A Five-Point Checklist to Help Performance Reports Incentivize Improvement and Effectively Guide Patients

Published in: Health Affairs, v. 31, no. 3, Mar. 2012, p. 612-618

Posted on RAND.org on March 01, 2012

by Mark W. Friedberg, Cheryl L. Damberg

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Research Question

  1. How can stakeholders who issue public reports of provider performance improve them so that they will lead to better, more efficient care?

Public reports of provider performance on measures of the quality, costs, and outcomes of health care can spur improvement and help patients find the best providers. However, the likelihood that these benefits will materialize depends on the methods underlying each performance report. This paper presents a five-point methodological checklist to guide those who want to improve their performance reporting methods. The central goal is to help report makers minimize the frequency and severity of provider performance misclassification and avoid adverse unintended consequences of reporting. We believe that if those who produce the reports publicly explain how they address each checklist item, this increased transparency will encourage more rigorous methods and improve the chances that reports will lead to better, more efficient care.

Key Finding

  • The likelihood that a performance report will help patients find the best providers depends on the soundness of the methods used to create the report.


  • Measure and address systematic performance misclassification to account for differences in patient mix.
  • Measure and address random performance misclassification with assistance from an experienced statistician.
  • Use composite scores appropriately.
  • Conduct sensitivity analyses to understand the implications of methodological choices.
  • Measure the extent to which a report fulfills its purpose.

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