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Abstract
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.
To synthesize the evidence for using publicly reported performance data to improve
quality.
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.
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 on study participants, reporting system or level, study design, selection of
providers, quality improvement activity, outcomes, and unintended consequences were
extracted.
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.
Heterogeneity made comparisons across studies challenging. Only peer-reviewed, English-language
articles were included.
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.