5. Public Reporting as a Quality Improvement Strategy

Table 4. Summary of evidence: quality of individual clinicians and outpatient clinics
Key Question 1: Does public reporting result in improvements in the quality of health care (including improvements in health care delivery structures, processes, or
patient outcomes)?
Key Question 2: What harms result from public reporting?
Key Question 3: Does public reporting lead to change in health care delivery structures or processes?
Key Question 4: Does public reporting lead to change in the behavior of patients, their representatives, or organizations that purchase care?
Key Question 5: What characteristics of public reporting increase its impact on quality of care?
Key Question 6: What contextual factors (population characteristics, decision type, and environmental) increase the impact of public reporting on quality of care?
Author
Year
(QA) Public Report Study Overview
Outpatient
Clinic
Bundorf
2009 93
(Good)
Individual
Clinicians
Epstein
2010 92
(Fair)
Glance
2008 69
(Fair)
Federally
Mandated
Report on
success rates
for fertility
clinics maintain
by the CDC.
Examines the effect of
public reports on choice of
fertility clinics before (1996-
98) and after (1998-2003)
public release.
N=411 fertility clinics.
PA Cardiac Examines the effect of
public report on referral
patterns to Cardiac
surgeons in PA vs. FL
before (2001-2002) and
after (2002-2003)
publication of the CABG
public report in PA.
n=23655 for PA and 38164
NYS CABG
Surgery
Reporting
System
for FL
Investigates the potential
negative effect of public
reports on access for highrisk
patients vs. low-risk
patients between 1997 and
1999 in NYS.
n=51750 CABG surgery
discharges
Key
Question
78
Results
(↑Improvement; ↓Worse; ↔No Difference)
4 ↑The differential effect of birth rates post vs. pre public reports is positive and
statistically significant, indicating that measured performance had larger,
positive effect on choice when the information was publicly disseminated to
consumers.
6 ↑The impact of public reporting was greater in States that mandate insurance
coverage for ART than in States that do not.
4 ↔There was a marginal difference in the probability of selection of lower
mortality surgeons in PA vs. FL in pre vs. post public reporting in the direction
expected, but it was not significant.
2 ↑For every 10% increase in patient risk of mortality, the surgeon’s Observed
to Expected mortality ratio (predictor of quality) is significantly reduced by
0.034 points.
↑After adjusting for race and other hospital characteristics, this relationship is
weakened by still significant.
No evidence that high quality surgeons are avoiding high-risk patients.