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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2008.153759v1 100/2/264    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mukamel, D. B. Articles by Osler, T. M. Search for Related Content PubMed PubMed Citation Articles by Mukamel, D. B. Articles by Osler, T. M. Related Collections Health Policy Quality of Care Public Health Practice Other Statistics/Evaluation/Research

Dana B. Mukamel, PhD, Laurent G. Glance, MD, Andrew W. Dick, PhD and Turner M. Osler, MD

At the time of this study, Dana B. Mukamel was with the Health Policy Research Institute, University of California, Irvine; Laurent G. Glance was with the University of Rochester School of Medicine and Dentistry, Rochester, NY; Andrew W. Dick was with the RAND Corporation, Pittsburgh, PA; and Turner M. Osler was with the Department of Surgery, University of Vermont, Burlington.

Correspondence: Correspondence can be sent to Dana Mukamel, PhD, Health Policy Research Institute, University of California-Irvine, 100 Theory, Suite 110, Irvine, CA 92697-5800 (e-mail: dmukamel{at}uci.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.

Public quality reports of hospitals, health plans, and physicians are being used to promote efficiency and quality in the health care system. Shrinkage estimators have been proposed as superior measures of quality to be used in these reports because they offer more conservative and stable quality ranking of providers than traditional, nonshrinkage estimators. Adopting the perspective of a patient faced with choosing a local provider on the basis of publicly provided information, we examine the advantages and disadvantages of shrinkage and nonshrinkage estimators and contrast the information made available by them. We demonstrate that 2 properties of shrinkage estimators make them less useful than nonshrinkage estimators for patients making choices in their area of residence.