Within Wisconsin, our residents experience some of the worst health disparities in the nation. Public reporting on disparities in the quality of care is important to achieving accountability for reducing disparities over time and has been associated with improvements in care. Disparities reporting using statewide electronic health records (EHR) data would allow efficient and regular reporting, but there are significant challenges with missing data and data harmonization. We report our experience in creating a statewide, centralized EHR data repository to support health systems in reducing health disparities through public reporting. We partnered with the Wisconsin Collaborative for Healthcare Quality (the “Collaborative”), which houses patient-level EHR data from 25 health systems including validated metrics of healthcare quality. We undertook a detailed assessment of potential disparity indicators (race and ethnicity, insurance status and type, and geographic disparity). Challenges for each indicator are described, with solutions encompassing internal (health system) harmonization, central (Collaborative) harmonization, and centralized data processing. Key lessons include engaging health systems in identifying disparity indicators, aligning with system priorities, measuring indicators already collected in the EHR to minimize burden, and facilitating workgroups with health systems to build relationships, improve data collection, and develop initiatives to address disparities in healthcare.

Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The international diffusion of public reporting might suggest greater similarity between health systems. Alternatively, national and local contexts (including health system imperatives, professional power and organisational culture) might continue to shape its form and impact, implying continued divergence. The paper considers public reporting in the USA and England through the lens of Scott's ‘pillars’ institutional framework. The USA was arguably the first country to adopt public reporting systematically in the late 1980s. England is a more recent adopter; it is now being widely adopted through the National Health Service (NHS). Drawing on qualitative data from California and England, this paper compares the behavioural and policy responses to public reporting by health system stakeholders at micro, meso and macro levels and through the intersection of ideas, interests, institutions and individuals through. The interplay between the regulative, normative and cultural-cognitive pillars helps explain the observed patterns of on-going divergence.

Improving the ability of patients to make informed choices of health care provider can give providers more incentive to compete based on quality. Still, it is not evident to what extent and when people search for information when choosing a provider. The aim of this study is to identify under what circumstances individuals seek information when choosing a primary care provider. Research to date has mostly focused on individuals’ demographic and socio-economic characteristics and the poor availability of information as barriers to information-seeking and use. Our results highlight the importance of taking individuals’ personal motivations and situational context into account when studying information-seeking behavior. Overall, these results suggest that not even individuals who are likely to search for information since they switched or considered switching primary care provider, do so to any greater extent. However, those motivated to change providers by internal factors such as dissatisfaction or a belief that other providers may provide superior services actively sought out information to a greater extent than those motivated by external factors such as the closure of their current provider, or by moving house. Gender, employment status, place of residence and education level was also significantly associated with information-seeking.

The objectives of this review were to discuss the potential impact of Big Data analytics in paediatric cardiovascular disease and its potential to address the challenges of transparency in delivery of care to this unique population.