Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA 16802, USA.
Int J Qual Health Care. 2010 Dec;22(6):461-8. doi: 10.1093/intqhc/mzq062. Epub 2010 Oct 12.
To examine the impact of voluntary information disclosure on quality of care in Health Maintenance Organization (HMO) markets in the USA.
Commercial HMOs that collected a set of standardized quality meausures, Health Plan Employer Data and Information Set (HEDIS), between 1997 and 2000 in the USA (1062 HMO-years). After collecting the HEDIS data, some HMOs disclosed their HEDIS-quality scores to the public (disclosing HMOs), whereas some HMOs declined to disclose the information (non-disclosing HMOs).
A secondary data analysis based on 4 years of quality scores of HMOs. The study uses non-disclosing plans as a control group. A treatment-effects model is used to address a potential bias associated with voluntary disclosure decisions by HMOs.
MAIN OUTCOME MEASURE(S): The study focuses on 13 HEDIS clinical indicators. On the basis of these indicators, a plan-level composite score and four domain scores were constructed. The four domains are childhood immunizations, treatments/exams for chronic conditions, screening tests and maternity services.
Public disclosure leads to an increase of 0.72 composite score units, which corresponds to ∼7% points in original quality scale (0-100%). The degree of quality improvement differed by the type of services.
Public release of quality information had a significant and positive effect on quality in HMO markets during the earlier years of the voluntary disclosure program; however, the improvement was not universal across all quality measures.
考察美国医疗保险组织（HMO）市场中自愿信息披露对医疗质量的影响。
1997 年至 2000 年期间，美国一些商业 HMO 收集了一套标准化质量指标，即健康计划雇主数据和信息集（HEDIS）（1062 个 HMO 年）。在收集 HEDIS 数据之后，一些 HMO 向公众披露了其 HEDIS 质量评分（披露 HMO），而一些 HMO 则拒绝披露信息（不披露 HMO）。
基于 HMO 质量评分的四年二次数据分析。该研究将不披露计划作为对照组。采用处理效应模型来解决与 HMO 自愿披露决策相关的潜在偏差。
本研究重点关注 13 项 HEDIS 临床指标。基于这些指标，构建了计划层面的综合评分和四个领域的评分。这四个领域是儿童免疫接种、慢性病的治疗/检查、筛查测试和产妇服务。
公开披露使综合评分提高了 0.72 个单位，相当于原始质量评分（0-100%）的约 7%。质量改进的程度因服务类型而异。
在自愿披露计划的早期阶段，HMO 市场中公开发布质量信息对质量产生了显著而积极的影响；然而，这种改进并非所有质量指标都普遍存在。
