Table 1 Description of the studies used in this paper

1

Cronenwett et al. 2007 [33]

Surgery - cardiovascular

Preoperative medication use: B-blocker increased from 72 to 91%; preoperative aspirin or clopidogrel from 73 to 83% and preoperative statin from 54 to 72%.

Not evaluated

Biannual meetings attended by different stakeholders (e.g. surgeons, data collection personnel, researchers, and hospital administrators). Participants received instruction in continuous quality improvement techniques and applied these principles to preoperative B-blocker usage.

Hospitals (n = 9)

Surgical operations (n = 6143)

Quality

Continuous

3

Internal purposes

Observational

2

Campion et al. 2011 [34]

Oncology - Palliative

Higher performance for recurring participants on 9 indicators related to the assessment of pain and dyspnea as well as hospice care.

Not specified

Not specified.

Clinics (n = 178)

Clinics (n = 178)

Quality

Continuous

15

Internal purposes

Observational

3

Stern et al. 2011 [35]

Cystic fibrosis

Not specified.

Centres improved on indicators related to patient weight and lung capacity over a three-year period.

Best centres asked to define their strategies and share them to feed a learning processes/quality improvement. Open internal discussions.

Plan-do-check-act (PDCA) cycles.

Cystic fibrosis centers (n = 12)

Cystic fibrosis centers (n = 12)

Quality

Continuous

3

Public disclosure

Observational

4

Hermans et al. 2013 [36]

Diabetes

No significant change.

Higher proportion of patients in the benchmarking group reached clinical targets than in the control group over a 12-month follow-up period.

Not specified.

Primary care physicians (n = 477)

Primary care physicians (n = 477)

Quality

Not continuous

4

Not reported

RCT

5

Merle et al. 2009 [37]

Hip replacement

Indicators related to clinical processes (e.g. time between discharge from orthopedic ward and completion of orthopedic hospitalization record) improved.

Lower percentage of readmissions to acute care in all participating hospitals. Lower percentage of pts. with pressure sores in one hospital. Time to surgery improved in single hospitals.

Review/discussion of comparative performance results by the teams followed by implementation of quality improvement as deemed necessary by each team: improving nutritional status, shorten delays, improving communication btwn professionals.

Hospitals (n = 3)

Hospitals (n = 3)

Quality, appropriateness and patient safety

Not continuous

15

Internal purposes

Interventional

6

Hall et al. 2009 [38]

Surgery - general

Not specified.

Improvement of both mortality and complication rates across participating hospitals.

Best practices guidelines; case studies of hospitals improving; and rapid data feedback for monitoring progress were provided to participating hospitals.

Hospitals (n = 187)

Hospitals (n = 187)

Quality, appropriateness and patient safety

Continuous

2

Internal purposes

Observational

7

Tepas III. et al. 2014 [39]

Surgery - general

Not specified.

Reduction of postoperative complications (14.5%): lower incidences of catheter-associated urinary tract infections, surgical site infections, and adverse events after colorectal surgeries in patients over 65.

Monthly participant conference calls.

Hospitals (n = 54)

Surgical operations (n = 38,896)

Patient safety

Non continuous

4

Internal purposes

Observational

8

Nuti et al. 2016 [40]

Multiple

Performance improvement on composite indicator (encompassing hospital, primary and preventive care) in 11 out of 21 regions.

Not evaluated.

Strategic planning and goal setting of health authorities involved.

P4P schemes for heads of health authorities.

Communication and discussion of results among different stakeholders including managers, clinicians and patients.

Regional healthcare systems (n = 21)

Regional healthcare systems (n = 21)

Population health, regional strategy compliance, quality, patient satisfaction, staff satisfaction, efficiency

Continuous

14

Public disclosure

Observational

9

Govaert et al. 2016 [41]

Oncology_colorectal cancer

Not specified.

Severe complication rate and mortality rate declined by 20 and 29% respectively. Length of hospital stay declined by 13%.

Not specified.

