A nemzetközi szakirodalom egyre gyakrabban foglalkozik azzal a kérdéssel, hogy a minőségi indikátorokra támaszkodó nyilvános minőségértékelésnek mi a hatása az ellátás minőségére és az érintettek döntésére vonatkozóan, illetve melyek azok a kritériumok, amelyek mentén nyilvános minőségértékelési rendszereket célszerű kialakítani. A nemzetközi szakirodalom alapján a dolgozat hat témakört mutat be: (1) az indikátorok képessége a szolgáltatók megkülönböztetésére; (2) az eredményindikátorok alkalmassága a szolgáltatók megítélésére; (3) a bajnoki tabellák képessége a szolgáltatók rangsorolására; (4) a lakosság viselkedése a szolgáltatók választása során; (5) az indikátorokra támaszkodó nyilvános minősítések hatásai; (6) ajánlások minősítési rendszerek kidolgozására. A szakirodalmi kutatások szerint elsősorban a kockázatkiegyenlítési problémák miatt az indikátorok képessége a szolgáltatók megkülönböztetésére a nyújtott ellátás minősége szempontjából kérdéses; az elért ellátási eredmények nem feltétlenül utalnak vissza az ellátási folyamatok minőségére; a több indikátorból komponált intézményi sorrendek (bajnoki tabellák) nem megbízhatóak; a lakosság a szolgáltatók kiválasztásakor elsősorban a környezet véleményét és a távolságot veszi figyelembe; és a nyilvános közlések hatására igazoltan romlik az ellátás átfogó minősége. A szolgáltatók értékelésében alkalmazott mérési eredmények közzétételét eszköznek kell tekinteni. A lakosság intézményválasztásának elősegítésére az ő preferenciáik mentén végzett betegelégedettségi vizsgálatok nyilvánossá tétele hozhatja meg a kívánt eredményt. A minőségfejlesztési célokat igazoltan segítik a szolgáltatói körben végzett közvetlen visszajelzések az indikátorok mért értékeiről, illetve pontosabb kép kapható az ellátási és szervezési folyamatok, standardok egységes felülvizsgálatára alapozott eljárások külső értékelési rendszerekbe történő beemelésével.
Steinbrook, R.: Public Report Cards – Cardiac Surgery and beyond. N. Engl. J. Med., 2006, 355 , 1847–1849.
Steinbrook R. , 'Public Report Cards – Cardiac Surgery and beyond ' (2006 ) 355 N. Engl. J. Med. : 1847 -1849 .
Mannion, R., Goddard, M.: Public disclosure of comparative clinical performance data: lessons from the Scottish experience. J. Eval. Clin. Pract., 2003, 9 , 277–286.
Goddard M. , 'Public disclosure of comparative clinical performance data: lessons from the Scottish experience ' (2003 ) 9 J. Eval. Clin. Pract. : 277 -286 .
Mason, A. M. A., Street, A.: Publishing outcome data: is it an effective approach?. J. Eval. Clin. Prac., 2006, 12 , 37–48.
Street A. , 'Publishing outcome data: is it an effective approach? ' (2006 ) 12 J. Eval. Clin. Prac. : 37 -48 .
Adab, P., Rouse, A. M., Mohammed, A. M. és mtsa: Performance league tables: the NHS deserves better. BMJ, 2002, 324 , 95–98.
Mohammed A. M. , 'Performance league tables: the NHS deserves better ' (2002 ) 324 BMJ : 95 -98 .
Takács, E., Belicza, É., Boncz, I.: Az NHS indikátorrendszerének tanulságai. Egészségügyi Menedzsment, 2003, 5/6 , 54–59.
Boncz I. , 'Az NHS indikátorrendszerének tanulságai ' (2003 ) 5 Egészségügyi Menedzsment : 54 -59 .
Vallet, G., Perrin, A., Keller, C. és mtsa: Public access to information about the services and quality of care in public hospitals: the need for methodologic clarity. A survey of 44 university hospital directors and administrators. Presse Med., 2006, 35 , 388–392.
Keller C. , 'Public access to information about the services and quality of care in public hospitals: the need for methodologic clarity. A survey of 44 university hospital directors and administrators ' (2006 ) 35 Presse Med. : 388 -392 .
Shahian, D. M., Normand, S. L., Torchiana, D. F. és mtsai: Cardiac surgery report cards: comprehensive review and statistical critique. Ann. Thorac. Surg., 2001, 72 , 2155–2168.
Torchiana D. F. , 'Cardiac surgery report cards: comprehensive review and statistical critique ' (2001 ) 72 Ann. Thorac. Surg. : 2155 -2168 .
Werner, R. M., Asch, D. A.: The Unintended Consequences of Publicly Reporting Quality Information. JAMA, 2005, 293 , 1239–1244.
