Effectiveness of Public Report Cards for Improving the Quality of Cardiac Care

Abstract

<h3>Context</h3>Publicly released report cards on hospital performance are increasingly common, but whether they are an effective method for improving quality of care remains uncertain.<h3>Objective</h3>To evaluate whether the public release of data on cardiac quality indicators effectively stimulates hospitals to undertake quality improvement activities that improve health care processes and patient outcomes.<h3>Design, Setting, and Patients</h3>Population-based cluster randomized trial (Enhanced Feedback for Effective Cardiac Treatment [EFFECT]) of 86 hospital corporations in Ontario, Canada, with patients admitted for acute myocardial infarction (AMI) or congestive heart failure (CHF).<h3>Intervention</h3>Participating hospital corporations were randomized to early (January 2004) or delayed (September 2005) feedback of a public report card on their baseline performance (between April 1999 and March 2001) on a set of 12 process-of-care indicators for AMI and 6 for CHF. Follow-up performance data (between April 2004 and March 2005) also were collected.<h3>Main Outcome Measures</h3>The coprimary outcomes were composite AMI and CHF indicators based on 12 AMI and 6 CHF process-of-care indicators. Secondary outcomes were the individual process-of-care indicators, a hospital report card impact survey, and all-cause AMI and CHF mortality.<h3>Results</h3>The publication of the early feedback hospital report card did not result in a significant systemwide improvement in the early feedback group in either the composite AMI process-of-care indicator (absolute change, 1.5%; 95% confidence interval [CI], −2.2% to 5.1%; P = .43) or the composite CHF process-of-care indicator (absolute change, 0.6%; 95% CI, −4.5% to 5.7%; P = .81). During the follow-up period, the mean 30-day AMI mortality rates were 2.5% lower (95% CI, 0.1% to 4.9%; P = .045) in the early feedback group compared with the delayed feedback group. The hospital mortality rates for CHF were not significantly different.<h3>Conclusion</h3>Public release of hospital-specific quality indicators did not significantly improve composite process-of-care indicators for AMI or CHF.<h3>Trial Registration</h3>http://clinicaltrials.gov Identifier: NCT00187460Published online November 18, 2009 (doi:10.1001/jama.2009.1731).