Interpreting market share changes as evidence for effectiveness of quality report cards.
Interpreting market share changes as evidence for effectiveness of quality report cards.
复制标题
将市场份额变化解释为质量报告卡有效性的证据。
DOI：
10.1097/mlr.0b013e31812f56bb
复制
发表时间：
2007
期刊：
影响因子：
3
通讯作者：
Mushlin,AlvinI
中科院分区：
文献类型：
--
作者：
Mukamel,DanaB;Weimer,DavidL;Mushlin,AlvinI
质量报告卡已成为美国医疗保健系统的一个组成部分。从20世纪80年代中期开始发布全国所有医院经风险调整后的死亡率报告的医疗保健融资管理局（HCFA）早期（现在已经放弃）的努力开始，我们已经进入了一个成绩单比比皆是的时代。联邦政府，通过医疗保险和医疗补助服务中心（CMS），以前的HCFA，现在发布基于网络的报告卡的医院，疗养院，家庭护理机构，和管理式护理组织（见http：//www。医疗保险gov）。许多州政府、健康计划、雇主和雇主联盟也公布成绩单。这些报告通常侧重于医疗提供者的临床服务质量，尽管有些可能包括有关护理其他方面的信息，如办公室工作人员的礼貌，乐于助人和尊重。[1]尽管市场似乎对成绩单的使用充满热情，但关于其有效性的科学证据，特别是其对患者转诊的影响，却喜忧参半。四篇综述文章检查了各种报告卡的研究，并得出结论，在大多数情况下，只有很少的证据表明报告卡影响患者及其医生的转诊选择。Mukamel和Mushlin 2回顾了8项研究，包括HCFA医院死亡率报告、纽约州（NYS）和宾夕法尼亚州冠状动脉旁路移植术（CABG）报告，以及健康计划雇主数据信息集（HEDIS）管理式护理报告（1988年至2000年期间发表的研究），并得出结论，对提供者的选择只有很小的影响。马歇尔等人3审查了9项研究，包括HCFA医院死亡率报告、纽约州和宾夕法尼亚州CABG报告以及医生费用数据（1988年至1998年期间发表的研究）。他们还发现，如果检测到对供应商选择和市场份额的影响，它往往很小。Schauffler和Mordavsky 4回顾了16项关于医院、心脏外科医生和管理式医疗机构的报告卡的研究（1996年至2000年出版），这些研究调查了患者、管理式医疗机构和雇主对提供者的选择。他们还发现，成绩单的影响很小，并得出结论认为，它们不会对决策产生影响。维尔纳和阿什最近的一项综述得出了类似的结论。这一证据使一些学者得出结论，认为成绩单不会影响对提供者的选择，这与“市场对成绩单重要性的信念”背道而驰，近年来这些报告的激增就是证明。这种明显的矛盾值得研究的问题是，从经验证据得出的结论是否确实意味着报告没有影响，没有在医疗保健系统中发挥重要作用。在这篇文章的其余部分，我们研究的理由和理论期望的报告卡，然后讨论几个原因的实证研究结果的影响最小的转介，包括不同的报告卡，其“新闻”的内容，和供应商的能力限制的影响的信息的可信度和有用性。我们认为，A
Quality report cards have become an integral part of the American health care system. From the early, now abandoned, efforts by the then Health Care Financing Administration (HCFA), which began publishing reports with risk-adjusted mortality rates for all hospitals in the country in the mid 1980s, we have moved into an era in which report cards abound. The federal government, through the Centers for Medicare & Medicaid Services (CMS), formerly HCFA, is now publishing Web-based report cards on hospitals, nursing homes, home care agencies, and managed care organizations (see http://www. medicare. gov). Many state governments, health plans, employers, and employer coalitions publish report cards as well. These reports typically focus on the quality of the clinical services of medical providers, although some may include information about other aspects of care, such as office staff courtesy, helpfulness, and respect. 1Although the market seems to have forged enthusiastically ahead with report cards, the scientific evidence about their effectiveness, and in particular, their impact on patient referrals, is mixed. Four review articles have examined studies of various report cards and concluded that, for the most part, there is only minimal evidence that report cards influence referral choices made by patients and their physicians. Mukamel and Mushlin2 reviewed 8 studies, including the HCFA Hospital Mortality reports, the New York State (NYS) and the Pennsylvania Coronary Artery Bypass Graft (CABG) reports, and the Health Plan Employer Data Information Set (HEDIS) managed care report (studies that were published between 1988 and 2000) and concluded that there is only a minimal effect on choice of provider. Marshall et al3 reviewed 9 studies including the HCFA Hospital Mortality reports, the NYS and the Pennsylvania CABG reports, and physician fee data (studies published between 1988 and 1998). They also found that, if an effect on provider choice and market shares is detected, it tends to be small. Schauffler and Mordavsky4 reviewed 16 studies of report cards on hospitals, cardiac surgeons, and managed care organizations (published between 1996 and 2000) that examined choice of providers made by patients, managed care organization, and employers. They also found that the impact of report cards is small and concluded that they do not make a difference in decisionmaking. A more recent review by Werner and Asch5 reached similar conclusions. This body of evidence, which has led some scholars to conclude that report cards do not influence choice of providers, flies in the face of the “market’s belief” in the importance of report cards, as evidenced by the proliferation of these reports in recent years. This apparent paradox warrants examination of the question of whether the conclusions drawn from the empirical evidence indeed imply that the reports have no impact and have failed to play an important role in the health care system. In the remainder of this essay we examine the rationale and theoretical expectations for report cards and then discuss several reasons for the empirical findings of minimal effect on referrals, including the credibility and usefulness of the information in different report cards, their “news” content, and the impact of providers’ capacity limitations. We then argue that a