Open Access
Bhandari, Neeraj
Graduate Program:
Health Policy and Administration
Doctor of Philosophy
Document Type:
Date of Defense:
June 06, 2016
Committee Members:
  • Dennis P. Scanlon, Dissertation Advisor
  • Dennis P. Scanlon, Committee Chair
  • John Raymond Moran Jr., Committee Member
  • Yunfeng Shi, Committee Member
  • Rachel Annette Smith, Outside Member
  • quality report cards
  • dissemination
Public reporting of provider quality has grown substantially and a number of public and private organizations now publish and disseminate data on hospital and physician quality. A large body of empirical work has tested the effectiveness of quality “report cards”, focusing heavily on outcomes related to consumer choice (e.g., choice of physicians or hospitals) or on changes in market shares of providers after publication. Despite recognition of the importance of dissemination of report cards to consumers, none of the existing studies attempt to capture the proactive dissemination strategies used by publishing sources or model how media coverage of issues related to provider quality and comparative performance impacts consumer awareness or use of report cards. In this study, we develop a framework that conceptualizes the trajectory by which public reports “reach” consumers to affect their attitudes towards comparative quality information (CQI), and their “shopping” behaviors for high quality providers. We also describe the spectrum of approaches used by the AF4Q multi-stakeholder alliances in disseminating their public reports to consumers and capture regional variation in availability, applicability, and credibility, dissemination, and media coverage of CQI. Finally, we use a two period panel data and fixed effects methodology to examine the relationship between CQI dissemination and consumers’ awareness of, use of, and attitudes towards CQI. We use a diverse set of data sources drawn from evaluation of the Aligning Forces for Quality (AF4Q) program, including a panel of 4235 chronically ill adults living in the 14 diverse regions of the United States. Our study finds that few consumers are paying attention to the provider quality reports while extending earlier work that shows an increasing regional “footprint” of report cards over time stemming from significant improvements in availability and applicability of CQI to the consumer. It also provides first empirical evidence that the credibility of CQI has improved over time, yields evidence of limited media coverage of report cards, bolsters the notion that reports need to be more applicable to consumers’ clinical needs to encourage their greater use, fails to detect a meaningful role of intensified producer dissemination in improving consumer “uptake” of report cards, and offers modest support for the proposition that increased print media coverage may induce more consumers to use public reports in making provider choices. Taken together, our findings suggest a “disconnect” between “supply” of CQI and its “demand” by consumers, even as financial resources invested into improving its content and accuracy have grown substantially. Deeper entrenchment of the provider transparency movement within the healthcare delivery landscape now needs to be followed by a higher engagement of the general public in its promise and potential.