Public Presentation of Health System or Facility Data About Quality and Safety

The Department of Veterans Affairs (VA) "Open Government Plan" outlines the agency's commitment to transparency, and defines transparency as both increasing access to public information and enabling better engagement and advocacy on behalf of Veterans. Key elements of the transparency initiative involve public presentation of health system and facility data about quality of care and safety. Examples include the VA Hospital Compare website, which provides outcomes and process data for selected diagnoses and the ASPIRE dashboard, which reports quality and safety goals for all VA hospitals. There are many reasons to make quality and safety information available to the public. One of the key goals of public reporting is to improve the quality of services. Theories and experience suggest multiple pathways from public reporting to health services improvement and ultimately to better patient outcomes. In a situation where patients and families have a choice among health care providers (systems or facilities), quality information makes it possible for patients to select providers based on performance. Public reporting also "levels the playing field" by making the knowledge about quality more accessible to patients. Without public reporting this information may only be known by providers. In turn, concern about loss of market share may motivate providers to improve processes and strive to improve outcomes. Publicly available data may also give provider organizations direct incentives to improve care. Report cards, rankings, and websites about quality allow organizations to compare their performance to that of their peers, but also make providers aware that others can make these comparisons as well. Concern about reputation can itself be a powerful motivator for change. Patient advocates, policy makers, and the media can also use publicly reported data to identify high and low performing organizations, track change over time, and promote high quality care. VA is committed to making its publicly reported performance data as accessible and useful as possible. This review and synthesis seeks to identify the key lessons for VA drawn from available research on public reporting that could be applied to future VA transparency efforts. The Key Questions were: 1. What is the most effective way of displaying quality and service information so that it is understandable? 2. How do patients prefer to receive or access this information? 3. What is the evidence that patients or their families use publicly reported quality and safety information to make informed health care decisions? 4. What is the evidence that public reporting of quality and safety information leads to improved quality of safety?