Quality performance transparency and accountability in urban safety net hospitals

The call for accountability in health care quality has led some hospitals to voluntarily share quality performance scores with consumers on the Internet (i.e., become more “transparent”) and with internal hospital staff. To better understand the scope of public hospitals' transparency efforts, researchers at the National Association of Public Hospitals and Health Systems (NAPH) conducted a survey of NAPH members' hospital quality directors and a content analysis of NAPH members' public websites. To determine characteristics that predict high quality scores and/or hospital transparency, logistic regression analyses were conducted in PASW/SPSS v. 18.0 using data from two sources: NAPH's 2008 annual characteristics study and CMS's “Hospital Compare” website.

Results: •In February 2008, 15% of public hospitals posted quality scores on their public website; in October 2009, that figure rose to 29%; •60% of public hospitals included transparency as one of their QI initiatives; •Public hospitals posted quality scores in their staff lounges (55%), on their intranet (33%), and in hospital newsletters (30%); •Public hospitals that are high performers on CMS metrics are more likely to publish quality scores. Likewise, public hospitals that publish data, have a fully-implemented EMR, or are part of a system are more likely to have higher quality scores.

Conclusions: Public hospitals are increasingly sharing performance scores to meet consumers' growing expectation of hospital quality transparency. This study suggests that hospitals interested in quality improvement should consider embracing greater transparency.