Does publicizing hospital performance stimulate quality improvement efforts?
(41/1536)
This study evaluates the impact on quality improvement of reporting hospital performance publicly versus privately back to the hospital. Making performance information public appears to stimulate quality improvement activities in areas where performance is reported to be low. The findings from this Wisconsin-based study indicate that there is added value to making this information public. (+info)
Consumers and quality-driven health care: a call to action.
(42/1536)
A key strategy for driving improvements in health care quality is providing comparative quality information to consumers. This strategy will not work, and could even be counterproductive, unless (1) consumers are convinced that quality problems are real and consequential and that quality can be improved; (2) purchasers and policymakers make sure that quality reporting is standardized and universal; (3) consumers are given quality information that is relevant and easy to understand and use; (4) the dissemination of quality information is improved; and (5) purchasers reward quality improvements and providers create the information and organizational infrastructure to achieve them. (+info)
Raising awareness of consumers' options in the individual health insurance market.
(43/1536)
Lack of consumer awareness of where to get health insurance, what it costs, and what options exist is a critical barrier that prevents many people from obtaining coverage in the individual market (coverage that can include family members). However, a recent study suggests that that three-fourths of the uninsured could find a policy for less than 2,000 dollars per year and that one-third could find a policy for less than 1,000 dollars per year. More widespread dissemination of accurate and transparent information on prices, options, and benefits could play a role in expanding insurance coverage. (+info)
Restoring trust to managed care, Part 3: A focus on public stakeholders.
(44/1536)
Managed care organizations face distrust from public policy-makers, the media, and other public stakeholders. To succeed, the managed care industry must work to restore trust in their approach to healthcare delivery. A variety of strategies are presented as ways to mitigate the public's distrust of the managed care industry. (+info)
Impact of an acute myocardial infarction report card in Ontario, Canada.
(45/1536)
OBJECTIVES: Acute myocardial infarction (AMI) 'report cards' are being developed using administrative databases in many jurisdictions, but little is known about their acceptance by and their usefulness to the medical community. The purpose of this study was to determine the impact of the publication of Cardiovascular Health and Services in Ontario: An ICES Atlas (Naylor CD, Slaughter P. (eds), 1999, Toronto: ICES), the first report featuring hospital-specific AMI performance measures to be published in Canada. DESIGN: We conducted a mail survey of physicians at Ontario hospitals to determine their views on the usefulness of various atlas performance measures for assessing and improving quality of care, the types of quality initiatives launched at their hospital in response to the atlas, and their views on the concept and limitations of reporting hospital-specific AMI mortality data. RESULTS: Respondents to the survey indicated that information on process of care measures such as post-infarction beta-blocker and angiotensin-converting enzyme (ACE) inhibitor use, and cardiac procedure waiting times were the most useful, and outcomes data (e.g. 30-day and 1-year risk-adjusted AMI mortality rates) the least useful of the multiple performance measures published in the atlas (P = 0.0385). Fifty-four percent of respondents reported launching one or more quality of care initiatives at their hospital in response to the atlas. The majority of respondents (65%) indicated that they support the public release of hospital-specific AMI mortality data, although many had concerns about potential miscoding in administrative databases and the adequacy of risk-adjustment methods. CONCLUSION: The publication of the first AMI report card in Canada stimulated quality of care initiatives at many Ontario hospitals. Inclusion of performance measures other than mortality in health care report cards may lead to greater acceptance and use by the medical community. (+info)
Reporting quality of nursing home care to consumers: the Maryland experience.
(46/1536)
OBJECTIVE: To design and implement a reporting system for quality of long-term care to empower consumers and to create incentives for quality improvement. To identify a model to approach this technically and politically difficult task. APPROACH: Establishment of a credible and transparent decision process using a public forum. Development of the system based on: (1) review of the literature and existing systems, and discussions with stakeholders about strengths and weaknesses; (2) focus on consumer preferences in the design; and (3) responsiveness to industry concerns in the implementation. LESSONS LEARNED: None of the existing systems appeared to be a suitable model. We decided to develop an entirely new system based on three key design principles that allowed us to tailor the system to consumer needs: (1) designing a decision tool rather than a database; (2) summarizing rather than simplifying information; and (3) accounting for the target audience in the creative execution. Industry concerns focused on the burden of the system, the potential for errors, and the possible communication of a negative impression of the industry. As methodological and data limitations prevented us from resolving those concerns, we addressed them by using cautionary language in the presentation and by making a commitment to incorporate improvements in the future. All stakeholders regarded the final design as an acceptable compromise. CONCLUSIONS: Despite its potentially controversial nature and many methodological challenges, the system has been well received by both the public and the industry. We attribute this success to two key factors: a collaborative decision process, in which all critical design and execution choices were laid out explicitly and debated with stakeholders in a public forum, and realism and honesty regarding the limitations of the system. (+info)
How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs.
(47/1536)
OBJECTIVE: To explore family physicians' experiences and perceptions of osteoporosis and to identify their educational needs in this area. DESIGN: Qualitative study using focus groups. SETTING: Four Ontario sites: one each in Thunder Bay and Timmins, and two in Toronto, chosen to represent a range of practice sizes, populations, locations, and use of bone densitometry. PARTICIPANTS: Thirty-two FPs participated in four focus groups. Physicians were identified by investigators or local contacts to provide maximum variation sampling. METHOD: Focus groups using a semistructured interview guide were audiotaped and transcribed. The constant comparative method of data analysis was used to identify key words and concepts until saturation of themes was reached. MAIN FINDINGS: Family physicians order bone densitometry and try to manage osteoporosis appropriately, but lack a rationale for testing and are confused about management. Participants' main concern was clinical management, followed by disease prevention and their educational needs. CONCLUSION: Family physicians are confused about how to manage osteoporosis. To reduce the burden of illness due to osteoporosis, educational interventions should be tailored to family physicians' needs. (+info)
Success factors for open access.
(48/1536)
Open access to the peer-reviewed primary research literature would greatly facilitate knowledge transfer between the creators and the users of the results of research and scholarship. Criteria are needed to assess the impact of recent initiatives, such as the Budapest Open Access Initiative. For example, how many open-access research journals exist within a given field, and what is the reputation of each one? And, how many openly-accessible institutional e-print archives have been created and how many are actually are being used by researchers and scholars? A simple approach to an assessment of the open-access portion of the medical literature is described, and some preliminary results are summarized. These preliminary results point to the need for incentives to foster the implementation of initiatives such as the Budapest Open Access Initiative. An example of an incentive model is proposed, where an agency or foundation that provides peer-reviewed grants-in-aid to researchers establishes an e-print archive. Only current grantees of the agency would be eligible to post reports about the results of research projects or programs that have been supported by the agency. Some advantages and implications of this particular model are outlined. It is suggested that incentive models of this kind are needed to increase the likelihood that open access to the primary medical research literature will soon reach a "tipping point" and move quickly toward wide acceptance. (+info)