Consumer use of publicly released hospital performance information: assessment of the National Hospital Evaluation Program in Korea

Dimensions of performance and related key performance indicators addressed in healthcare organisations: A literature review

INTRODUCTION

Performance measurement systems have become essential managerial tools for healthcare organisations in the last few decades. They allow hospital managers to pilot their institution and assess the development of the organisation in helping managers in decision-making and viewing the different impacts of these decisions. However, there is a need to investigate further the dimensions of performance those performance measurement systems address.

METHODS

A literature review was primarily conduced about performance measures in healthcare organisations. A comparative study was secondly made to identify the different performance dimensions that are present in the literature during the last decade. Forty-nine studies were considered and sixteen proposal frameworks were used to make the comparative analyses.

RESULTS

We classified dimensions depending on the frequency of mobilisation of their components in four categories: the stars, the first runners-up, the opportunists and the forgotten ones. For each of the dimensions presented in this classification, the main types of KPIs proposed in the theoretical frameworks are presented. A discussion on relevance and possible blind spots is then conducted.

CONCLUSION

Although they were a lot of proposal frameworks of KPI proposed in the last decades to assess healthcare organisations, some dimensions remain underrepresented. There is still a need to develop structure KPI and describe their links. To go further, the development of dashboards asks the question of the definition of KPI, the description of their interconnections and their temporality of driving, because static performance reporting systems are not able to completely satisfy healthcare manager's decision support needs.

Antibiotic Control Policies in South Korea, 2000-2013

Antibiotic stewardship is a key strategy for limiting antibiotic resistance. Over the last decade the South Korean government has implemented a series of healthcare policies directed to this end, consisting of legislative separation of drug prescribing and dispensing, antibiotic utilization reviews, healthcare quality assessment, and public reporting. As a result, the proportion of antibiotic prescriptions for acute upper respiratory tract infections in primary healthcare facilities decreased from 72.9% in 2002 to 42.7% in 2013. However, no significant decrease in antibiotic resistance occurred over the same period in clinically important bacteria such as Streptococcus pneumoniae. These government-driven policies played a pivotal role in improving antibiotic use for outpatients and surgical patients in South Korea. However, to achieve long-lasting successful outcomes, coordinated efforts and communications among the stakeholders, including physicians and medical societies, are needed.

Probable transmission chains of Middle East respiratory syndrome coronavirus and the multiple generations of secondary infection in South Korea

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As of July 14, 2015, the South Korean outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection has involved 185 secondary infections belonging to three overlapping generations of cases who have contracted the virus almost exclusively in the healthcare environment.

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Fomite transmission may explain a significant proportion of the infections occurring in the absence of direct contact with infected cases.

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The analysis of publicly available data collected from multiple sources, including the media, is useful for describing the epidemic history of an infectious disease outbreak.

Background

In May 2015, South Korea reported its first case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in a 68-year-old man with a history of travel in the Middle East. In the presence of secondary infections, an understanding of the transmission dynamics of the virus is crucial. The aim of this study was to characterize the transmission chains of MERS-CoV infection in the current South Korean outbreak.

Methods

Individual-level data from multiple sources were collected and used for epidemiological analyses.

Results

As of July 14, 2015, 185 confirmed cases of MERS have been reported in the Korean outbreak. Three generations of secondary infection, with over half belonging to the second generation, could be delineated. Hospital infection was found to be the most important cause of virus transmission, affecting largely non-healthcare workers (154/184). Healthcare switching has probably accounted for the emergence of multiple generations of secondary infection. Fomite transmission may explain a significant proportion of the infections occurring in the absence of direct contact with infected cases.

Conclusions

Publicly available data from multiple sources, including the media, are useful to describe the epidemic history of an outbreak. The effective control of MERS-CoV hinges on the upholding of infection control standards and an understanding of health-seeking behaviours in the community.

Applying the concept of consumer confusion to healthcare: development and validation of a patient confusion model

As patient autonomy and consumer sovereignty increase, information provision is considered essential to decrease information asymmetries between healthcare service providers and patients. However, greater availability of third party information sources can have negative side effects. Patients can be confused by the nature, as well as the amount, of quality information when making choices among competing health care providers. Therefore, the present study explores how information may cause patient confusion and affect the behavioral intention to choose a health care provider. Based on a quota sample of German citizens (n = 198), the present study validates a model of patient confusion in the context of hospital choice. The study results reveal that perceived information overload, perceived similarity, and perceived ambiguity of health information impact the affective and cognitive components of patient confusion. Confused patients have a stronger inclination to hastily narrow down their set of possible decision alternatives. Finally, an empirical analysis reveals that the affective and cognitive components of patient confusion mediate perceived information overload, perceived similarity, and perceived ambiguity of information.

