The unintended consequences of publicly reporting quality information
The unintended consequences of publicly reporting quality information
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DOI：
10.1001/jama.293.10.1239
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发表时间：
2005-03-09
影响因子：
120.7
通讯作者：
Asch, DA
中科院分区：
文献类型：
--
作者：
Werner, RM;Asch, DA
卫生保健报告卡公开报告有关医生，医院和健康计划质量的信息，以提高质量。公开报告质量信息被认为是通过两个主要机制来激励质量改进。首先，公共质量信息允许患者、转诊医生和医疗保健购买者优先选择高质量的医生。第二，公共报告卡可以激励医生在质量上竞争，并通过提供反馈和确定质量改进措施的领域，帮助医生这样做。尽管有这些看似合理的质量改进机制，但公开报告质量信息的价值在很大程度上尚未得到证明，公开报告可能会对医疗保健产生意想不到的负面影响。这些意想不到的后果包括导致医生避免生病的病人，试图提高他们的质量排名，鼓励医生实现“目标率”的医疗保健干预措施，即使它可能是不适当的一些病人，和折扣患者的偏好和临床判断。公开报告高质量信息促进了一种开放精神，这可能有助于增强对卫生专业人员的信任，但其改善健康的能力仍未得到证明，公开报告可能会无意中降低而不是提高质量。鉴于这些限制，可能有必要重新评估公共质量报告在质量改进中的作用。
Health care report cards publicly report information about physician, hospital, and health plan quality in an attempt to improve that quality. Reporting quality information publicly is presumed to motivate quality improvement through 2 main mechanisms. First, public quality information allows patients, referring physicians, and health care purchasers to preferentially select high-quality physicians. Second, public report cards may motivate physicians to compete on quality and, by providing feedback and by identifying areas for quality improvement initiatives, help physicians to do so. Despite these plausible mechanisms of quality improvement, the value of publicly reporting quality information is largely undemonstrated and public reporting may have unintended and negative consequences on health care. These unintended consequences include causing physicians to avoid sick patients in an attempt to improve their quality ranking, encouraging physicians to achieve "target rates" for health care interventions even when it may be inappropriate among some patients, and discounting patient preferences and clinical judgment. Public reporting of quality information promotes a spirit of openness that may be valuable for enhancing trust of the health professions, but its ability to improve health remains undemonstrated, and public reporting may inadvertently reduce, rather than improve, quality. Given these limitations, it may be necessary to reassess the role of public quality reporting in quality improvement.