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The Challenges Ahead for Quality Report Cards

Arnold M. Epstein, MD, MA

JAMA. 1998;279:1691-1696.

Today, steadily increasing numbers of hospitals and health plans are publicly releasing performance reports on the quality of care to permit comparisons across different providers. Our experience in recent years has provided important new evidence of what public quality reporting can accomplish and the difficulties it faces. Several years ago, the most important impediments to quality reporting may have been the availability of acceptable quality indicators and the feasibility of voluntary, standardized data collection by health plans. We have made strides in these areas. The Health Employer Data and Information Set (HEDIS) has expanded, and there have been new innovations in collecting data on quality from both patients and physicians. Hundreds of health plans have begun to report standardized quality data on a routine basis either voluntarily or in response to requirements from the Health Care Financing Administration, state Medicaid agencies, or private payers. Now, the more formidable barriers to the use of quality report cards may relate to the ways we report the data and use it. We need to find acceptable middle ground for those who believe information on individual physicians is critical and those who believe it is harmful. We need to reap the advantages in different modalities of data collection and different tools for quality management. Most of all, we need to find better ways to use quality reporting to empower purchasers and consumers and improve quality of care.

From the Department of Health Policy and Management, Harvard School of Public Health, the Division of General Medicine, Section on Health Services and Policy Research, Brigham and Women's Hospital, and the Department of Health Care Policy, Harvard Medical School, Boston, Mass.

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