Public reporting of quality data for stroke: is it measuring quality?
OBJECTIVE
Public reporting of quality data is becoming more common and increasingly used to improve choices of patients, providers, and payers. We reviewed the scope and content of stroke data being reported to the public and how well it captures the quality of stroke care.


METHODS
We performed a cross-sectional survey of all report cards within the Agency for Healthcare Research and Quality Report Card Compendium. Stroke quality data were categorized into one of 5 groups: structure, process, outcomes, utilization, and finances. We also determined the congruence of mortality ratings of New York hospitals provided by 2 different report cards.


RESULTS
Of 221 available report cards, 19 (9%) reported quality information regarding stroke and 17 specifically addressed the quality of hospital-based stroke care. The most frequent data reported were utilization measures (n=15 report cards) and outcome measures (n=14 report cards). Data regarding finances (n=4), structure of care (n=2), and process of care (n=1) were reported infrequently. Ratings were incongruent in 61 of the 157 hospitals (39%) with the same hospital being rated below average on one report care and average on another in 44 hospitals.


CONCLUSIONS
Publicly reported quality data pertaining to patients with stroke are incomplete, confusing, and inaccurate. Without further improvements and a better understanding of the needs and limitations of the many stakeholders, targeted transparency policies for stroke care may lead to worse quality and large economic losses.
Kelly
Adam
A
Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.
Thompson
Joel P
JP
Tuttle
Deborah
D
Benesch
Curtis
C
Holloway
Robert G
RG
D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D006077:Government Agencies; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D009518:New York; D010342:Patient Acceptance of Health Care; D011639:Public Opinion; D011785:Quality Assurance, Health Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D012107:Research Design / Q000592:standards*; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States; D014483:United States Dept. of Health and Human Services
Am J Prev Med. 2006 Dec;31(6 Suppl 2):S246-50
17178313
JAMA. 2007 Oct 17;298(15):1800-2
17940238
Med Decis Making. 1996 Oct-Dec;16(4):348-56
8912296
N Engl J Med. 2006 Nov 2;355(18):1847-9
17079758
Neurologist. 2006 Sep;12(5):245-8
16990736
Int J Qual Health Care. 2004 Apr;16 Suppl 1:i57-63
15059988
JAMA. 2006 Jul 5;296(1):72-8
16820549
Stroke. 2005 Jul;36(7):1597-616
15961715
JAMA. 2007 Aug 15;298(7):802-4
17699014
Stroke. 2005 Jun;36(6):1227-31
15879336
Circulation. 2006 Jan 24;113(3):456-62
16365198
JAMA. 1988 Sep 23-30;260(12):1743-8
3045356
JAMA. 2000 Apr 12;283(14):1866-74
10770149
J Pain Palliat Care Pharmacother. 2008;22(4):306-11
21923316
Stroke. 2001 Sep;32(9):2058-74
11546898
JAMA. 2000 Jun 21;283(23):3102-9
10865305
JAMA. 2005 Mar 9;293(10):1239-44
15755946
Lancet. 2004 Apr 3;363(9415):1147-54
15064036
JAMA. 2006 Apr 26;295(16):1912-20
16639050
Arch Surg. 2007 Sep;142(9):863-8; discussion 868-9
17875841