COMMENTS AND RESPONSES Is Reporting of Quality Scores Worth Refining?

TO THE EDITOR: I read with interest the analysis (1) by Fung and colleagues on quality improvement methods in biomedicine. Except for some efficacy at the hospital level, the effect of publicly reported quality scores seems, from what little data are available, to be mini-mal. The editorial by Hibbard (2) urges readers “not to give up on the consumer model, ” to which she has contributed some of the publications cited in her own discussion. Further technical refine-ment in the reporting itself is urged, with the assumption that quality reporting will work properly once it is sufficiently developed. This presumes that patients are positioned like the consumers of any other commodity—and that medical care will behave in a marketplace in the same way as less socially complicated goods. Hibbard urges deeper exploration of the effects of quality-reporting pathways but fails to address a central lesson of Fung and colleagues ’ paper: The conjectured pathways showed few effects to explore further. Befor