Putting the public back in public reporting of health care quality.

摘要

RECENT EFFORTS TO INCREASE TRANSPARENCY RE-garding the quality of health care have been guided, in part, by the notion that this information will help patients make better choices about where to seek care. Despite substantial progress in measure development and dissemination, there is limited evidence that patients are putting such information to use, and only 6% of Americans are familiar with Hospital Compare, the quality reporting Web site maintained by the Centers for Medicare & Medicaid Services (CMS). There are several reasons for this: patients who are acutely ill rarely have the time to compare potential sources of care, clinical knowledge is required to make sense of most hospital process measures, the concept of a risk-standardized outcome is difficult to understand, and patients may not recognize the possibility that quality of care might vary. Additionally, patients may still prefer referrals from trusted family members or physicians over information obtained on the internet; practical matters, such as hospital location, often trump other considerations; and insurance co-payments may instill additional barriers to choice.