Does public disclosure of quality indicators influence hospitals' inclination to enhance results?

OBJECTIVE The national guideline on oesophageal carcinoma's recommendation of a minimum number of 10 resections per year and the intervention of the Dutch Health Care Inspectorate have highlighted hospitals' 'need to score' on the public quality indicator for the annual number of oesophageal resections. To determine whether low-volume hospitals are inclined to adjust their numbers, we studied the difference between the reported and actual numbers of oesophageal resections in 2005 and 2006. DESIGN A retrospective cohort study. Hospitals were asked to submit all operative reports on resections from 2005 to 2006. Two pairs of evaluators independently labelled all anonymous operative reports from the selected hospitals as resection or non-resection. SETTING Hospitals in the Netherlands. PARTICIPANTS Ten hospitals that reported 10 or 11 resections in 2006, or an average of fewer than 10 resections per year in the period 2003-2006. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Difference between the reported and actual numbers of oesophageal resections in 2005 and 2006. RESULTS Oesophageal resection criteria were not met in 7% of the 179 operative reports from the 10 selected hospitals. The difference between the reported and actual numbers of resections in 2005 was not significant, while in 2006 it was. Of the hospitals studied, 70% actually performed fewer resections than they reported. CONCLUSION Our results support the assumption that low-volume hospitals are inclined to adjust their numbers when, because outcomes are public, pressure to report a sufficient number is high. So, external verification of data is essential when this 'need to score' is high.