Systematic review: the evidence that publishing patient care performance data improves quality of care.
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.


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


METHODS
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.


METHODS
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.


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


RESULTS
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.


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


CONCLUSIONS
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.
Fung
Constance H
CH
RAND, Santa Monica, California 90407-2138, USA.
Lim
Yee-Wei
YW
Mattke
Soeren
S
Damberg
Cheryl
C
Shekelle
Paul G
PG
D016536:Competitive Medical Plans / Q000592:standards; D006761:Hospitals / Q000592:standards; D033181:Information Dissemination; D005791:Patient Care / Q000592:standards*; D011331:Private Practice / Q000592:standards; D011643:Publishing; D011785:Quality Assurance, Health Care / Q000592:standards*; D014481:United States