Unintended Consequences of Transparency – Creating Confusion

A new study, published in Infection Control & Hospital Epidemiology, found that the recent transparency effort providing federal data on hospital-acquired infections actually confuses patients, instead of helping them, as proponents of transparency claim.

The study’s authors randomly selected inpatients at the University of Maryland Medical Center from June 2014 to September 2014 and had them compare hypothetical hospital-acquired infection (HAI) data for two hospitals. The hypothetical HAI data was presented in the same tabular format as is used by the Centers for Medicare and Medicaid Services.

Of 110 participants in the study, 72% were able to correctly identify which of the two hospitals was better when given written descriptions of the HAI measure. When the written descriptions were presented in the same way they are on the CMS website, with additional numerical information added, such as the underlying number of infections, patient-time, and standardized infection ratio, only 60% of participants were able to correctly identify the better of the two comparator hospitals. That means that four in ten patients were unable to identify which of the two hospitals had a higher success rate.

When the written HAI measure was not informative and identical for both hospitals, only 50% of the participants were able to choose the better of the two hospitals. Even worse, when no written HAI measure description was provided and hospitals differed by denominator for infection rate, a measly 38% of participants were able to identify the better-performing hospital.

The study’s researchers concluded that current public HAI data presentation methods may be inadequate and that additional research is needed to identify better ways to convey these data to the public. Lead study author Max Masnick, PhD, University of Maryland School of Medicine, stated, “[p]resenting healthcare-acquired infection data is difficult. We found that the current way public HAI data are communicated is confusing for consumers who are trying to make informed decisions on their care.”

This is a cause for concern. Based on the findings of this study, members of the general public (i.e. healthcare consumers) may reach incorrect conclusions when comparing hospitals using the current HAI reporting format.

CMS had previously stopped providing data on the broad category of hospital-acquired conditions (different from HAIs) because it wasn’t appropriate for comparing one hospital to another. However, CMS changed course after just a few months, citing repeated requests for such information, and the information is back to being publicly accessible.

This recent study is yet another reason to oppose the recent “transparency kick” the healthcare industry has been forced to reckon with. The data is being presented to patients and healthcare consumers in such a way that they are unable to clearly understand the meaning behind the data, and are forming incorrect assumptions and conclusions based upon the data. Those incorrect assumptions are leading patients to “punish” doctors and hospitals who do not deserve such, simply because of misinterpreted data provided to them. Simply providing more information does not create a “more informed” public, especially when the information cannot easily be interpreted to reach correct conclusions.

CMS and other data providers should review this study to garner a better understanding of the opposition to making this data public. A review of the study might also provide them with information on how to improve the data they make available so it can lead to more informed patient decisions. In the interim, it might be wise to halt public reporting of the data until a better presentation is feasible.

For the study results, click here.

For the survey used in the study and select survey results, click here.