Prosjekt: Effekter knyttet til offentliggjøring av kvalitetsindikatorer – en kritisk evaluering av den empiriske forskningen

Summary

The evidence base concerning intended and unintended effects of the public release of health system performance data is incomplete. In an ongoing Cochrane (EPOC) review, interventional studies with rigorous study designs have been evaluated in order to estimate the effectiveness of publicly available performance data in changing consumer, healthcare professional or organisational behaviour. The purpose of the present study is to extend and broaden this Cochrane review to get a better understanding of methodological approaches of a variety of empirical studies addressing the impact of such programmes. Special focus will be on whether putative theoretical models that form the bases for the monitoring systems are explored in the studies, which constructs have been measured and whether the rationale for methodological approach has been made explicit by the authors. Results of the review will be used to propose an agenda for further research in this area.

Objectives

Publication of data about the performance of hospitals, health professionals and health care organisations has become increasingly common in Western countries. However, the evidence base concerning the impact of such interventions is incomplete. In an ongoing Cochrane (EPOC) review, interventional studies with rigorous study designs have been evaluated in order to estimate the effectiveness of the public release of performance data in changing consumer, healthcare professional or organisational behaviour. Only three studies were found that met the EPOC inclusion criteria (these comprise well-designed randomized controlled trials, controlled clinical trials, interrupted time series or controlled before-after studies).

Concomitant with the need for firm knowledge about the effectiveness of public disclosure of health care performance data, there is also a need to gather information about empirical studies of less rigorous study designs, in order to gain a broader understanding of the research performed in this field, including methodological approaches and overall results. Some of these studies may be characterized as the earlier stages in the development phase of new complex interventions. They may therefore provide valuable documentation on theories used in studies of the relationship between the public disclosure of performance data and the impact on health care quality, as well as knowledge about important gaps in the research in this area.

This study is an extension of the ongoing Cochrane review. In addition to the studies fulfilling the strict inclusion criteria adopted in the EPOC review, we will include empirical studies with less rigorous study designs in order to identify and analyze theoretical models and methodological approaches.

The following questions will be addressed:

1. What, if any, theories or conceptual frameworks have been used in studies of the relationship between public release of performance data and health care quality?
2. What are the explicit (according to the authors) rationale underlying the choice of research design for studying the effects of public disclosure?
3. What are the methodological approaches chosen for assessing the impact of the measurement systems (such as research design, construct of study variables, and organizational level of analysis)?
4. What are the overall results from such empirical studies?
5. What are important areas for future research in this area?