Mechanisms and effects of public reporting of surgeon outcomes: A systematic review of the literature

• Englands’ public reporting of surgeon outcomes is unprecendeted in scope;evidence about its effectiveness is insufficient.
• Some studies suggest adverse patient selection after the introduction of public reporting of surgeon outcomes.
• Public reporting is often legitimized as empowering patients, but the data uptake in discussions with patients is low.
• Public reporting is most likely an incentive for low performing surgeons.
• A number of key criteria need to be satisfied for public reporting of surgeon outcomes to be effective.

BackgroundPublic reporting of surgeon outcomes has become a key strategy in the English NHS to ensure accountability and improve the quality of care. Much of the evidence that supported the design of the strategy originates from the USA. This report aims to assess how the evidence on public reporting could be harnessed for cross-country translation of this health system strategy; in particular, to gauge the expected results of the UK surgeon outcome initiative and to propose criteria that elucidate that prerequisites and factors that are needed to public reporting effective.MethodsA systematic search of academic databases was followed by snowballing from the reference lists. Only peer-reviewed articles and primary studies were included.Results25 studies from the USA (n = 22) and the UK (n = 3) were included. Suggestive evidence of a negative effect on access to surgery was found for high-risk patients and non-whites; one survey indicated presence of gaming. There was anecdotal evidence of quality improvement measures adopted by low-rated hospitals in New York. Most studies reported only on the effectiveness of public reporting, rather than addressing how effects accrue. This limits cross-country transferability of policy lessons. Based on our analysis, we propose factors impacting on the transferability of the evidence underlying the public reporting of surgeon outcomes, which may inform the adoption of this strategy in other health systems.ConclusionsThere is some evidence that public reporting can be an incentive for low performing surgeons to improve quality. Negative incentive on patient selection as suggested in the USA have not yet been observed in the UK.