Creating knowledge from public disclosure of quality-of-care information: The experience of Taiwan's health insurance

Background:Public disclosures of quality-of-care information on the Internet through a web-based query system allow the stakeholders — governments, purchasers, provider professional associations, and patients — to explore options to enhance provider accountability with regard to quality-of-care in both nations and communities. Furthermore, insurance payers can examine the quality-of-care variations from providers to both improve the quality and reduce costs.

Method:The public disclosure of quality-of-care information is based on larger aggregations of claims data selected by provider professional associations. At the same time, various indicators of quality-of-care are accompanied by appropriate descriptive information of health care. A total of 53 indicator of quality-of-care information was public disclosed from 2005 to 2007. We adopt Nonaka's theory of knowledge creation after public disclosure of quality-of-care information to examine tacit and explicit knowledge of quality variations among health care providers.

Results: The distribution of quality-of-care indicators into inadequate and adequate quality has been found to be from the lower to higher percentile throughout the period under study, but with large variations among providers. The comparison shows that analysis of the adequate quality-of-care providers has been helpful to capture the relevant tacit knowledge and to explore the impact of these underlying critical factors on guidelines of clinical practice. Conversely, examining the inadequate quality-of-care providers can address the existing knowledge gaps in how to best use guidelines of clinical practice.

Conclusion:Public disclosure of quality-of-care information not only offers transparency to patients, also addresses the existing knowledge gaps with regard to clinical practice among providers.