Department of Primary Care and Public Health at Imperial College London, London, England.
Health Aff (Millwood). 2012 Mar;31(3):593-601. doi: 10.1377/hlthaff.2011.0810.
Amid international concerns about health care safety and quality, there has been an escalation of investigations by health care regulators into adverse events. England has a powerful central health care regulator, the Care Quality Commission, which conducts occasional high-profile investigations into major lapses in quality at individual hospitals. The results have sometimes garnered considerable attention from the news media, but it is not known what effect the investigations have had on patients' behavior. We analyzed trends in admission for discretionary (nonemergency) care at three hospitals that were subject to high-profile investigations by the Healthcare Commission (the predecessor to the Care Quality Commission) between 2006 and 2009. We found that investigations had no impact on utilization for two of the hospitals; in the third hospital, there were significant declines in inpatient admissions, outpatient surgeries, and in numbers of patients coming for their first appointment, but the effects disappeared six months after publication of the investigation report. Thus, the publication and dissemination of highly critical reports by a health care regulator does not appear to have resulted in patients' sustained avoidance of the hospitals that were investigated. Our findings reinforce other evaluations: Reporting designed to affect providers' reputations is likely to spur more improvement in quality and safety than relying on patients to choose their providers based on quality and safety reports, and simplistic assumptions regarding the power of information to drive patient choices are unrealistic.
在国际上对医疗保健安全和质量的关注中，医疗保健监管机构对不良事件的调查有所升级。英国有一个强大的中央医疗保健监管机构——医疗保健质量委员会（Care Quality Commission），该机构偶尔会对个别医院在质量方面的重大失误进行高调调查。调查结果有时会引起新闻媒体的广泛关注，但尚不清楚这些调查对患者行为产生了什么影响。我们分析了 2006 年至 2009 年期间，医疗保健委员会（医疗保健质量委员会的前身）对三家医院进行高调调查期间，这三家医院非紧急（选择性）护理入院人数的变化趋势。我们发现，对其中两家医院的利用率没有影响；而第三家医院的住院病人入院人数、门诊手术次数以及首次就诊人数均出现显著下降，但在调查报告发布六个月后，这些影响就消失了。因此，医疗保健监管机构发布和传播高度批评性报告似乎并没有导致接受调查的医院的患者持续回避。我们的发现与其他评估结果一致：旨在影响提供者声誉的报告可能会比依赖患者根据质量和安全报告来选择提供者更能促进质量和安全的改善，而关于信息驱动患者选择的力量的简单假设是不现实的。
