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Do They Make a Difference in Patient Care?

Daniel R. Longo, ScD; Garland Land, MPH; Wayne Schramm, MA; Judy Fraas; Barbara Hoskins; Vicky Howell, PhD

JAMA. 1997;278(19):1579-1584.

Abstract
Context.
—Consumer reports in health care are a relatively recent phenomenon. Primarily designed to assist consumers in making more informed decisions about their personal health care, they appear to have an important by-product—they led to positive changes in the behavior of clinicians and health care delivery organizations. While there has been much speculation on their impact on health care consumer behavior, consumer reports offer an effective strategy in improving the quality of patient care.

Objective.
—To examine the impact of an obstetrics consumer report developed and issued by the Missouri Department of Health on hospital behavior.

Design and Setting.
—A retrospective study of hospital behavior using both primary survey and secondary clinical data.

Participants.
—Consumer reports were issued in 1993 to all Missouri hospitals providing obstetrical services (n=90). A survey was conducted a year later, and the results were analyzed with other available data to determine the effect of the report. Two hospitals discontinued obstetrical services by the time of the survey; of the remaining 88 hospitals, 82 (93%) responded to the survey.

Main Outcome Measures.
—The following outcomes were examined: (1) number and percentage of hospitals that previously did not have services at the time report was issued, but had, or planned to have, services after a guide was published; (2) the percentage of obstetrical policies that were changed, planned to change, or are under discussion for change (car seat program, obstetrical follow-up services, formal transfer agreement, nurse educator for breast-feeding, and availability of tubal ligations); and (3) clinical outcomes, including satisfaction, appropriateness of charges, and the rates of cesarean delivery, high-risk infant transfer, ultrasound, vaginal birth after cesarean, very low birth weight, and newborn death.

Results.
—Within 1 year of the report, approximately 50% of hospitals that did not have car seat programs, formal transfer agreements, or nurse educators for breast-feeding prior to the report either instituted or planned to institute these services. Hospitals in competitive markets that did not offer one of these services at the time of the report were more likely to institute a service and/or were about twice as likely to consider improving several indicators. Clinical outcome indicators all improved in the expected direction.

Conclusion.
—Public release of consumer reports may be useful not only in assisting consumers to make informed health care choices, but also in facilitating improvement in the quality of hospital services offered and care provided. Changes occur especially in competitive markets.

Author Affiliations
From the Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia (Dr Longo), and the Division of Health Resources, Missouri Department of Health, Jefferson City (Messrs Land and Schramm, Mss Fraas and Hoskins, and Dr Howell).

Footnotes
Reprints: Daniel R. Longo, ScD, MA306 Medical Sciences Bldg, University of Missouri-Columbia, Columbia, MO 65212 (e-mail: danl@fcm.missouri.edu).

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