• M N Marshall, P G Shekelle, S Leatherman, and R H Brook.
• School of Postgraduate Medicine and Health Sciences, University of Exeter, England, UK. mmarshall@fs1.cpcr.man.ac.uk
• JAMA. 2000 Apr 12; 283 (14): 1866-74.

ContextInformation about the performance of hospitals, health professionals, 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 been made clear, and both the benefits and potential risks have received minimal empirical investigation.ObjectiveTo summarize the empirical evidence concerning public disclosure of performance data, relate the results to the potential gains, and identify areas requiring further research.Data SourcesA literature search was conducted on MEDLINE and EMBASE databases for articles published between January 1986 and October 1999 in peer-reviewed journals. Review of citations, public documents, and expert advice was conducted to identify studies not found in the electronic databases.Study SelectionDescriptive, observational, or experimental evaluations of US reporting systems were selected for inclusion.Data ExtractionIncluded studies were organized based on use of public data by consumers, purchasers, physicians, and hospitals; impact on quality of care outcomes; and costs.Data SynthesisSeven US reporting systems have been the subject of published empirical evaluations. Descriptive and observational methods predominate. Consumers and purchasers rarely search out the information and do not understand or trust it; it has a small, although increasing, impact on their decision making. Physicians are skeptical about such data and only a small proportion makes use of it. Hospitals appear to be most responsive to the data. In a limited number of studies, the publication of performance data has been associated with an improvement in health outcomes.ConclusionsThere 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.

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