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To the Editor: The study of Hospital Compare quality performance measures by Drs Werner and Bradlow¹ compared the mortality rates for Medicare patients cared for in hospitals classified as poor performing with the mortality rates of patients in high-performing hospitals; this was based on the performance measures that are used by the Joint Commission on Accreditation of Healthcare Organizations. The study found the differences in mortality to be very small and in some cases only marginally statistically significant.

The authors seek methodological explanations for this modest association. One problem may be their assumption that the performance measures have been tightly linked to patient outcomes in clinical trials. This is not true of at least 1 of the pneumonia standards. Houck et al,² which is cited in support of that standard, is a retrospective analysis of Medicare data that showed a lower mortality rate for patients with pneumonia who received antibiotics . . . [Full Text of this Article]

Joshua Fierer, MD
jfierer@ucsd.edu
Section of Infectious Diseases
VA San Diego Healthcare
San Diego, Calif

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