Hospitals (n = 29)

Patients (n = 9913)

Quality, appropriateness and patient safety

Continuous

4

Internal purposes

Observational

10

Piccoliori et al. 2020 [42]

Primary care

Improvement on indicators related to documentation of patient charatersitics, diagnostic tests and prescription of anticoagulants.

Improvement over 1 to 2 years follow-up: Lower percentage of patients with lower blood pressure; Higher number of diabetic patients with HbA1c < 7.0%; Higher percentage of patients with lower LDL-cholesterol.

Self-audit.

Technical support provided to participants.

Quality circles conducted twice a year to discuss results and strategies for improvement.

General practitioners (n = 36)

General practitioners (n = 36)

Quality

Not continuous

91

Not reported

Interventional

11

Qvist et al. 2004 [43]

Multiple

Improvement on indicators related to documentation of patient charatersitics, planning of clinical pathway, medication and information provision to patients.

No significant changes.

Conference held btwn two audit rounds. Wards with highest performance gave presentationson local processes of care.

Quality improvment projects.

Hospitals (n = 47)

Hospitals (n = 47)

Quality

Not continuous

10

Internal purposes

Observational

12

Nuti et al. 2013 [44]

Multiple

More than 50% of the indicators significantly improved their yearly performance over the 4-year period.

More than 50% of the indicators significantly improved their yearly performance over the 4-year period, including the percentage of femur fractures operated within 2 days.

Linkage between preformance on indicators and CEO’s reward system.

Regular meetings between different stakeholders, including managers and clinicians.

Regional local health authorities (n = 12) and teaching hospitals (n = 4)

Regional local health authorities (n = 12) and teaching hospitals (n = 4)

Population health, capacity to pursue regional strategies, clinical performance, patient statisfaction, staff satisfaction, effiency

Continuous

130

Public disclosure

Observational

13

Van Leersum et al. 2013 [45]

Oncology_colorectal cancer

Increase in % of patients discussed in a pre-operative meetings. Improvement inù the implementation of recommended guidelines on preoperative MR-imaging for rectal cance. Improved standard of pathological reporting.

Postoperative morbidity, length of hospital stay and postoperative mortality decreased significantly.

The re-intervention rate decreased.

Not specified.

Hospitals (n = 92)

Patients (n = 24,828)

Quality, appropriateness and patient safety

Continuous

10

Public disclosure

Observational

14

Margeirsdottir et al. 2010 [46] 

Diabetes

Use of intensive insulin treatment and pumps increased.

The mean HbA1c of all clinics improved.

Quality meetings and discussions. Provision of clinical guidelines to participating teams at the start of the study.

Clinics (n = 25)

Patients (n = 5599)

Quality and appropriateness

Continuous

7

Internal purposes

Observational

15

Kodeda et al. 2015 [47]

Oncology_colorectal cancer

Preoperative radiotherapy and chemoradiotherapy became more common. Number of multidisciplinary team conferences increased.

Indicators related to specific surgical procedures improved.

Postoperative mortality after 30 and 90 days decreased.

5-year local recurrence rate dropped.

Proportion of non-operated patients increased.

Regional and national meetings where points and specific findings are presented and discussed by representatives from all hospitals.

All hospitals in Sweden

Patients (n = 29,925)

Quality, appropriateness and patient safety

Continuous

22

Public disclosure

Observational

16

Pinnarelli et al. 2011 [48]

Hip replacement

Not specified.

Proportion of hip operations performed within 48 h increased by 34% for Lazio and 46% for Tuscany.

Workshops for discussion and training organised among regional managers and professionals.

Performance on indicators are linked with CEO’s compensation system/DRG reimbursement.

Hospitals in Lazio (n = 42) and Tuscany (n = 26)

Patients (n = 273,320)

Quality

Continuous

1

Public disclosure

Observational

17

Miyata et al. 2012 [49]

Surgery - cardiovascular

Not specified

Improvement of operative mortality and morbidity.

Not specified.

Hospitals (n = 99)

Isolated CABG procedures (n = 3882)

Quality and patient safety

Continuous

2

Internal purposes

Observational