Public Reporting and Healthcare Performance Improvements

A new systematic review found that public reporting is associated with improvements in healthcare performance measures and may prompt healthcare providers to engage in activities to improve quality. The report was recently released by the Agency for Healthcare Research and Quality.

Public reporting has been suggested as a way to improve healthcare quality because it can provide incentives for change. This systematic review, which is part of the Closing the Quality Gap: Revisiting the State of the Science series, sought to determine the effectiveness of public reporting as a quality improvement strategy, while also investigating whether public reporting leads to change in healthcare delivery or can be influenced by the characteristics or contextual factors of the reports.

As part of the systematic review, researchers conducted database searches to identify 198 studies published from January 1980 to December 2011 that assessed the impact of public reporting. To be included in the analysis, studies were required to address 1 of 6 key questions developed by researchers to meet the objectives of the review and needed to meet the Populations, Intervention, Comparators, Outcomes, Timing, and Settings information outlined in the analysis.

The 6 key questions were: (1) Does public reporting result in improvements in the quality of healthcare?; (2) What harms result from public reporting?; (3) Does public reporting lead to change in healthcare delivery structures or processes?; (4) Does public reporting lead to change in the behavior of patients, their representatives, or organizations that purchase care?; (5) What characteristics of public reporting increase its impact on quality of care?; and (6) What contextual factors increase the impact of public reporting on quality of care?

Researchers specified the outcomes of the review to align with each key question.

After conducting the review, they found that public reporting was associated with improvements to healthcare performance measures. Most of the studies included in the review focused on mortality as a quality measure. In general, these studies saw a decrease in mortality with public reporting. Researchers noted, however, that the results were not uniformly consistent and may not be comparable.

In addition, studies involving health plans and long-term care, which often focused on quality measures for specific outcomes, generally saw that public reporting had a positive impact on quality measures.

When evaluating possible harms from public reporting, the review's authors found that those studies that investigated harms more often revealed that there was no harm associated with public reporting.

The authors of the review also found that providers, clinicians, and organizations often made positive changes to their behavior after reports were made public. These changes included actions such as adding new services, changing policies, and/or increasing quality improvement activities.

While public reporting may have influenced providers, it did not seem to have an impact on how patients and their families selected providers, often because patients were not aware that the information was available, were not able to get the information they wanted from the reports, or did not have access to the information when they needed to choose a provider.

Researchers were unable to find much data on specific characteristics of public reports that may influence quality of care, but did find that public reporting had the biggest impact in competitive markets.

Despite these findings, the authors of the systematic review acknowledged several limitations to the review including that studies may have been excluded from the review because they were not indexed in the databases used or may not have been published in peer-reviewed journals. In addition, the results may have limited applicability because the studies included covered a variety of different healthcare settings, public reporting research has its own limitations, and studies included in the analysis lacked information on the public report itself.