title: High-profile investigations into hospital safety problems in England did not prompt patients to switch providers.
abstract: Amid international concerns about health care safety and quality, there has been an escalation of investigations by health care regulators into adverse events. England has a powerful central health care regulator, the Care Quality Commission, which conducts occasional high-profile investigations into major lapses in quality at individual hospitals. The results have sometimes garnered considerable attention from the news media, but it is not known what effect the investigations have had on patients' behavior. We analyzed trends in admission for discretionary (nonemergency) care at three hospitals that were subject to high-profile investigations by the Healthcare Commission (the predecessor to the Care Quality Commission) between 2006 and 2009. We found that investigations had no impact on utilization for two of the hospitals; in the third hospital, there were significant declines in inpatient admissions, outpatient surgeries, and in numbers of patients coming for their first appointment, but the effects disappeared six months after publication of the investigation report. Thus, the publication and dissemination of highly critical reports by a health care regulator does not appear to have resulted in patients' sustained avoidance of the hospitals that were investigated. Our findings reinforce other evaluations: Reporting designed to affect providers' reputations is likely to spur more improvement in quality and safety than relying on patients to choose their providers based on quality and safety reports, and simplistic assumptions regarding the power of information to drive patient choices are unrealistic.
authors.affiliation: Department of Primary Care and Public Health at Imperial College London, London, England. a.laverty@imperial.ac.uk
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Laverty
authors.forename: Peter C
authors.initials: PC
authors.lastname: Smith
authors.forename: Utz J
authors.initials: UJ
authors.lastname: Pape
authors.forename: Alex
authors.initials: A
authors.lastname: Mears
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wachter
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D001294:Attitude to Health; D002755:Choice Behavior; D004739:England; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D033181:Information Dissemination; D010343:Patient Admission / Q000639:trends*; D061214:Patient Safety / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care