Impact of public release of performance data on the behaviour of healthcare consumers and providers.

BACKGROUND: It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. OBJECTIVES: To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. SELECTION CRITERIA: We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. MAIN RESULTS: We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. AUTHORS\u27 CONCLUSIONS: The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes

Evaluatie door casemanagers dementie: een explorerende praktijkstudie naar vormen en inhoud

Achtergrond Deze praktijkgerichte explorerende studie beoogt inzicht te geven in dewijzewaarop casemanagers dementie vorm en inhoud geven aan de evaluatie van hun begeleiding van het informele zorgnetwerk. Methode Er is gebruik gemaakt van een combinatie van kwantitatieve en kwalitatieve onderzoeksmethoden, uitgevoerd onder 57 casemanagers dementie, verbonden aan drie verschillende dementienetwerken. Resultaten De kwantitatieve en kwalitatieve data zijn ondergebracht in vier thema’s: (1) houding ten aanzien van evaluatie, (2) vormen van evaluatie, (3) uitvoering van evaluatie en (4) inhoud van evaluatie. Er bestaat diversiteit in vorm en inhoud van het evalueren door casemanagers met cliënten enmantelzorgers. Casemanagers erkennen het belang van een tussentijdse- en eindevaluatie, maar het ismoeilijk daarmethodisch vorm aan te geven. Belemmeringen die casemanagers ervaren, hebben te maken met cliënt- en professionalfactoren en laten hierin diverse aspecten zien. Conclusie Casemanagers evalueren vooral informeel en doorlopend om hun begeleiding op de behoeften van cliënt en mantelzorger af te stemmen. In mindere mate gebruiken casemanagers evaluatie om de kwaliteit van hun handelen systematisch te toetsen. Een vervolgdiscussie over vorm en inhoud van evalueren dientmet casemanagers en cliënten op individueel, professioneel en maatschappelijk niveau gevoerd te worden

Performance measurements in diabetes care: the complex task of selecting quality indicators

Item does not contain fulltextPURPOSE: /st> To review the literature on the content and development of the sets of quality indicators used in studies on the quality of diabetes care in primary care settings. DATA SOURCES: /st> The MEDLINE (Ovid), PubMed, PsychINFO, Embase and CINAHL databases were searched for relevant articles published up to January 2011. STUDY SELECTION: and data extraction We included studies on the quality of adult diabetes care, using quality indicators. We excluded studies focusing on the hospital setting, patient subgroups, specific components of diabetes care and specific outcomes. In total, 102 studies (including 102 sets and 1494 indicators) were analyzed by two independent reviewers, using the criteria of the National Quality Measures Clearinghouse and international guidelines to document the content and selection of the identified indicators. RESULTS OF DATA SYNTHESIS: /st> Sets varied greatly in number, content and definitions of quality indicators. Most of the indicators concerned HbA1C, lipids, blood pressure, eye and foot examination and urinalysis. Few sets included indicators on lifestyle counseling, patient experiences, healthcare structure or access to healthcare providers. Seventy sets did not specify explicit selection criteria, and 19 of these did not report the sources of the indicators. CONCLUSIONS: /st> Sets of quality indicators are diverse in number, content and definitions. This diversity reflects a lack of uniformity in the concept of diabetes care quality and hinders the interpretation of and comparison between quality assessments. METHOD: logy regarding defining constructs such as the quality of diabetes care and indicator selection procedures is available and should be used more rigorously