Accountability and Improvement:

Lessons from the Field

2007 National Health PolicyConference

Christopher Queram

President and CEO

Does Public Reporting Matter?

• University of Oregon Research Team– Judith Hibbard, PhD

– Funding from Robert Wood Johnson Foundation

• Experimental Design using WI Hospitals– Does making hospital performance public improve

quality compared to sharing performance information with hospitals on a private basis?

Percent of Hospitals with Statistically Significant Improvements or Declines in Maternity Performance in the Post-Report Period:

35%

23%

13%

5%

14% 13%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Public Report(n=20)

PrivateReport (n=37)

No Report(n=41)

SignificantImprovement

Significant Decline

Changes in Performance in the Post-Report Period – Among Hospitals with ‘Worse Than Expected’ Scores at Baseline*

12%

67%58%

88%

33%42%

0%

20%

40%

60%

80%

100%

Public Report (n=8) Private Report (n=15) No Report (n=12)

Performance Unchanged in Post-Report Period

Performance Improved in Post-Report Period

* p < .05

WCHQ Ambulatory Performance Reporting - - Anecdotal Evidence

Baseline (72%)

Year One (82%)

35% to 50% in ‘Good Control’

46%

35%

50%

47% to 56% in ‘Good Control’

A1c<7 Year Three

A1c<7 Baseline

Factors Influencing Positive Gains in Quality

• Public Reporting• Professional/Institutional Pride• Enlightened Clinical Leadership• Collaborative Models for Knowledge Sharing,

Transfer• Financial Incentives?