Home and Community Care Digest

Home and Community Care Digest 7(4) November -0001

Publicly Releasing Performance Data Stimulates Quality Improvement Activity, but has Little Effect on the Public

Abstract

A systematic review of 45 studies published since 1999 were synthesized and assessed for impact on consumer decisions, quality improvement efforts, clinical outcomes, and unintended consequences. Reports at the health plan, hospital, and provider levels were examined. This study found that public reporting of hospital performance stimulates hospitals to make efforts to improve quality but has only a moderate impact on the publics' selection of health plans. This study suggests that if the design and implementation of publicly reported performance data were improved its impacts on the effectiveness of care delivery, patient safety, and patient-centered care may be increased.
Background: Improving the quality of care is a high priority for those who pay for and regulate health care. Nevertheless, policy makers have a limited number of levers for encouraging efforts to improve quality. The public release of performance data has been proposed as a mechanism for improving quality of care by providing more transparency and greater accountability of health care providers. This study synthesizes the evidence for using publicly reported performance data to improve quality.

Methods: Data sources, including Web of Science, MEDLINE, EconLit, and Wilson Business Periodical Abstracts, were searched for articles published between January 1999 and March 2006. References cited in included studies were also examined and experts on public reporting were contacted. Only peer-reviewed, English-language articles were reviewed. In addition, articles that provided empirical evidence on the impact of public reporting on clinical outcomes (effectiveness, patient safety, and patient-centeredness) and unintended consequences, as well as the selection and quality improvement activity pathways were included.

Findings: Forty-five articles published since 1999 were eligible for review. Data suggest that public reporting of hospital performance stimulates hospitals to make efforts to improve quality. Nonetheless, it has only a moderate impact on the publics' selection of health plans and does not effect the selection of hospitals. Eleven studies examining the effect of hospital performance data revealed that public reporting stimulates quality improvement activity. The evidence for all other potential impacts of public reporting, including clinical outcomes and unintended consequences were mixed, with some studies showing an effect and others showing no effect.

Conclusions: Publicly releasing performance data has diverse outcomes. It stimulates hospital quality improvement activity. However, its effects on improving patient safety and patient-centeredness remain unclear. This study suggests that if design and implementation of publicly reported performance data are sufficiently improved, its impacts on effectiveness, patient safety, and patient-centered care could be increased.

References

Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med. 2008; 148 (2): 111-23.

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