1. Public Report Cards: What providers want consumers to know Sandra Leggat March 2002

2. Presentation Outline Public Report Cards: what providers are telling consumers Public Report Cards: what consumers want to know

3. Who provides public report cards? “Various organisations produce report cards, with diverse motivations & little communication or collaboration among them” (Marshall et al 2000) Governments Non-government coalitions Media Health plans, health services & hospitals

4. California Hospital Outcomes Project (CHOP) Legislative mandate requiring State office to study & report on risk-adjusted measures of patient outcomes in California hospitals AMI mortality ICU mortality Hip fracture mortality Maternal outcomes following delivery Pneumonia mortality

5. New York State Cardiac Surgery Reporting System

6. Ontario Hospital Reports To help people in Ontario understand the performance of their hospital system Includes hospital specific data for 95 hospital corporations Condensed version of the 2001 report published in newspapers

7. Ontario Hospital Balanced Scorecard Patient Satisfaction What patients say about their hospital stay: overall quality, clinical & support service quality Patient Care How patients fare during & after hospitalisation: access to technology, length of stay, complications Hospital Finances What resources hospitals have & how they are used: financial position, equipment spend, staff time on patient care Keeping Pace with Change Whether hospitals partner with community: partnerships, IT, coordination of care

8. ORYX JCAHO link between accreditation & outcomes of patient care Participating organisations select 6 measures from listed performance measures Core measures for hospitals – MI, heart failure, community acquired pneumonia, pregnancy

10. US News – Best Hospitals 2001

11. London Health Sciences Centre, Canada

15. Presentation Outline Public Report Cards: what providers are telling consumers Public Report Cards: what consumers want to know

16. Information requested by focus groups Equipment technology Hospital specialisation Nurse/doctor to patient ratios Average waiting times Success/mortality rates Reputation/quality of care Hospital facilities Number of beds Cleanliness/sanitation Doctor/nurse qualifications

17. Information requested by individuals Equipment technology Hospital specialisation Average waiting times Nurse/doctor to patient ratios Availability of support services Success/mortality rates Doctor/nurse qualifications Reputation/quality of care Research conducted Financial information

18. Summary of type of information Descriptive: information about services, specialties and the health system Evaluative: information to help chose the ‘best’ hospital for different things, but was not always sure what this information should be

20. Existing report cards were unable to reliably detect true practice differences in the management of diabetes among doctors at the medical practices studied (Greenfield & Kaplan 1999) Hospital mortality rate is extremely inaccurate & publication does more to misinform (Thomas & Hofer 1998, 1999)

21. Efforts to aid patient decision making with performance reports are unlikely to succeed without a tailored and intensive program for dissemination and patient education (Schneider & Epstein 1998 )