The goal of this postdoctoral fellowship will be to facilitate the candidate's development as leader in academic surgery with a focus on health services research, surgical outcomes, and quality improvement. Two key goals of public reporting of hospital performance data are to help patients select high-quality hospitals and to encourage hospitals to improve their quality of care.1,2 However, public reporting has not been particularly effective in helping patients select high-quality hospitals.1,2 Methodological constraints of prior studies have also made it challenging to determine whether there is an improvement in outcomes as a result of public reporting.1,2 The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) provides each of the 390 participating hospitals with confidential, risk-adjusted benchmarked reports for 24 surgical outcomes, based on validated clinical data.4 Although the outcomes are not publicly reported, ACS NSQIP hospitals have demonstrated some improvement in outcomes.5 This study will focus on assessing the effect of public reporting by comparing participating and non-participating hospitals in a CMS-NSQIP public reporting pilot project. This research has the potential to (1) improve patients' ability to select the highest quality hospital for their surgeryand (2) demonstrate the impact of public reporting in order to entice all hospitals to publicly report outcomes, expand their publicly reported metrics, and ultimately improve the quality of surgical care delivered. To do this, we will assess differences in selected surgical outcomes and hospital quality improvement activity at baseline and after two years of CMS-NSQIP public reporting implementation between participating and non-participating hospitals. This will make it possible to prospectively compare hospitals that choose to participate in public reporting with those that do not. This should provide novel insights about the effect of public reporting on reported outcomes, on unreported outcomes, and on the culture of quality improvement amongst participating and non-participating hospitals. This research is significant because it may provide the evidence for hospitals to increase transparency and expand public reporting across all of surgery, thus affecting the care of millions of patients.
Public reporting of clinical outcomes and quality measures enable patients to make educated decisions regarding where to seek their healthcare, introducing a competitive advantage to those hospitals demonstrating a propensity for providing the highest quality of care. This project will benefit public health by demonstrating the positive correlation between public reporting of institutional outcomes and overall healthcare quality improvement activity amongst publicly reporting hospitals. This will effectively incentivize hospitals to maximize the quality of care delivered to patients, leading a higher quality of care provided and ultimately decreasing morbidity, mortality, and cost of care.
