Effectiveness of public report cards for improving the quality of cardiac care: the EFFECT study: a randomized trial.
BACKGROUND
Publicly released report cards on hospital performance are increasingly common, but whether they are an effective method for improving quality of care remains uncertain.


OBJECTIVE
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.


METHODS
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).


METHODS
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Public release of hospital-specific quality indicators did not significantly improve composite process-of-care indicators for AMI or CHF.


BACKGROUND
http://clinicaltrials.gov Identifier: NCT00187460.
Tu
Jack V
JV
Institute for Clinical Evaluative Sciences, G106-2075 Bayview Ave, Toronto, ON M4N 3M5, Canada. tu@ices.on.ca
Donovan
Linda R
LR
Lee
Douglas S
DS
Wang
Julie T
JT
Austin
Peter C
PC
Alter
David A
DA
Ko
Dennis T
DT
D019985:Benchmarking; D030881:Disclosure; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care; D017150:Public Sector; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D017749:Total Quality Management