Performance reporting can improve hospital care

The study compared hospital scores between 2002 and 2004 on 18 indicators used to assess the quality of care provided to heart failure, heart attack and pneumonia patients (Stein, Washington Post, 7/21). The study found that the hospitals improved between three percent and 33 percent on the 18 quality indicators between 2002 and 2004 and that "poorly performing hospitals improved the most, USA Today reports (Weise, USA Today, 7/21). In addition, the hospitals had significant improvement on 15 of the quality indicators, according to the study (Barnum, San Francisco Chronicle, 7/21).

The study also found that, although 91 percent of heart attack patients received beta-blockers, only 55 percent of patients received necessary discharge instructions (USA Today, 7/21). Loeb said, "Public reporting has been a strong motivator for hospitals to improve. We’re beginning to see very significant improvements" (San Francisco Chronicle, 7/21). He added, "We do not have an electronic infrastructure in health care in this country that permits us to track that data over time" (Winstein, Wall Street Journal, 7/21). In addition, Loeb said that "there are clearly areas where there is still room for improvement" (Washington Post, 7/21).

Second Study

For the second study, Ashish Jha of the Harvard School of Public Health and colleagues analysed patient care data from 3,558 hospitals from the Hospital Quality Alliance, which includes CMS, the American Medical Association and ten other organisations (Washington Post, 7/21). The study examined hospital compliance with ten care recommendations for heart failure, heart attack and pneumonia patients.

According to the study, 85 percent of teaching hospitals complied with all of the care recommendations for congestive heart failure patients, compared with 81 percent of nonteaching facilities, and teaching hospitals ranked two percentage points higher in compliance with care recommendations for heart attack patients.

However, nonteaching hospitals ranked two percentage points higher than teaching facilities in compliance with care recommendations for pneumonia patients, the study found. In addition, the study found that not-for-profit hospitals ranked one to two percentage points higher than for-profit facilities in compliance with care recommendations for all three conditions.

The study also found that hospitals in the Northeast and Midwest ranked two to three percentage points higher than facilities in the South and West in compliance with care recommendations for heart failure and heart attack patients. Hospitals in the Midwest ranked the highest in compliance with care recommendations for pneumonia patients, the study found (Johnson, AP/Philadelphia Inquirer, 7/21).

Overall, the study found that the hospitals did not comply with care recommendations for 19 percent of heart failure patients, 11 percent of heart attack patients and 29 percent of pneumonia patients (USA Today, 7/21). Jha said, "Clearly, quality is getting better for some measures, but for many lifesaving therapies, we are not doing nearly well enough. It’s really basic things that everyone should be getting." He added, "Where you live — and the hospital you go to — has a profound impact on whether you will receive these lifesaving therapies or not" (San Francisco Chronicle, 7/21).

In an editorial that accompanied the studies, Patrick Romano of the University of California-Davis wrote that, despite the results, "we should not rest on our laurels and assume that we have solved the problem of quality by improving 15 measures for three conditions in about 1,400 to 2,000 acute care hospitals" (Fahy, Pittsburgh Post-Gazette, 7/21). He added that, although the JCAHO study "brings us good news," the results might prove "somewhat illusory," with some hospitals possibly "gaming the system" (Kowalczyk, Boston Globe, 7/21).

According to Romano, "Given how much we collectively spend on health care, we ought to be doing a lot better" (Washington Post, 7/21). The JCAHO study, HQA study and the editorial are available online.

Hospital Bills Study

In related news, a study released this week by the Agency for Healthcare Research and Quality found that hospitals billed patients and health insurers almost $754 billion in 2003, CQ HealthBeat reports. The study found that care provided for blocked arteries or other heart conditions accounted for the highest hospital bills — $44 billion for treatment of 1.2 million patients.

In addition, the study found that care provided for heart attacks accounted for the second-highest hospital bills — $31 billion for treatment of 750,000 patients. Care for congestive heart failure, pneumonia and newborns also accounted for high hospital bills, the study found.