Impact of Public Reporting on Clinical Outcomes in Healthcare: A Systematic Review and Meta-analysis [Comunicazione orale]

Background Public reporting (PR) has been recommended as a useful public health strategy for stimulating improvement of quality and reduce inequalities in healthcare (HC) by adding transparency and addressing accountability in the interaction between HC providers and users. The aim of this study was to perform a systematic review of scientific literature in order to assess qualitatively and quantitatively the impact of PR on clinical outcomes. Methods Literature search was performed by accessing MEDLINE, ISI Web of Science, SCOPUS, and Cochrane Library databases to identify studies that investigated the relationship between PR and clinical outcomes, published from 1991 to 2014. Metaanalysis was performed to assess the PR effect on overall mortality rate. Subgroup analyses were performed for different study design and setting. Results Twenty-seven studies that evaluated the effect of PR on clinical outcomes were included in the systematic review. The metaanalysis involved 10 studies with a total of 1,840,401 experimental and 3,670,446 control events and resulted in a RR of 0.85 (95% CI, 0.79–0.92), p for heterogeneity <0.01; I2 = 99.1%. In a subgroup analysis, six publications were included reporting mortality rates in the same facilities during different periods and a RR of 0.85 (95% CI, 0.76–0.94) was obtained with reported high heterogeneity (p < 0.01; I2 = 100%). When comparing different facilities that recorded mortality rates during the same period from four studies, a RR of 0.91 (95% CI, 0.85-0.97) was calculated, with heterogeneity I2 = 95% (p < 0.01). Conclusions Meta-analysis reported a positive effect of PR on mortality, with reduced rates when combining data from the same facilities during different periods of PR, as well as for comparing different facilities that recorded mortality rates during the same period. The experiences descripted in this paper can represent a framework of opportunities for changing the relationship between HC providers and users. Key message Transparency and accountability resulting from PR are key points in the process that make patients and citizens empowered protagonist of their care.