In this session, I plan on uncovering the history, the objectives, and key examples of public reporting of healthcare quality and safety data both in the United States and in the United Kingdom. The public reporting of comparative information about healthcare quality and safety has been an accepted way of improving both accountability and quality. For purposes of this lecture, I'll discuss the historical perspective of public reporting of healthcare quality data from the experience of two countries, the United States and the United Kingdom. The interest in disclosing information publicly about quality of healthcare is not new either in the United States or the United Kingdom. In the 1860s, Florence Nightingale, she highlighted differences in mortality rates of patients in London hospitals. And in 1917, the US surgeon, Ernest Codman, complained to his colleagues that they failed to publish their results publicly for fear that they might be not impressed with how those turned out. The vision of Florence Nightingale and Ernest Codman really has only started to become a reality in the last two decades, and this is really due to developments in information technology, as well as rising expectations regarding patient choice, and holding health systems accountable. There's really two primary reasons that we would actually put performance information about the quality of healthcare out in the public domain. The first one is to increase accountability of healthcare organizations, the professionals, and their managers. This greater accountability offers different stakeholders, such as patients, payers, and purchasers, a more informed basis on which to hold providers accountable either directly through purchasing and treatment decisions or indirectly through political processes. The second reason for putting performance data out in the public domain is to either maintain standards or stimulate improvements in the quality of care, or both. The United States has really been the country that has led the modern public disclosure movement. In 1984, the Health Care Financing Administration, HCFA, which now we know today as the Centers for Medicare and Medicaid Services or CMS, they began to publicly report on hospital mortality rates of Medicare patients. In an effort to target their administrative oversight activities, the agency identified 269 hospitals that had either significantly higher or significantly lower death rates than predicted for Medicare patients. Although their analysis controlled a variety of external factors, their analysis was severely criticized and eventually, HCFA stopped publishing the so-called death list. In the 1990s, there were several US states that actually began reporting mortality information for both hospitals and surgeons, specifically for open heart surgery. New York State began a groundbreaking reporting of severity-adjusted mortality rates for coronary artery bypass graft or CABG surgery both for hospital and for surgeon. And in 1982, Pennsylvania also began reporting on CABG mortality rates. And in 1998, the state was reporting risk-adjusted CABG mortality rates for surgeons, hospitals, and 34 health insurance plans. Other efforts around public reporting in the United States have included, in 1993, the National Committee for Quality Assurance or NCQA, which is a private, nonprofit organization, began to report their data on the quality of health insurance plans using a dataset called HEDIS, H-E-D-I-S. In 2001, the Leapfrog Group, which is a coalition of major business purchasers or Fortune 500 companies, started publicly reporting on the quality and safety of care in US hospitals. The Centers for Medicare and Medicaid Services or CMS has, since their initial efforts around the mortality rates, developed a series of a number of consumer-facing websites that share comparative performance data, and these websites include Hospital Compare; which shares quality information about hospitals, Physician Compare; which shares information about physicians, Nursing Home Compare, Home Health Compare. And recently, they've just introduced a Hospice Compare website as well. At least in the United States, information is no readily available about comparative performance of health insurance plans, hospitals, and individual physicians, and that includes both government entities, nonprofit entities, and for a profit entities doing that reporting. But there continues to be an ongoing, and sometimes, controversial debate about the content of the data, the process of disclosing those data, and the associated merits and risks of publicly disclosing quality information. One could say that public reporting in the United States is actually very much now like healthcare delivery in the United States: It's diverse, it's primarily a market-based approach, and lacks an overarching organizational structure or strategic plan. In the United Kingdom, basic information about hospital performance in both England and Wales has been in the public domain since the early 1980s. In the early 1990s, information for hospitals outcomes data in Scotland began to be published, but that release of that information was purposely low-key to discourage hostile responses from both clinicians and from the media. National reporting initiatives of a high-profile nature weren't introduced in the United Kingdom until the late 90s, specifically in 1998. And from this date, the United Kingdom has actually adopted a much more coordinated and strategic approach to public reporting that has been seen in the United States.
