5. Public Reporting as a Quality Improvement Strategy

Overview of Effectiveness of Public Reporting as a Quality
Improvement Strategy
The following summary of the results is organized by Key Question and seeks to identify
cross cutting trends and implications. These are also included in the Discussion section and the
summary table at the end of the document. However this does not reflect how the analyses were
originally compiled. Research studies of public reporting concern reports and the resulting
changes in behavior and outcomes for a specific health care setting. Our analyses followed the
literature and presents the results by setting, but the other reason we organized the detailed
reporting of the results in later sections by setting was because we believe that the inherent
differences in the nature of the decisions (e.g., selecting a cardiac surgeon vs. selecting a nursing
home) merit careful consideration when attempting to judge effectiveness.
Overall we found that both the amount of evidence and the results varied by Key Questions
and outcome as well as by setting. Here we provide our conclusions as well as the strength of
evidence assessment for that conclusion followed by general comments and the relevant key
points for each setting. These key points are repeated in the results section for each setting. The
key points for hospitals are also divided into those resulting from studies of cardiac care and
those from non cardiac care (that is any hospital care that is not cardiac surgery or care for a
cardiac condition) as this is the structure we used to organize the large number of articles about
hospitals. The strength of evidence assessments are not repeated in the sections by health care
setting, they are presented only here and in the summary table in the Discussion section. This is
because this assessment was made only across settings.
Summary of Results by Key Question
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)?
Overall Findings
Mortality. Public Reporting was associated with a small decline in mortality after controlling for
trends in reductions in mortality (19 studies, moderate strength of evidence).
Quality and process indicators (e.g. Consumer Assessment of Healthcare Providers and
Systems [CAHPS],Healthcare Effectiveness Data and Information Set [HEDIS], and
Nursing Home [NH] Compare). Most studies found that public reporting is associated with
improvement in quality and process indicators, though this varies across specific measures (19
studies, high strength of evidence).
Mortality was often the focus in studies of hospitals and was also the primary outcome in one
study of individual providers. Most of the studies find a decrease in mortality, though these
results are not uniformly consistent and many questions about the appropriateness of the
comparisons (both groups and risk adjustment methods) are an ongoing subject of debate. In
studies of health plans and long term care, the outcomes studied most often were the quality
measures for more specific outcomes such as pain, pressure ulcers, and satisfaction with care. In
general these studies find that public reporting has a positive impact on the quality measures
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