Bentley J M, Nash D B
Pennsylvania State University at Harrisburg, Middletown, USA.
Jt Comm J Qual Improv. 1998 Jan;24(1):40-9. doi: 10.1016/s1070-3241(16)30358-3.
A Consumer Guide to Coronary Artery Bypass Graft Surgery, published annually since 1992 by the Pennsylvania Health Care Cost Containment Council, compares the outcomes and charges for the state's hospitals and surgeons providing this surgery. To determine whether performance data caused hospitals to change their policies and practices, hospitals were surveyed in Pennsylvania, where the state releases annual coronary artery bypass graft (CABG) outcomes data and, as a control, in New Jersey, where the state does not release these data.
Key informants representing hospitals, health insurance payers, health maintenance organizations, and purchasers were asked to list specific changes made because of comparative performance data released in public reports. Focus groups were conducted and surveys were then developed and administered to samples of hospitals, payers, and purchasers in both states.
The results suggested, for example, that access to performance information encouraged hospitals to implement new approaches to marketing their CABG services. Thirty-eight percent of Pennsylvania CABG hospitals reported using performance information to recruit staff thoracic surgeons and residents, compared with none in New Jersey. For the most frequently initiated changes in patient care, the Pennsylvania hospitals depended on performance information released by a "government agency" to a much greater degree than did the hospitals in New Jersey.
The results suggest that public release of performance information has encouraged hospitals in Pennsylvania to make changes in the areas of marketing, governance, and clinical care and that the impact of the release of public data on performance was greater in Pennsylvania hospitals than New Jersey hospitals.
自1992年起，宾夕法尼亚医疗成本控制委员会每年发布一份《冠状动脉搭桥手术消费者指南》，对该州提供此类手术的医院和外科医生的手术结果及收费情况进行比较。为了确定手术表现数据是否促使医院改变其政策和做法，研究人员对宾夕法尼亚州的医院进行了调查，该州会公布年度冠状动脉搭桥（CABG）手术结果数据；同时，作为对照，还对新泽西州的医院进行了调查，该州不公布这些数据。
研究人员要求代表医院、医疗保险支付方、健康维护组织和采购方的关键信息提供者列出因公共报告中公布的比较表现数据而做出的具体改变。开展了焦点小组讨论，随后针对两个州的医院、支付方和采购方样本设计并实施了调查。
例如，结果表明，获取表现信息促使医院采用新方法来推广其冠状动脉搭桥手术服务。宾夕法尼亚州38%的冠状动脉搭桥手术医院报告称使用表现信息来招聘胸外科医生和住院医生，而新泽西州则没有医院这么做。对于患者护理方面最常启动的改变，宾夕法尼亚州的医院比新泽西州的医院在更大程度上依赖于“政府机构”公布的表现信息。
结果表明，表现信息的公开促使宾夕法尼亚州的医院在营销、管理和临床护理领域做出改变，而且公开数据对手术表现的影响在宾夕法尼亚州的医院比在新泽西州的医院更大。
