A provision in the Medicare Prescription Drug, Improvement and Modernization Act of 2003 that gives money to hospitals that release statistics has resulted in a database of formerly unavailable information that will help patients and payers to evaluate hospitals’ performance.
Findings based on the 3,500 hospitals reporting data were published in the July 21 New England Journal of Medicine as “Quality of Care in U.S. Hospitals as Reflected by Standardized Measures, 2002-2004.”
For the first time, with 99 percent of hospitals reporting data–up from one-third before the law was passed–the information allowed doctors at Harvard University’s School of Public Health to rate city hospitals across the country on how they handled common medical practices.
“Using data reported to the Centers for Medicare and Medicaid Services (CMS) under the Hospital Quality Alliance (HQA)–the first initiative to routinely report information on hospital performance nationally–Commonwealth Fund-supported researchers have now been able to see how hospitals measure up,” the authors of the study wrote.
Hospitals’ Performance Measured
The Harvard study ranks city hospitals by the way they treat patients for three common problems: acute myocardial infarction (AMI) (heart attacks), congestive heart failure (CHF), and pneumonia.
Measurements of quality of care included:
- Was aspirin administered within 24 hours of arriving at the hospital?
- Was assessment made of left ventricular function for heart-failure patients?
- Did pneumonia patients get vaccinated?
Treatment Quality Varies Widely
According to the study, there were substantial quality differences among geographic regions.
The top-ranked region in treatment of pneumonia, Oklahoma City, had a score of 82 percent, while the lowest-ranked region, San Bernardino, California, scored 59 percent. The gaps were smaller between the top- and bottom-ranked AMI and CHF performers.
Boston ranked highest on both of those measures, while San Bernardino scored lowest on AMI and Lexington, Kentucky scored lowest on CHF.
Key Quality Indicators Identified
For four of the five quality indicators for AMI, half of the hospitals scored above 90 percent. The top-ranked regions scored 12 percentage points higher for AMI and 23 percentage points higher for pneumonia than did the bottom-ranked regions.
Academic hospitals had somewhat higher performance scores for AMI than did nonacademic hospitals (91 percent vs. 89 percent) and also scored higher on treatment of CHF (85 percent vs. 81 percent), but the academic hospitals had somewhat lower scores for pneumonia (69 percent vs. 71 percent). Not-for-profit hospitals had somewhat higher performance scores than for-profit hospitals in treatment of all three conditions: AMI (90 percent vs. 88 percent), CHF (82 percent vs. 80 percent), and pneumonia (71 percent vs. 70 percent).
Researchers asked questions such as:
- How well do hospitals perform?
- How even is performance across regions?
- What is the likelihood that a high level of performance in one condition will predict high performance in another?
- Do certain hospital characteristics–profit or nonprofit status, number of beds, academic involvement, geographic region–predict a high level of performance?
Data Don’t Reveal All
A related study in the same issue of the NEJM revealed that hospitals that report their own data tend to improve over time.
But Richard Dolinar, M.D., an endocrinologist and senior fellow for The Heartland Institute, warns certain standards of care are not a true reflection of overall care. “The government is paying not for performance but for compliance. There is no correlation between a patient being sent home on aspirin and the whole experience of an intensive care unit hospital stay after a heart attack in truly rating a hospital’s performance overall,” he said.
Susan Konig ([email protected]) is managing editor of Health Care News.
For more information …
The Department of Health and Human Services makes the Harvard University data available online as part of the HHS “Hospital Compare” Web site, at http://www.hospitalcompare.hhs.gov/. Users can search for hospitals by name as well as by state, city, county, and zip code.