For additional discussion of John Wennberg's work, see Symposium,
Variations Revisited, Health Affairs Web Exclusive (2004).
For more on evidence-based medicine, see Symposium, 24(1) Health
Affairs (Jan. 2005). Atul Gawande's article "The Bell Curve" in
the Jan. 31, 2005 New Yorker,
is a compelling account of the power of reports cards to motivate
improvement in the quality of cystic fibrosis treatment.
Medicare now requires hospitals to participate in public reporting of 10 comparative quality measures (focused on heart failure and pneumonia) in order to obtain full reimbursement. For more information see Medicare's Hospital Quality Initiative web page.
Questioning the utility of report cards, one study by prominent
found that cardiac surgery report cards in New York and Pennsylvania
patient and social welfare by prompting physicians and hospitals to
sicker or more severe cases. David Dranove, Daniel Kessler, Mark
McClellan, & Mark Satterthwaite, Is More Information Better? The
of 'Report Cards' on Health Care Providers, 111 J. Pol. Econ. 555
(2003). Another study found that a hospital's or surgeon's
ranking did not lead to a change in their market share. Ashish K.
Jha & Arnold M. Epstein, The Predictive Accuracy of the New York
State Coronary Artery Bypass Surgery Report-Card System, 25(3) Health
Aff. 844 (June 2006).
This is an example of a report used by the Pennsylvania Health Care
Cost Containment Council, giving statistical ratings for cardiac
who performed bypass operations in 1991.
|Hospital Physician Practice Group and Surgeons||Total Patients||Actual Number||Expected Range||Statistical Rating||P- Value|
|Hospital A||332||4||5.35 - 18.08||+||0.018|
|Doctor A||206||2||2.64 - 12.81||+||0.029|
|Doctor B||126||2||0.21 - 7.86||=||0.307|
|Hospital B||323||15||3.91 - 15.30||=||0.061|
|Doctor A||58||1||0.00 - 4.50||=||0.632|
|Doctor C||50||3||0.00 - 3.26||=||0.079|
|Doctor D||133||8||0.00 - 6.82||-||0.008|
|Doctor E||75||3||0.24 - 6.34||=||0.873|
|Hospital C||467||21||6.24 - 20.09||-||0.026|
|Doctor B||62||1||0.00 - 4.52||=||0.518|
|Doctor D||40||1||0.00 - 2.98||=||0.986|
|Doctor E||56||4||0.00 - 4.71||=||0.149|
|Doctor F||43||3||0.00 - 29.4||-||0.039|
| Statistical Rating Key
+ fewer deaths than expected
- more deaths than expected
= the number of deaths was not different than what was expected
*NA not applicable because fewer than 30 patients were treated
Hospitals and Physicians may have commented on these data. Copies are available upon request.
These are examples of health plan performance measures included in the [HEDIS] Health Plan Employer Data and Information Set
Acute and chronic disease
Pap smears for cervical cancer
Readmission rate for treatment of
|Access and satisfaction||Access
|Percent of members
age 42 to 64
plan visit in previous two years
Members who had no problem receiving
care or referrals
Percent of members who are "very satisfied"
|Utilization||High occurrence/high cost||Frequency and
average cost of
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