CONSUMER REPORTS IN HEALTH-CARE - DO THEY MAKE A DIFFERENCE IN PATIENT-CARE

Context.-Consumer reports in health care are a relatively recent pheno menon. Primarily designed to assist consumers in making more informed decisions about their personal health care, they appear to have an imp ortant by-product-they led to positive changes in the behavior of clin icians and health care delivery organizations. While there has been mu ch speculation on their impact on health care consumer behavior, consu mer reports offer an effective strategy in improving the quality of pa tient care, Objective.-To examine the impact of an obstetrics consumer report developed and issued by the Missouri Department of Health on h ospital behavior. Design and Setting.-A retrospective study of hospita l behavior using both primary survey and secondary clinical data. Part icipants.-Consumer reports were issued in 1993 to all Missouri hospita ls providing obstetrical services (n=90). A survey was conducted a yea r later, and the results were analyzed with other available data to de termine the effect of the report, Two hospitals discontinued obstetric al services by the time of the survey; of the remaining 88 hospitals, 82 (93%) responded to the survey. Main Outcome Measures.-The following outcomes were examined: (1) number and percentage of hospitals that p reviously did not have services at the time report was issued, but had , or planned to have, services after a guide was published; (2) the pe rcentage of obstetrical policies that were changed, planned to change, or are under discussion for change (car seal program, obstetrical fol low-up services, formal transfer agreement, nurse educator for breast- feeding, and availability of tubal ligations); and (3) clinical outcom es, including satisfaction, appropriateness of charges, and the rates of cesarean delivery, high-risk infant transfer, ultrasound, vaginal b irth after cesarean, very low birth weight, and newborn death. Results .-Within 1 year of the report, approximately 50% of hospitals that did not have car seat programs, formal transfer agreements, or nurse educ ators for breast-feeding prior to the report either instituted or plan ned to institute these services. Hospitals in competitive markets that did not offer one of these services at the time of the report were mo re likely to institute a service and/or were about twice as likely to consider improving several indicators. Clinical outcome indicators all improved in the expected direction. Conclusion.-Public release of con sumer reports may be useful not only in assisting consumers to make in formed health care choices, but also in facilitating improvement in th e quality of hospital services offered and care provided, Changes occu r especially in competitive markets.