Asch D. A. , 'The Unintended Consequences of Publicly Reporting Quality Information ' (2005 ) 293 JAMA : 1239 -1244 .
Smith, P. C., York, N.: Quality incentives: the case of UK general practitioners. Health Aff., 2004, 23 , 112–118.
York N. , 'Quality incentives: the case of UK general practitioners ' (2004 ) 23 Health Aff. : 112 -118 .
Belicza, É., Takács, E., Boncz, I.: Indikátorrendszer kialakítása az egészségügyi szolgáltatások értékelésére. Orv. Hetil., 2004, 145 , 1567–1572.
Boncz I. , 'Indikátorrendszer kialakítása az egészségügyi szolgáltatások értékelésére ' (2004 ) 145 Orv. Hetil. : 1567 -1572 .
Scott, I. A., Ward, M.: Public reporting of hospital outcomes based on administrative data: risks and opportunities. Med. J. Aust., 2006, 184 , 571–575.
Ward M. , 'Public reporting of hospital outcomes based on administrative data: risks and opportunities ' (2006 ) 184 Med. J. Aust. : 571 -575 .
Jacobson, B., Mindell, J., McKee, M.: Hospital mortality league tables. Question what they tell you – and how useful they are. BMJ, 2003, 326 , 777–778.
McKee M. , 'Hospital mortality league tables. Question what they tell you – and how useful they are ' (2003 ) 326 BMJ : 777 -778 .
Lilford, R., Mohammed, M. A., Spiegelhalter, D. és mtsa: Use and misuse of process and outcome data in managing performance of acute medical care: avoiding institutional stigma. Lancet, 2004, 363 , 1147–1154.
Spiegelhalter D. , 'Use and misuse of process and outcome data in managing performance of acute medical care: avoiding institutional stigma ' (2004 ) 363 Lancet : 1147 -1154 .
Shiu, M. F.: Use of language should be more careful in describing league tables. BMJ, 2002, 324 , 542–542.
Shiu M. F. , 'Use of language should be more careful in describing league tables ' (2002 ) 324 BMJ : 542 -542 .
Glance, L. G., Osler, T. M., Dick, A. W.: Evaluating Trauma Center Quality: Does the Choice of the Severity-Adjustment Model Make a Difference? J. Trauma, 2005, 58 , 1265–1271.
Dick A. W. , 'Evaluating Trauma Center Quality: Does the Choice of the Severity-Adjustment Model Make a Difference? ' (2005 ) 58 J. Trauma : 1265 -1271 .
Glance, L. G., Dick, A., Osler, T. M. és mtsai: Impact of changing the statistical methodology on hospital and surgeon ranking: the case of the New York State cardiac surgery report card. Med. Care, 2006, 44 , 311–319.
Osler T. M. , 'Impact of changing the statistical methodology on hospital and surgeon ranking: the case of the New York State cardiac surgery report card ' (2006 ) 44 Med. Care : 311 -319 .
Reed, J. F., Olenchock, S. A.: Comparative analysis of risk-adjusted bypass surgery stratification models in a community hospital. Heart Lung, 2003, 32 , 383–390.
Olenchock S. A. , 'Comparative analysis of risk-adjusted bypass surgery stratification models in a community hospital ' (2003 ) 32 Heart Lung : 383 -390 .
Aylin, P., Jarman, B., Kelsey, T.: What hospital mortality league tables tell you. BMJ, 2003, 326 , 1397–1398.
Kelsey T. , 'What hospital mortality league tables tell you ' (2003 ) 326 BMJ : 1397 -1398 .
Seagroatt, V., Goldacre, M. J.: Hospital mortality league tables: influence of place of death. BMJ, 2004, 328 , 1235–1236.
Goldacre M. J. , 'Hospital mortality league tables: influence of place of death ' (2004 ) 328 BMJ : 1235 -1236 .
Joyce, R., Webb, R., Peacock, J. L. és mtsa: Adjusted mortality rates: a tool for creating more meaningful league tables for stillbirth and infant mortality rates. Public Health, 2002, 116 , 315–321.
Peacock J. L. , 'Adjusted mortality rates: a tool for creating more meaningful league tables for stillbirth and infant mortality rates ' (2002 ) 116 Public Health : 315 -321 .
Bradley, E. H., Herrin, J., Elbel, B. és mtsai: Hospital Quality for Acute Myocardial Infarction. Correlation among Process Measures and Relationship with Short-term Mortality. JAMA, 2006, 296 , 72–78.
Elbel B. , 'Hospital Quality for Acute Myocardial Infarction. Correlation among Process Measures and Relationship with Short-term Mortality ' (2006 ) 296 JAMA : 72 -78 .
