Policymakers and practioners are increasingly interested
in the use of quality indicators to measure performance of healthcare
providers in public reporting and pay for performance (P4P) schemes
but the available evidence is limited. This presentation summarizes
the US experience with the use of quality indicators with an emphasis
on hospital care.
Public reporting: Few evaluations of public reporting programs
can be found in the peer-reviewed literature and most focus on cardiac
procedures. No evaluations exist for well-known governmental (e. g.,
www.hospitalcompare.hhs.gov) or commercial (e. g., Healthgrades)
reporting programs. The existing publications and systematic reviews
have found mixed or limited effects. Public reporting appears to
stimulate quality improvement activities in hospitals, but has limited
impact on patients’ selection of hospitals. There is an
inconsistent association between public reporting and improved effectiveness
and scant evidence on the impact of public reporting on patient
safety and patient-centeredness.
Pay for performance: Only 3 hospital P4P programs have been formally
evaluated, even though about 40 programs exist in the US. Many evaluations
lack an appropriate comparison strategy so that their results have
to be viewed with caution. Monetary rewards to hospitals seem associated
with a modest improvement (2 – 4 percentage
points) in care processes, but there is no consistent evidence for
better outcomes or reduced cost.
Conclusions: Overall, while the use of quality indicators has
increased dramatically, there are only few publications that evaluate
their effect, many studies have methodologic flaws and many evaluate
data from the same programs. There is a paucity of evidence on the
impact of quality indicators on quality of care and efficiency.
Concerns about gaming and unintended consequences have been raised.
More evidence is needed to decide on the proper role of public reporting
and P4P based on quality indicators.
Author’s declaration: The author
does not have any financial interests or conflicts of interest relevant
to the subject of this manuscript.
