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01.12.2017 | Research | Ausgabe 1/2017 Open Access

Health Economics Review 1/2017

Public release of hospital quality data for referral practices in Germany: results from a cluster-randomised controlled trial

Health Economics Review > Ausgabe 1/2017
Martin Emmert, Nina Meszmer, Lisa Jablonski, Lena Zinth, Oliver Schöffski, Fatemeh Taheri-Zadeh
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi: 10.​1186/​s13561-017-0171-5) contains supplementary material, which is available to authorized users.



To evaluate the impact of different dissemination channels on the awareness and usage of hospital performance reports among referring physicians, as well as the usefulness of such reports from the referring physicians’ perspective.

Data sources/Study setting

Primary data collected from a survey with 277 referring physicians (response rate = 26.2%) in Nuremberg, Germany (03–06/2016).

Study design

Cluster-randomised controlled trial at the practice level. Physician practices were randomly assigned to one of two conditions: (1) physicians in the control arm could become aware of the performance reports via mass media channels (Mass Media, \( {n}_{MM}^{pr} \)=132, \( {n}_{MM}^{ph} \)=147); (2) physicians in the intervention arm also received a printed version of the report via mail (Mass and Special Media, \( {n}_{MSM}^{pr} \)=117; \( {n}_{MSM}^{ph} \)=130).

Principal findings

Overall, 68% of respondents recalled hospital performance reports and 21% used them for referral decisions. Physicians from the Mass and Special Media group were more likely to be aware of the performance reports (OR 4.16; 95% CI 2.16–8.00, p < .001) but not more likely to be influenced when referring patients into hospitals (OR 1.73; 95% CI 0.72–4.12, p > .05). On a 1 (very good) to 6 (insufficient) scale, the usefulness of the performance reports was rated 3.67 (±1.40). Aggregated presentation formats were rated more helpful than detailed hospital quality information.


Hospital quality reports have limited impact on referral practices. To increase the latter, concerns raised by referring physicians must be given more weight. Those principally refer to the underlying data, the design of the reports, and the lack of important information.
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