Cover image for Dying to know : public release of information about quality of health care
Dying to know : public release of information about quality of health care
Marshall, Martin (Martin N.)
Publication Information:
Santa Monica, CA : Rand, [2000]

Physical Description:
137 pages : illustrations ; 21 cm.
Reading Level:
1510 Lexile.
Format :


Call Number
Material Type
Home Location
Item Holds
RA399.A1 D95 2000 Adult Non-Fiction Central Closed Stacks-Non circulating

On Order



Public disclosure of the comparative performance of health care providers is seen as one mechanism for improving quality of care and controlling health care costs. This report the result of a collaboration between the Nuffield Trust in London and RAND, assesses the U.S. experience with publicly releasing health care performance data and offers guidelines for establishing public disclosure policy in the United Kingdom. Because the United States leads the world in reporting clinical information by hospital and by physician name, this report will be of interest to any country considering public release of performance data. Principal findings: Despite a rapidly expanding report card industry, U.S. physicians are skeptical about report cards, and consumers and purchasers rarely use them. Hospitals may respond to performance data with internal changes, especially in a competitive environment. Publishing comparative mortality data seems to improve outcomes, but the mechanism by which this happens is unclear. Key recommendations: Public disclosure should be viewed as an evolutionary process, becoming more sophisticated and comprehensive over time. Disclosure should be a tool to support all

Table of Contents

Forewordp. 9
Acknowledgementsp. 12
Executive Summaryp. 15
Abbreviationsp. 18
1. Introductionp. 21
1.1 Backgroundp. 21
1.2 Definitionsp. 22
1.3 Scope of reportp. 22
1.4 Aimsp. 24
2. Methodologyp. 25
3. Public disclosure in the context of health care systemsp. 27
3.1 Structure of the United States (US) health systemp. 27
3.2 Historical development of US reporting systemsp. 29
3.3 Public disclosure in the United Kingdomp. 35
4. The purpose of public release of performance datap. 41
4.1 Overviewp. 41
4.2 Regulation and public accountabilityp. 42
4.3 Consumer choicep. 43
4.4 Purchasing decisionsp. 44
4.5 Provider behaviourp. 44
4.6 A coherent rationale for public disclosurep. 45
5. Overview of publicly available performance data in the United Statesp. 46
5.1 Organisations involvedp. 46
5.2 Types of data availablep. 47
5.3 Publication formatp. 50
5.4 The controversyp. 51
6. Evaluation of the impact of public datap. 54
6.1 General critiquep. 54
6.2 Attitude of physiciansp. 55
6.3 Impact on behaviour of hospitals and other provider organisationsp. 58
6.4 Information that consumers want to accessp. 60
6.5 Impact on decision making of consumersp. 62
6.6 Explanation of impact on decision makingp. 65
6.7 Information wanted by purchasersp. 66
6.8 Impact on employers' purchasing decisionsp. 66
6.9 Impact on quality of care outcomesp. 68
6.10 Mechanisms of action of performance datap. 70
6.11 Impact on costsp. 70
6.12 Summary of the evidencep. 72
7. Discussion: policy issues for the United Kingdomp. 73
7.1 Generalisability of the United States researchp. 73
7.2 The purpose of public disclosure: a conceptual modelp. 74
7.3 Public disclosure and quality improvementp. 76
7.4 Factors influencing the content of the datap. 78
7.5 Risk adjustment of performance indicatorsp. 82
7.6 Factors influencing the release of the datap. 83
7.7 The role of the medical professionp. 85
7.8 The adverse consequences of publicationp. 86
7.9 The financial cost of implementing a policy on public disclosurep. 88
7.10 The research agendap. 88
8. Recommendationsp. 91
Referencesp. 99
Appendix 1 Frequency of conditions/procedures studied in report cardsp. 109
Appendix 2 Evidence tablesp. 112
Appendix 3 Conceptual model of public disclosurep. 121
Appendix 4 Summary of reporting systems that have been subject to evaluationp. 122
Appendix 5 US Diagnosis Related Group frequency datap. 125
Appendix 6 UK common causes of hospital bed occupancyp. 126
Appendix 7 Illustrative examples of performance indicators in the UKp. 127