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Hospital Statistics Not a Good Guide to Quality of Care

December 13, 2006

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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 current issue of JAMA.

The researchers found "limited evidence" linking quality measurements with the outcomes experienced by patients.

"Our study suggests that in the case of hospital performance, the CMS's current set of performance measures are not tightly linked to patient outcomes," said the authors, 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.

"Attention should be focused on finding measures of health care quality that are more tightly linked to patient outcomes. Only then will performance measurement live up to expectations for improving health care quality," the authors concluded.

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.

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