5. Public Reporting as a Quality Improvement Strategy

The results of five studies support this hypothesis, while three found no difference, and one
produced mixed results.
• The five studies that find no effect included an inquiry that found CABG volume across
hospitals was stable during the early years of public reporting (1989–1992). 28 Other
studies also of CABG volume found no change in Pennsylvania following public
reports 37,82,83 or in New York State. 31
• One study with mixed results found no change in California for AMI while finding
increases in CABG volume for low mortality hospitals 1 month after release of public
reports and decreases in volume for high mortality hospitals after reports in New York
State. 85
• The three studies that found public reports affected market share often cautioned that the
impact was limited.
o Mukamel et al. 84 found that reports of increased mortality led to a decrease in market
share for hospitals in New York State, but that all of this was accounted for by a
decline in Upstate New York, while there was no effect in New York City. Another
study identified effects immediately after reporting but that did not persist over time
in New York State. 30
o The exception is one study of CA CABG reporting documented a statistically
significant increase of 8.9 percent in market share in low-mortality hospitals in the 6
months after the publication of the data. 37 Analyses by Dranove and Sfekas found that
public reports affected market share when they provided new information, but this
was not symmetrical in that hospitals with lower than expected rankings experienced
a significant decrease in demand but the market share of higher ranking hospitals did
not change. 86
Hospital Public Reporting (Noncardiac)
Twenty-two studies were identified that evaluated public reporting about hospitals for either
a wide range of services or for a specific noncardiac service. Like the cardiac public reports,
most of these examined how public reporting influences quality of care (Key Question 1) with
mortality, the most common measure that was publicly reported, and changes in mortality used
to assess the impact of public reporting. Only one study in the group addressed harms and a
small subset assessed the effect on providers or patients or the influence of context. These studies
are listed and described below.
Key Question 1. Quality of Health Care
Fourteen overall studies addressed Key Question 1. There were seven studies that evaluated
the effect of regional public reporting efforts on hospital. The most common of these were part
of the CHQC program from 1993 to 1998. Five 40-44 articles reported the results of research on the
impact of CHQC on quality of care, out of which one also looked at the impact on market share
(discussed in Key Question 4).
• One of the six studies showed an effect of CHQC on mortality rates.
o In the study published in 1997, Rosenthal et al. 40 tracked mortality for eight diagnoses
in 30 hospitals during the year prior to data collection for one period in which the data
was provided confidentially to the hospitals, and for 2 years after it was public. Risk
adjusted in hospital mortality for all eight conditions combined declined from 7.5
percent to 6.5 percent but was not significant (p=0.06), while the separate analyses by
41