Hospital performance measures may not accurately reflect quality of care
A comparison of hospitals with high and low Medicare performance measures found little difference in the rate of death for three common conditions at the hospitals, indicating that the measures may not accurately reflect patient outcomes, according to a study in the December 13 issue of JAMA.
In the United States, quality of care delivered in hospitals is often variable. Because it is assumed that measuring quality of care is a key component in improving care, quality measurement has an increasingly prominent role in quality improvement, according to background information in the article. These measures can provide an incentive to improve the quality of the care delivered and to influence consumer choice of hospitals and health care plans. While some research has documented an association between higher adherence to care guidelines and better outcomes of patients who receive that care, to date there has been limited evidence demonstrating that hospitals that perform better on process measures also have better overall quality.
Rachel M. Werner, M.D., Ph.D., of the Philadelphia Veterans Affairs Medical Center, Philadelphia, and Eric T. Bradlow, Ph.D., of the University of Pennsylvania, Philadelphia, conducted a study to determine whether certain quality measures are correlated with and predictive of hospitals' risk-adjusted death rates. The researchers analyzed data from Hospital Compare, a website of the Centers for Medicare & Medicaid Services (CMS) that reports results of hospital performance measures. This study included data on hospital care between Jan. 1 and Dec. 31, 2004, for heart attack, heart failure, and pneumonia at acute care hospitals included on the Hospital Compare website. Ten process performance measures were compared with hospital risk-adjusted death rates, which were measured using Medicare Part A claims data. A total of 3,657 acute care hospitals were included in the study based on their performance reported in Hospital Compare.
Across all heart attack performance measures, the absolute reduction in risk-adjusted death rates between hospitals performing in the 25th percentile vs. those performing in the 75th percentile was 0.005 for inpatient death, 0.006 for 30-day death, and 0.012 for death at 1-year. For the heart failure performance measures, the absolute death reduction was smaller, ranging from 0.001 for inpatient death to 0.002 for 1-year death. For the pneumonia performance measures, the absolute reduction in death ranged from 0.001 for 30-day death to 0.005 for inpatient death.