to evaluate if implementing the measure in this way resulted in expected improvements in measured performance. The second goal was to examine if the proportion of patients with SUD who qualified for the denominator contracted after the quality measure was implemented, and to describe the facility-level variation in and correlates of denominator contraction or expansion. DESIGN: Using 40 quarters of data straddling the implementation of the performance measure, an interrupted time series design was used to evaluate changes in two outcomes. PARTICIPANTS: All veterans with an SUD diagnosis in all VA facilities from fiscal year 2000 to 2009. MAIN MEASURES: The two outcomes were 1) measured performance-patients retained/patients qualified and 2) denominator prevalence-patients qualified/patients with SUD program contact. KEY RESULTS: Measured performance improved over time (P < 0.001). Notably, the proportion of patients with SUD program contact who qualified for the denominator decreased more rapidly after the measure was implemented (p = 0.02). Facilities with higher pre-implementation denominator prevalence had steeper declines in denominator prevalence after implementation (p < 0.001). CONCLUSIONS: These results should motivate the development of measures that are less vulnerable to denominator management, and also the exploration of Bshadow measures^to monitor and reduce undesirable denominator management.

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Quality assessment by external bodies: intended and unintended impact on healthcare delivery

Cited by 9 publications

References 38 publications

Effect of HCAHPS reporting on patient satisfaction with physician communication

Effect of HCAHPS reporting on patient satisfaction with physician communication

What has to happen before we report radical prostatectomy outcomes of individual surgeons to the public?

Are Improvements in Measured Performance Driven by Better Treatment or “Denominator Management”?

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