Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care

15 January 2008 | Volume 148 Issue 2 | Pages 111-123

Background: Previous reviews have shown inconsistent effects of publicly reported performance data on quality of care, but many new studies have become available in the 7 years since the last systematic review.

Purpose: To synthesize the evidence for using publicly reported performance data to improve quality.

Data Sources: Web of Science, MEDLINE, EconLit, and Wilson Business Periodicals (1999–2006) and independent review of articles (1986–1999) identified in a previous systematic review. Only sources published in English were included.

Study Selection: Peer-reviewed articles assessing the effects of public release of performance data on selection of providers, quality improvement activity, clinical outcomes (effectiveness, patient safety, and patient-centeredness), and unintended consequences.

Data Extraction: Data on study participants, reporting system or level, study design, selection of providers, quality improvement activity, outcomes, and unintended consequences were extracted.

Data Synthesis: Forty-five articles published since 1986 (27 of which were published since 1999) evaluated the impact of public reporting on quality. Many focus on a select few reporting systems. Synthesis of data from 8 health plan–level studies suggests modest association between public reporting and plan selection. Synthesis of 11 studies, all hospital-level, suggests stimulation of quality improvement activity. Review of 9 hospital-level and 7 individual provider–level studies shows inconsistent association between public reporting and selection of hospitals and individual providers. Synthesis of 11 studies, primarily hospital-level, indicates inconsistent association between public reporting and improved effectiveness. Evidence on the impact of public reporting on patient safety and patient-centeredness is scant.

Limitations: Heterogeneity made comparisons across studies challenging. Only peer-reviewed, English-language articles were included.

Conclusion: Evidence is scant, particularly about individual providers and practices. Rigorous evaluation of many major public reporting systems is lacking. Evidence suggests that publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain.

Author and Article Information

From RAND, Santa Monica, and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.

Acknowledgment: The authors thank Roberta Shanman for assistance with the literature search and Susan Chen and Carlo Tringale, Southern California Evidence-based Practice Center, for assistance with retrieving the articles and preparing the manuscript.

Financial Support: This manuscript was supported by RAND Health's Comprehensive Assessment of Reform Options (COMPARE) Initiative, which receives funding from a consortium of sources, including RAND's corporate endowment, contributions from individual donors, corporations, foundations, and other organizations. After completing this project, Dr. Fung began employment with Zynx Health.

Potential Financial Conflicts of Interest: Employment: C.H. Fung (Zynx Health, Veterans Affairs [past], RAND [past]). Consultancies: C.H. Fung (Society of General Internal Medicine, Health Benchmarks). Grants received: C.H. Fung (California HealthCare Foundation).

Requests for Single Reprints: Constance H. Fung, MD, MSHS, 10880 Wilshire Boulevard, No. 300, Los Angeles, CA 90024.

Current Author Addresses: Dr. Fung: 10880 Wilshire Boulevard, No. 300, Los Angeles, CA 90024.

Drs. Lim, Damberg, and Shekelle: RAND, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138.

Dr. Mattke: RAND, 1200 South Hayes Street, Arlington, VA 22202-5050.