Krumholz, H. M., Rathore, S. S., Chen, J. és mtsai: Evaluation of a consumer-oriented Internet health care report card: the risk of quality ratings based on mortality data. JAMA, 2002, 287 , 1277–1287.
Chen J. , 'Evaluation of a consumer-oriented Internet health care report card: the risk of quality ratings based on mortality data ' (2002 ) 287 JAMA : 1277 -1287 .
Mohammed, M. A., Mant, J., Bentham, L. és mtsa: Comparing processes of stroke care in high- and low-mortality hospitals in the West Midlands, UK. Int. J. Qual. Health Care, 2005, 17 , 31–36.
Bentham L. , 'Comparing processes of stroke care in high- and low-mortality hospitals in the West Midlands, UK ' (2005 ) 17 Int. J. Qual. Health Care : 31 -36 .
Jacobs, R., Goddard, M., Smith, P. C.: How Robust Are Hospital Ranks Based on Composite Performance Measures? Med. Care, 2005, 43 , 1177–1184.
Smith P. C. , 'How Robust Are Hospital Ranks Based on Composite Performance Measures? ' (2005 ) 43 Med. Care : 1177 -1184 .
Spiegelhalter, D. J.: Handling over-dispersion of performance indicators. Qual. Saf. Health Care, 2005, 14 , 347–351.
Spiegelhalter D. J. , 'Handling over-dispersion of performance indicators ' (2005 ) 14 Qual. Saf. Health Care : 347 -351 .
Barker, R. M., Pearce, M. S., Irving, M.: Star wars, NHS style. BMJ, 2004, 329 , 107–109.
Irving M. , 'Star wars, NHS style ' (2004 ) 329 BMJ : 107 -109 .
Bird, S. M., Cox, D. R., Farewell, V. T. és mtsai: Performance indicators: good, bad, and ugly. J. R. Stat. Soc. Ser. A, 2005, 168 , 1–27.
Farewell V. T. , 'Performance indicators: good, bad, and ugly ' (2005 ) 168 J. R. Stat. Soc. Ser. A : 1 -27 .
Broder, M. S., Payne-Simon, L., Brook, R. H.: Measures of surgical quality: what will patients know by 2005. J. Eval. Clin. Pract., 2005, 11 , 209–217.
Brook R. H. , 'Measures of surgical quality: what will patients know by 2005 ' (2005 ) 11 J. Eval. Clin. Pract. : 209 -217 .
Jha, A. K.: Measuring Hospital Quality. What Physicians Do? How Patients Fare? Or Both? JAMA, 2006, 296 , 95–97.
Jha A. K. , 'Measuring Hospital Quality. What Physicians Do? How Patients Fare? Or Both? ' (2006 ) 296 JAMA : 95 -97 .
Cheng, S. H., Song, H. Y.: Physician performance information and consumer choice: a survey of subjects with the freedom to choose between doctors. Qual. Saf. Health Care, 2004, 13 , 98–101.
Song H. Y. , 'Physician performance information and consumer choice: a survey of subjects with the freedom to choose between doctors ' (2004 ) 13 Qual. Saf. Health Care : 98 -101 .
Marshall, M. N., Shekelle, P. G., Leatherman, Sh. és mtsa: The Public Release of Performance Data. What Do We Expect to Gain? A Review of the Evidence. JAMA, 2000, 283 , 1866–1874.
Leatherman Sh. , 'The Public Release of Performance Data. What Do We Expect to Gain? A Review of the Evidence ' (2000 ) 283 JAMA : 1866 -1874 .
Morrison, I.: Quality information: Are consumers ready for report cards? Hosp. Health Netw., 2003, 77 , 38–38.
Morrison I. , 'Quality information: Are consumers ready for report cards? ' (2003 ) 77 Hosp. Health Netw. : 38 -38 .
Schauffler, H. H., Mordavsky, J. K.: Consumer Reports in Health Care: Do They Make a Difference? Annu. Rev. Public Health, 2001, 22 , 69–89.
Mordavsky J. K. , 'Consumer Reports in Health Care: Do They Make a Difference? ' (2001 ) 22 Annu. Rev. Public Health : 69 -89 .
Schneider, E. C., Lieberman, T.: Publicly disclosed information about the quality of health care: response of the US public. Qual. Health Care, 2001, 10 , 96–103.
Lieberman T. , 'Publicly disclosed information about the quality of health care: response of the US public ' (2001 ) 10 Qual. Health Care : 96 -103 .
Beck, C. A., Richard, H., Tu, J. V. és mtsa: Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, a cluster randomized trial. JAMA, 2005, 294 , 309–317.
Tu J. V. , 'Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, a cluster randomized trial ' (2005 ) 294 JAMA : 309 -317 .
