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Brief analytical summaries or syntheses #16

How health systems make available information on service providers: experience in seven countries

Summary

This technical report examines seven countries' experience with systems that release information on the performance of healthcare providers. It is meant to guide the further development of quality information systems in Britain's NHS. Systems in Denmark, England, Germany, Italy, the Netherlands, Sweden and the United States are reviewed.

Background

There is growing interest in the public release of information on the performance of healthcare providers as a means to improve the quality of care and promote transparency and accountability. Countries have made considerable investments in creating systems to make available such information. However, there is lack of systematic comparative assessment of such systems. The report aims to help fill the gap by reviewing the information systems reporting on the quality of healthcare provision in seven countries.

Analysis and results

The review highlights that despite variations in the policy context for quality reporting and in the nature and scope of quality information systems in each of the seven countries, these systems often pursue similar objectives: supporting patient choice and influencing provider behaviour to enhance the quality of care and increase transparency. However, system objectives are not always well defined and documented. Systems vary in their target audiences. In most countries, several systems co-exist, each serving slightly different purposes. They may focus on one particular aspect of performance, typically waiting times, but sometimes also gather information from surveys of patients’ experience and satisfaction with health services. The report also finds that governments and health authorities play a key role in operating and funding quality information systems.

Countries have developed a great number and variety of information systems, but evidence on their effectiveness and impact is limited. Systematic evaluations are mainly available for the U.S., and these suggest that public reporting can improve the quality of care in some areas. However, the effects of information systems on quality of care are difficult to isolate, as these are frequently part of broader quality improvement initiatives.

It is important to note that information systems can encourage changes in provider behaviour that improve the quality of services, even when the public makes limited use of the information.

Conclusion

This review was motivated by the need for more systematic research to guide the design and implementation of systems that provide information on the performance of healthcare providers and the quality of care to ensure that these systems actually do lead to quality improvements. The recommendations listed below provide a guide to the development of reporting systems that lead to quality improvement.

Implications and recommendations

The report identified a number of considerations for the design of quality information systems.

Define goals :

The purpose of publishing information on the quality of service providers needs to be well defined, as does the primary target group(s) meant to use the system. Information systems must ensure access and usability by the group(s) targeted by the system.

Involve stakeholders :


Stakeholder involvement can improve acceptance of information systems and potentially increase public use. It is necessary to decide early on which stakeholders to include and at what stage of the process.

Put quality assurance mechanisms in place :

The data published must be of the highest quality and mechanisms for ensuring the validity, reliability and consistency of reported data must be developed.
 
Use incentives:

Incentives can help achieve high participation among healthcare providers.

Systematically evaluate information systems:

Put rigorous measurement protocols in place to assess the impact of these systems on healthcare provider behaviour.

Source

How health systems make available information on service providers. Experience in seven countries