Johns Hopkins Docs Call for Transparent Reporting Standards

Apparently “come to us, we have no infections,” doesn’t qualify as adequate reporting.

“Transparency is becoming the norm in US health care,” opens a new viewpoint article in the Journal of the American Medical Association. The article calls for new, transparent reporting standards for healthcare organizations, and was authored by Peter J. Pronovost, MD, PhD; Albert W. Wu, MD, MPH; and J. Matthew Austin, PhD, all of Johns Hopkins University or its medical system.

The authors argue that, while private organizations, insurance companies, and state and federal agencies all report on provider performance in some capacity, the lack of uniformity in reporting hurts patients’ ability to assess the quality of the information at hand when making care decisions. Self-reporting is a conflict of interest, they believe, given that the incentive to portray one’s practice or hospital in a positive light might inherently silence breakdowns in care.

An example they give of misleading information was found on a hospital’s website: “Come to us, we have no infections,” in essence, without any qualifier of type of infection, time since last infection, or how that was measured. With more metrics being measured and reported than ever, there are ever more opportunities to misinform. “Many of these efforts appear to be led by marketing departments that are not aware of specific scientific standards,” the authors write.

They make two proposals: one, that “hospitals and physicians adopt standards for their own public reporting of quality measures,” and two, that “an external entity make transparent the extent to which reporting by each organization adheres to these standards.”

Providing a table of suggested standards, the Johns Hopkins staffers place emphases on accurate descriptions of the patient population being measured (including the period during which care was provided), thorough descriptions of the measures themselves (whether or not it’s a new measure developed by the healthcare organization, as well as all aspects of validity and reliability), and also on matters of acknowledged biases and potential uncertainty.

Once established, Pronovost et. al recommend that hospitals could use them to guide “the reporting of their own quality data on their websites” that an external organization could then analyze to determine what organizations were and weren’t compliant, in order to inform public trust. The imperative “could provide an important foundation for improving quality measures, and ultimately the quality of care that patients receive.”

They acknowledge that this might be a difficult sell: hospitals are busy enough places before such measures are installed, and the burden this would create are unknown. Enforcing adherence is another matter, though the authors proffer that endorsements of the standards by leading national organizations and agency would go a long way, and there’s still no guarantee that the public will receive the information.

“Patients deserve truthful, timely, and transparent measures of quality,” the trio concludes, noting that without them, the industry is essentially telling patients “let the buyer beware.”