The multiple causal pathways between performance measures' use and effects

In recent decades, there has been a growing interest in the design and implementation of systems using public reporting of performance measures to improve performance. In their simplest form, such interventions rest on the market-based logic of consumers using publicly released information to modify their behavior, thereby penalizing poor performers. However, evidence from large-scale efforts to use public reporting of performance measures as an instrumental performance improvement tool suggests that the causal mechanisms involved are much more complex. This article offers a typology of four different plausible causal pathways linking public reporting of performance measures and performance improvement. This typology rests on a variety of conceptual models and a review of available empirical evidence. We then use this typology to discuss the core elements that need to be taken into account in efforts to use public reporting of performance measures as a performance improvement tool.

[Development and validation of a questionnaire to measure hospitals' social reputation]

OBJECTIVE

To design and validate a questionnaire (MeFio) to measure the social reputation of a hospital from patients' and citizens' perspective.

MATERIAL AND METHODS

We performed a literature review to define the concept of a hospital's social reputation. Four nominal groups were conducted to set up the a priori factors of the MeFio questionnaire. These groups consisted of 47 managers and health professionals and 32 potential customers. Reactive items were identified and a pilot test was conducted to examine comprehension. A random sample of 385 subjects was selected. Ceiling and floor effects, internal consistency, reliability, and construct and criteria validity were analyzed.

RESULTS

A total of 343 validated questionnaires (response rate 89%) were collected. The MeFio questionnaire has 21 items grouped into five factors. All items had an item-total correlation higher than 0.30. All factor loads were higher than 0.5; between 66.2% and 80.4% of the variance was explained and Cronbach's alpha was 0.7- 0.88. The construct-composite-reliability scores were higher than 0.7. Standardized scores in the convergent discriminant validity test were higher than 0.6. The factors explained 50% of the variability in satisfaction with the health care received (F = 66.5; p <0.001).

CONCLUSION

The MeFio questionnaire is a valid and reliable tool to measure the five dimensions that define the reputation of a hospital in Spain.

Direct-to-consumer advertising (DTCA) for prescription drugs: consumers' attitudes and preferences concerning its regulation in South Korea

OBJECTIVE

To examine consumers' attitudes toward direct-to-consumer advertising (DTCA) for prescription drugs in Korea.

METHODS

We conducted a survey of 350 patients visiting community pharmacies to fill their prescriptions. Consumers' attitudes toward DTCA were assessed in terms of whether they felt DTCA was necessary, their trust in the information provided by DTCA, and their intention to use the information provided by DTCA. We examined consumers' preferences regarding the regulation of DTCA and their expectations of the effects of DTCA.

RESULTS

About 60% of the respondents responded that DTCA is necessary and that they intended to use the information from DTCA. Less than half of the respondents reported that they would trust DTCA information. About 70% of the participants expressed the need for prior vetting of the DTCA content. Respondents had the highest expectation on the effect of DTCA as an information source for patients. Positive consumer expectations regarding the effects of DTCA were significantly associated with positive consumer attitudes toward DTCA (odds ratio=4.70, 95% confidence interval: 2.25-9.82).

CONCLUSIONS

This study provides evidence that consumers in South Korea generally have positive attitudes toward DTCA. However, most of the respondents wanted a prior examination system of DTCA content to ensure that the information conveyed to them via DTCA was trustworthy. Policy-makers should be cautious and well-prepared if they decide to introduce DTCA in Korea.

Patient's assessment of primary care of medical institutions in South Korea by structural type

OBJECTIVE

To compare patient's assessment of primary care of medical institutions by structural type.

DESIGN

Cross-sectional study.

SETTING

Primary care clinics where family physicians work in South Korea (nine private clinics, three health cooperative clinics, three public health center clinics and five teaching hospital clinics). We collected data by questionnaire survey from April 2007 to June 2007.

PARTICIPANTS

Study subjects were patients who had visited their primary care clinic on six or more occasions over a period of more than 6 months as a usual source of care.

MAIN OUTCOME MEASURES

Scores in each domain of primary care, evaluated by the Korean Primary Care Assessment Tool.

RESULTS

A total of 968 subjects were surveyed. The median of primary care average scores was the highest (78) in health cooperative clinics, the second in teaching hospitals clinics, the third in private clinics and the lowest (62) in public health center clinics. When compared with private clinics, the odds ratio for having a high primary care average score was 2.1 (95% confidence interval 1.3-3.3) for health cooperative clinics, and 0.55 (95% confidence interval 0.34-0.88) for public health center clinics.

CONCLUSION

Among medical institutions where family physicians work in South Korea, health cooperative clinics showed the highest primary care average score, and public health center clinics the lowest. To reinforce primary care in South Korea, where medical service delivery systems are only loosely established, health cooperative clinics could serve as an alternative.