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  Table of Contents  
EDITORIAL
Year : 2017  |  Volume : 54  |  Issue : 4  |  Page : 592-593
 

Public reporting of healthcare data – Need of the hour in India


Director, Tata Memorial Centre, Dr E Borges Road, Parel, Mumbai, Maharashtra, India

Date of Web Publication30-Jul-2018

Correspondence Address:
Prof. R A Badwe
Director, Tata Memorial Centre, Dr E Borges Road, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_358_18

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How to cite this article:
Badwe R A. Public reporting of healthcare data – Need of the hour in India. Indian J Cancer 2017;54:592-3

How to cite this URL:
Badwe R A. Public reporting of healthcare data – Need of the hour in India. Indian J Cancer [serial online] 2017 [cited 2018 Oct 17];54:592-3. Available from: http://www.indianjcancer.com/text.asp?2017/54/4/592/237891




In recent years, healthcare and its management have evolved a lot. There is greater stress upon the quality of care provided, outcomes, and patient satisfaction. The quality of care can be assessed by various methods such as appraisals, external peer reviews, and audits. Clinical audits have become part of normal hospital functioning in North America, the United Kingdom, and in several countries in Europe. As a part of an audit, the quality, outcomes, and complications of a procedure or surgery or the care provided are compared with the standard of care. Such a standard is generally as per the accepted international or implementable national guidelines. Many a times, guidelines may not exist or even if they do they may not be applicable in that particular setting due to differential demographic profile and healthcare facilities available. In such a case, locally accepted standards may be used for comparison. By doing such audits, we come to know whether best clinical practices are being followed and whether ideal patient care is being provided. This can help in assessing the shortcomings and working toward fulfilling them. It can even highlight deficit areas from resource allocation viewpoint and help healthcare managers in taking corrective actions.

We should not forget that patients are at the center of our healthcare system. Patients and patient welfare organizations should form part of the team assessing the healthcare. They need to be aware of the various healthcare options available, expected results, and complications. This means going public with the healthcare data. Public reporting of data may occur at different levels. There may be release of data having national figures which may help in sensitizing the public to different causes of healthcare problems and their effects – like that of tobacco in causing cancer, and so on. These can be used by the government for healthcare education and for controlling epidemics. Besides this, there may be release of hospital-based or individual doctor-based data. Such a data may be about patient satisfaction and quality of healthcare. These may help other patients in forming opinions, decision-making, and also help healthcare managers and doctors in improving healthcare facilities to suit the patient's needs. More debatable is the release of data about a hospital or an individual doctor's procedure or treatment-related outcomes, morbidity, and mortality.

Public release of such a data has been practiced in the United States and United Kingdom. It is believed to increase public accountability, facilitate consumer choice and decision-making, and motivate healthcare providers to improve their services. As expected, release of such information is controversial. By making data public, the quality of healthcare is expected to improve by two methods. First, the hospital and the healthcare provider (doctor) will be motivated to perform better and provide superior patient care at competitive rates/prices. They will be forced to look into their shortcomings and correct them. Second, the patients will have the option of comparing treatment from different places based on their quality and costs.[1] Reviews have been conducted to assess the impact of public reporting of performance data. They have shown inconsistent results. A systematic review showed that publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain.[2] A Cochrane review was conducted to determine the effectiveness of the public release of performance data in changing the behavior of healthcare consumers, professionals, and organizations. They concluded that there is no consistent evidence that the public release of performance data changes consumer behavior or improves care. Evidence that the public release of performance data may have an impact on the behavior of healthcare professionals or organizations is lacking.[3] One of the study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than 2 months after each public release.[4] Contrary to these, a review demonstrated that publication of such results had a positive impact on performances of the hospitals leading to improvement in quality of healthcare.[5]

Public disclosure of information has been criticized for being backward looking and unable to predict future performances. Doctors may fear that data may not be risk stratified or may not be considered with respect to relevant coexisting factors. It may lead to manipulation of data, undue focus on the aspect being studied and reported, and neglect of others.[6] Some studies have shown that consumers or patients may not try to search for such an information and even when available to them may not understand it fully.[7],[8] It may also lead to operating or treating less risky patients as was reported after the results of coronary artery bypass surgery in New York were publicized.[9] Though this was ruled out by other study groups which showed that publication of results of bypass surgery had actually improved the outcomes.[10] Irrespective of these, public reporting of healthcare data is essential. Such information is published by various agencies such as National Committee for Quality Assurance in the United Kingdom and the Centre for Medicare and Medicaid Services in the United States.

The aim of all the healthcare professionals is the same, to improve patient-related outcomes. In this regard, the field of oncology provides its own challenges and advantages. There are generally widely accepted staging systems and treatment protocols. Outcomes and complications can be compared according to the treatment modality used and the staging of the disease. Publicizing such results will demonstrate that the hospital or the doctor is providing standard of care. It will be a source of motivation to perform better and will also give an opportunity to work upon the shortfalls. It will also be reassuring for the patient that his or her care is of acceptable standards.



 
  References Top

1.
Berwick DM, James B, Coye MJ. Connections between quality measurement and improvement. Med Care 2003;41 (1 Suppl):I-30-8.  Back to cited text no. 1
    
2.
Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: The evidence that publishing patient care performance data improves quality of care. Ann Int Med 2008;148:111-23.  Back to cited text no. 2
    
3.
Ketelaar NA, Faber MJ, Flottorp S, Rygh LH, Deane KH, Eccles MP. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Cochrane Database Syst Rev 2011:CD004538. doi: 10.1002/14651858.CD004538.pub2.  Back to cited text no. 3
    
4.
Romano PS, Hong Zhou MPH. Do well-publicized risk adjusted outcomes reports affect hospital volume? Med Care 2004;42:367-77.  Back to cited text no. 4
    
5.
Marshall MN, Shekelle PG, Leatherman S, Brook RH. The public release of performance data: What do we expect to gain? A review of the evidence. JAMA 2000;283:1866-74.  Back to cited text no. 5
    
6.
Marshall MN, Shekelle PG, Leatherman S, Brook RH. Public disclosure of performance data: Learning from the US experience. Qual Health Care 2000;9:53-7.  Back to cited text no. 6
    
7.
Schneider EC, Epstein AM. Use of public performance reports. JAMA 1998;279:1638-42.  Back to cited text no. 7
    
8.
Marshall M, Hiscock J, Sibbald B. Attitudes to the public release of comparative information on the quality of general practice care: Qualitative study. BMJ 2002;325:1278.  Back to cited text no. 8
    
9.
Hannan EL, Kilburn H, Racz M, Shields E, Chassin MR. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA 1994;271:761-6.  Back to cited text no. 9
    
10.
Peterson ED, Delong ER, Jollis JG, Muhlbaier LH, Mark DB. The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly. J Am Coll Cardiol 1998;32:993-9.  Back to cited text no. 10
    




 

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