League tables for performance improvement in health care

Abstract

Objectives: Increasingly health care performance data are being disseminated in the form of 'league tables' of health care providers, with the implication that such publication helps purchasers select the better providers, and spurs providers into improvements. This paper examines progress to date.

Methods: Three stages of the league table process are considered: measurement, analysis and action.

Results: A wide range of measurement schemes are now in place, although the emphasis has been on process variables and mortality as a measure of outcome. Several analytical techniques have been deployed to help users make sense of league tables, and to help determine the causes of variations in reported performance. The weakest aspect of current methods relates to the use to which such analysis is put.

Conclusions: A haphazard approach to using league table data exists, with few reports on the impact of publication. A variety of directions for future research into the use of performance data are needed.