structure with the strongest potential for dissemination. Accordingly, it is the committee’s conclusion that additional funding will likely be needed to ensure the full implementation of uniform, compatible federal health information technology that lends itself easily to private-sector applications in the spirit of technology transfer from the government.

As the history of the Internet illustrates, the proliferation of electronic capacity among large numbers of providers creates its own momentum, driving the expansion of usage among others not previously engaged (Gladwell, 2000). The surmountable financial, organizational, and inertia challenges to building an information technology infrastructure in the health care sector are apparent. Given the demonstrated need for effective quality enhancement activities, however. it is equally clear that the status quo is not acceptable.

ACCESS TO INFORMATION

It is the committee’s conclusion that improving public access to information on health care quality will increase the impetus for addressing safety and quality concerns and is an important component of a comprehensive strategy to achieve significant improvement in the coming decade. Improving consumers’ awareness of the variability in the quality of health care is a necessary prerequisite to engaging them in making choices based on quality. Public access to such information has the potential to drive consumers to select better care, while also giving providers incentives to improve care (Marshall et al., 2000), furnishing accrediting boards and certifying entities with additional information and tools to motivate improved clinical care, and facilitating community and public health planning.

Overview of Reporting Efforts

To date, public reporting efforts have focused primarily on health plans, and to a lesser degree, hospitals or particular surgical interventions (Schauffler and Mordavsky, 2001). Very limited comparative information has been released for medical groups or physicians.

Most health plan report cards include process of care measures (HEDIS), patient perceptions of care (CAHPS), and accreditation status (McGlynn and Adams, 2001; National Committee for Quality Assurance, 2002). Analyses of impact have consistently found that such report cards have little impact on consumer decision-making (Schauffler and Mordavsky, 2001). Many factors appear to contribute to the lack of impact (Hibbard et al., 2001; Hibbard, 1998; McGlynn and Adams, 2001; Schauffler and Mordavsky, 2001), including:



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