The public release of performance data - What do we expect to gain? A review of the evidence

Context information about the performance of hospitals, health professional s, and health care organizations has been made public in the United States for more than a decade. The expected gains of public disclosure have not be en made clear, and both the benefits and potential risks have received mini mal empirical investigation. Objective To summarize the empirical evidence concerning public disclosure of performance data, relate the results to the potential gains, and identif y areas requiring further research. Data Sources A literature search was conducted on MEDLINE and EMBASE databa ses for articles published between January 1986 and October 1999 in peer-re viewed journals. Review of citations, public documents, and expert advice w as conducted to identify studies not found in the electronic databases. Study Selection Descriptive, observational, or experimental evaluations of CIS reporting systems were selected for inclusion. Data Extraction Included studies were organized based on use of public data by consumers, purchasers, physicians, and hospitals; impact on quality of care outcomes; and costs. Data Synthesis Seven US reporting systems have been the subject of publishe d empirical evaluations. Descriptive and observational methods predominate, Consumers and purchasers rarely search out the information and do not unde rstand or trust it; it has a small, although increasing, impact on their de cision making. Physicians are skeptical about such data and only a small pr oportion makes use of it, Hospitals appear to be most responsive to the dat a. In a limited number of studies, the publication of performance data has been associated with an improvement in health outcomes. Conclusions There are several potential gains from the public disclosure of performance data, but use of the information by provider organizations for quality improvement may be the most productive area for further research.