No.24 January 2008

The Effects of Reporting Provider 

Performance Data to the Public

Unlike information on quality of services and products (e.g., Zagat Restaurant 

Survey or America’s Best Colleges), U.S. consumers have limited access to 

information on healthcare providers, even though studies suggest consumer 

interest in comparative information. The public release of performance data has 

been proposed as a mechanism for improving quality of care by providing more 

transparency and greater accountability of healthcare providers. This article 

provides a systematic review of 45 peer-reviewed articles on publicly reported (nonVA) performance data that were published between 1/86 and 3/06 (27 since 1999). 

Investigators had two main goals:

● Synthesize the evidence for using publicly reported performance data to 

stimulate quality improvement activity, affect selection of providers, and 

improve clinical outcomes; and

● Assess the evidence for unintended consequences.

Investigators found:

● Publicly releasing performance data stimulates quality improvement activity 

at the hospital level; however, the impact of public reporting on effectiveness 

and patient safety remains uncertain due to a lack of evidence. For example, 

the effects of major reporting systems, such as HealthGrades and 

HealthScope, on effectiveness, patient safety, and patient-centeredness have 

not been published in peer-reviewed literature. Also absent are studies that 

compare the different reporting systems.

● Studies show an inconsistent association between public reporting and 

patient selection of health plans, hospitals, and individual providers.

● Several studies reported on the potential for unintended consequences; for 

example, surgeons stating a reluctance to care for high-risk patients after 

the New York State Cardiac Surgery Reporting System (NYS CSRS) data 

were released. The NYS CSRS data reported risk-adjusted mortality rates 

associated with coronary artery bypass graft (CABG) surgery in New York 

hospitals. However, other studies report no decrease in the rate of surgery 

for high-risk patients, so direct evidence of unintended consequences is rare.

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This review had limitations:

● It did not include the “gray” or trade literature, e.g., National Committee for 

Quality Assurance report that describes improvements in quality associated 

with public reporting. 

● Improvements in report card design and implementation (i.e., web-based) 

may limit the generalizability of older studies to current public reporting 

systems.

important HSR&D 

findings and 

information to policy 

makers, managers, 

clinicians, and 

researchers working 

to improve the health 

and care of veterans. 

Fung C, Yee-Wei L, Mattke S, Damberg C, and Shekelle P. Systematic Review: The Evidence that Releasing 

Performance Data to the Public Improves Quality of Care. Annals of Internal Medicine January 2008;148(2):111-123.