Changes in Quality, Market Share and Disparities after Performance Publication: A Systematic Review [Pitch presentation]

Background Public reporting (PR) of health-care provider’s quality was proposed as a public health instrument for providing the transparency and accountability in health-care (HC) which could enable patients to make informed and rational choices about their health-care. The aim of this study was to perform a systematic review of literature to assess the impact of PR on improvement, market share and unintended consequences. Methods Literature search was performed by accessing MEDLINE, ISI Web of Science, SCOPUS and EconLit databases to identify studies that investigated relationship between PR and quality improvement, changes in market share and unintended consequences, published in English or Italian until 01/04/ 2016. Additional publications were identified from the references of initially retrieved articles. GRADE derived approach was used to assess quality of the studies and narrative review was used for describing the results.Results Forty-tree studies published between 1994 and 2016 were included in this review. Nineteen studies had quality improvement as main outcome, 16 unintended consequences and remaining 8 tackled market share and economic outcomes. Most of the studies were conducted in USA (86%) and in hospital settings (76.7%) with cohort design used throughout the studies. Performance information was presented in the form of ‘‘report cards’’ in the majority of the studies. The body of evidence was characterized by moderate to low quality level. Mainly, the effect of PR was positive on quality improvement (57.9%), unintended consequences (56.3%) and market share (37.5%). Conclusions PR is associated with changes in HC provider’s behavior and can influence the market share. Unintended consequences are concern of PR and should be taken into account when allocating the HC resources. The experiences collected in this paper could make an impact on HC user’s perception of the providers’ quality and help them make empowered choices.