Public disclosure of comparative clinical performance data: lessons from the Scottish experience

There is growing international interest in making information available on the clinical quality and performance of health care providers. In the United States of America, where public reporting is most advanced, comparative performance information in the form of 'report cards', 'provider profiles' and 'consumer reports' has been published for over a decade. In Europe, Scotland has been at the forefront of releasing clinical performance data and has disseminated such information since 1994. This paper reviews the Scottish experience of public disclosure and distils the key lessons for other countries seeking to implement similar programmes. It is based on the findings of the first empirical evaluation of a national clinical reporting initiative outside the United States. The study examined the impact of publication of Scottish (CRAG) clinical outcome indicators on four key stakeholder groups: health care providers, regional government health care purchasers, general practitioners and consumer advocacy agencies. We conclude that those responsible for developing clinical reporting systems should not only pay close attention to developing technically valid and professionally credible data which are tailored to the information needs of different end users, but should also focus on developing a suitable incentive structure and organizational environment that fosters the constructive use of such information.