Borzak, S.: Administrative data feedback failed to improve quality of care in acute myocardial infarction. ACP J. Club, 2005, 143 , 79–79.
Borzak S. , 'Administrative data feedback failed to improve quality of care in acute myocardial infarction ' (2005 ) 143 ACP J. Club : 79 -79 .
Bridgewater, B., Hooper, T., Campbell, C. és mtsai: Publication of league tables needs to be open and accurate. BMJ, 2002, 324 , 542–543.
Campbell C. , 'Publication of league tables needs to be open and accurate ' (2002 ) 324 BMJ : 542 -543 .
Fong, T.: Not making the grade. Mod. Healthc., 2003, 33 , 12–13.
Fong T. , 'Not making the grade ' (2003 ) 33 Mod. Healthc. : 12 -13 .
Davies, O., Marshall, M. N.: Public disclosure of performance data: does the public get what the public wants? Lancet, 1999, 353 , 1639–1640.
Marshall M. N. , 'Public disclosure of performance data: does the public get what the public wants? ' (1999 ) 353 Lancet : 1639 -1640 .
Dranove, D., Kessler, D., McClellan, M. és mtsa: Is More Information Better? The Effects of ‘Report Cards’ on Health Care Providers, NBER Working Paper No. 8697*, 2002. www.nber.org/papers/w8697.
Mullen, P. M.: Using performance indicators to improve performance. Health Serv. Manage. Res., 2004, 17 , 217–228.
Mullen P. M. , 'Using performance indicators to improve performance ' (2004 ) 17 Health Serv. Manage. Res. : 217 -228 .
Werner, R. M., Asch, D. A., Polsky, D.: The Unintended Consequences of Coronary Artery Bypass Graft Report Cards. Circulation, 2005, 111 , 1257–1263.
Polsky D. , 'The Unintended Consequences of Coronary Artery Bypass Graft Report Cards ' (2005 ) 111 Circulation : 1257 -1263 .
McGlynn, E. A., Cassel, Ch. K., Leatherman, Sh. T. és mtsai: Establishing National Goals for Quality Improvement. Med. Care, 2003, 41 , I16–I29.
Leatherman Sh. T. , 'Establishing National Goals for Quality Improvement ' (2003 ) 41 Med. Care : I16 -I29 .
McGlynn, E. A.: Selecting Common Measures of Quality and System Performance. Med. Care, 2003, 41 , I39–I47.
McGlynn E. A. , 'Selecting Common Measures of Quality and System Performance ' (2003 ) 41 Med. Care : I39 -I47 .
Krumholz, H. M., Brindis, R. G., Brush, J. E. és mtsai: Standards for Statistical Models Used for Public Reporting of Health Outcomes. An American Heart Association Scientific Statement from the Quality of Care and Outcomes Research Interdisciplinary Writing Group. Circulation, 2006, 113 , 456–462.
Brush J. E. , 'Standards for Statistical Models Used for Public Reporting of Health Outcomes. An American Heart Association Scientific Statement from the Quality of Care and Outcomes Research Interdisciplinary Writing Group ' (2006 ) 113 Circulation : 456 -462 .
Leatherman, S. T., Hibbard, J. H., McGlynn, E. A.: A Research Agenda to Advance Quality Measurement and Improvement. Med. Care, 2003, 41 , I80–I86.
McGlynn E. A. , 'A Research Agenda to Advance Quality Measurement and Improvement ' (2003 ) 41 Med. Care : I80 -I86 .
Scobie, S., Thomson, R., McNeil, J. J. és mtsa: Measurement of the safety and quality of health care. Med. J. Aust., 2006, 184 , S51–S55.
McNeil J. J. , 'Measurement of the safety and quality of health care ' (2006 ) 184 Med. J. Aust. : S51 -S55 .
Finkelstein, B. S., Harper, D. L., Rosenthal, G. E.: Patient assessments of hospital maternity care: a useful tool for consumers? Health Serv. Res., 1999, 34 , 623–640.
Rosenthal G. E. , 'Patient assessments of hospital maternity care: a useful tool for consumers? ' (1999 ) 34 Health Serv. Res. : 623 -640 .
Berwick, D. M., James, B., Coye, M. J.: Connections between Quality Measurement and Improvement. Med. Care, 2003, 41 , I30–I38.
Coye M. J. , 'Connections between Quality Measurement and Improvement ' (2003 ) 41 Med. Care : I30 -I38 .
Marshall, M. N., Hiscock, J., Sibbald, B.: Attitudes to the public release of comparative information on the quality of general practice care: qualitative study. BMJ, 2002, 325 , 1278–1282.
Sibbald B. , 'Attitudes to the public release of comparative information on the quality of general practice care: qualitative study ' (2002 ) 325 BMJ : 1278 -1282 .