More doubt cast on impact of info

Presenting high quality data to patients is unlikely to directly drive improvements in the quality of care, according to a paper in the BMJ.

Professor Martin Marshall and Vin McLoughlin from the Health Foundation, a charity set up to improve the quality of healthcare in the UK, analyse research conducted over the past 20 years in several countries. 

They conclude it provides little evidence that patients behave in a consumerist fashion as far as their health is concerned.

The authors argue that although patients are clear that they want information to be made publicly available they rarely search for it, often do not understand it, and are unlikely to use it in a rational way to choose the best provider.

Their analysis follows research published by the King’s Fund last week that argued that simply publishing more information would not lead to patients making more informed choices about their care.

Professor Marshall and McLoughlin argue that increasing amounts of data are available to patients, thanks to organisations ranging from the Care Quality Commission to NHS Choices, the Society of Cardiothoracic Surgery and Dr Foster Intelligence, whichthis week published its latest Hospital Guide.

However, the paper says research evidence shows that public reporting of comparartive data has had a limited role in improving quality.

When it does have a role in improving quality, the paper says the underlying mechanism is usually providers’ concern about their reputation rather than competition driven by service users.

The authors argue that the public “has a clear right to know how well their health system is working, irrespective of whether they want to use the information” and suggest several ways in which currently available performance data could be made more useful.

These include: ensuring the information comes from a trusted source; making it relevant to the target audience; and presenting it in a visually attractive way.

The authors add that patients also need to know how the NHS works before they can realistically judge comparative performance data and say personal stories can be compelling and influential when used alongside numeric data.

The authors argue that their paper presents a significant challenge to those who believe that providing information to patients to enable them to make choices between providers will be a major driver for improvement in the near or medium term.

“We suggest that, for the foreseeable future, presenting high quality information to patients should be seen as having the softer and longer term benefit of creating a new dynamic between patients and providers, rather than one with the concrete and more immediate outcome of directly driving improvements in quality of care," they conclude.