Stevenson David G
Harvard Medical School.
J Health Polit Policy Law. 2006 Aug;31(4):773-810. doi: 10.1215/03616878-2006-003.
Publicizing quality information has been used as a quality improvement strategy in the acute care sector for more than a decade. Despite research showing mixed results of these efforts, publicly reporting quality measures is currently being pursued as a quality improvement strategy for nursing homes. Designed to empower consumers to make informed choices and to stimulate provider competition on quality, nursing home public reporting began in 1998 with the Nursing Home Compare Web site and has received greater emphasis in the 2002 Nursing Home Quality Initiative, both directed by the federal government. Focusing on the response of three key stakeholder groups across settings of care-consumers, providers, and purchasers-I identify several challenges that nursing home reporting must overcome to be successful. I conclude that publicly reporting quality measures for nursing homes will have a harder time promoting quality improvement than for acute care settings, where results have been disappointing thus far. In addition to the conceptual analysis, I evaluate whether the quality information reported on Nursing Home Compare had any impact on nursing home occupancy rates following its release. Using a pre/post-release design, I find that the effect of public reporting on nursing home occupancy rates has been minimal thus far. Although some estimates of effect are statistically significant and in the hypothesized direction, they all suggest very small effect sizes. It is unclear whether the absence of a larger reporting effect to date is specific to Nursing Home Compare or whether it inheres to the broader task of using quality information to promote change in the nursing home care sector.
在急性护理领域，公布质量信息作为一种质量改进策略已被采用了十多年。尽管研究表明这些努力的结果好坏参半，但目前养老院仍在推行公开报告质量指标，将其作为一种质量改进策略。养老院公开报告旨在使消费者能够做出明智的选择，并刺激供应商在质量方面展开竞争，始于1998年的“养老院比较”网站，并在2002年的“养老院质量倡议”中得到了更多重视，这两项举措均由联邦政府主导。着眼于护理环境中三个关键利益相关者群体——消费者、供应商和购买者——的反应，我确定了养老院报告要取得成功必须克服的几个挑战。我的结论是，与急性护理环境相比，公开报告养老院的质量指标在促进质量改进方面将面临更大困难，急性护理环境的结果迄今令人失望。除了概念分析，我还评估了“养老院比较”网站上公布的质量信息在发布后是否对养老院入住率产生了任何影响。采用发布前/发布后设计，我发现到目前为止，公开报告对养老院入住率的影响微乎其微。尽管一些影响估计在统计上具有显著性且符合假设方向，但它们都表明效应量非常小。目前尚不清楚迄今为止缺乏更大的报告效应是“养老院比较”网站所特有的，还是使用质量信息来推动养老院护理领域变革这项更广泛任务所固有的。
