What is the aim of this review?
The aim was to find out if publicly releasing information about the performance of healthcare providers (e.g. hospitals and individual professionals) has a measurable influence on changing the behaviour of consumers, providers, and purchasers of care. We also sought to determine whether this affected the performance of healthcare providers, patient outcomes, and staff morale.
Public release of performance data may lead to little or no difference in healthcare choices (made by either consumers or providers), or provider performance. However, it may slightly improve outcomes for patients.
What was studied in the review?
Healthcare providers are increasingly expected to inform the public on how well they are performing. However, it is not yet known whether public release of performance data has a measurable influence on patients' choice of healthcare services, or whether it can truly drive improvements in the quality of health care.
What are the main results of the review?
The authors searched the literature for studies evaluating the effects of publicly releasing healthcare performance information, and found 12 relevant studies that analysed data from more than 7570 providers, and a further 3,333,386 clinical encounters, e.g. individual patients.
There was low-certainty evidence that public release of performance data may lead to little or no difference in the services that patients choose to access, the decisions taken by healthcare providers, or overall provider performance. There was low-certainty evidence suggesting that some patient outcomes may slightly improve following public release of performance data, but that this might have less of an effect on the behaviour of disadvantaged populations. There was no evidence relating to healthcare utilisation decisions by purchasers, or adverse effects.
Although a number of the studies were individually well conducted, there were limitations: in particular, the evidence base varied substantially in terms of setting (e.g. United States or Korea), health condition (e.g. heart attack or hip replacement), type of performance data (e.g. process or patient outcome), and the mode of data publication (e.g. mail shot or poster). Their findings were also inconsistent, with some reporting changes attributed to public release of information, and others reporting no such changes.
How up-to-date is this review?
The review authors searched for studies that had been published up to June 2017.
The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes.
It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers.
To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale.
We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies.
We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care.
Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis.
We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.
There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects.