This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (80)  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Quality of Care  • Quality of Care, Other  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

Rachel M. Werner, MD, PhD; Eric T. Bradlow, PhD

JAMA. 2006;296:2694-2702.

Context  In response to concerns about the quality of care in US hospitals, the Centers for Medicare & Medicaid Services began measuring hospital performance and reporting this performance on their Web site, Hospital Compare. It is unknown whether these process performance measures are related to hospital-level outcomes.

Objective  To determine whether quality measured with the process measures used in Hospital Compare are correlated with and predictive of hospitals' risk-adjusted mortality rates.

Design, Setting, and Participants  Cross-sectional study of hospital care between January 1 and December 31, 2004, for acute myocardial infarction, heart failure, and pneumonia at acute care hospitals in the United States included on the Hospital Compare Web site. Ten process performance measures included in Hospital Compare were compared with hospital risk-adjusted mortality rates, which were measured using Medicare Part A claims data.

Main Outcome Measures  Condition-specific inpatient, 30-day, and 1-year risk-adjusted mortality rates.

Results  A total of 3657 acute care hospitals were included in the study based on their performance as reported in Hospital Compare. Across all acute myocardial infarction performance measures, the absolute reduction in risk-adjusted mortality rates between hospitals performing in the 25th percentile vs those performing in the 75th percentile was 0.005 for inpatient mortality, 0.006 for 30-day mortality, and 0.012 for 1-year mortality (P<.001 for each comparison). For the heart failure performance measures, the absolute mortality reduction was smaller, ranging from 0.001 for inpatient mortality (P = .03) to 0.002 for 1-year mortality (P = .08). For the pneumonia performance measures, the absolute reduction in mortality ranged from 0.001 for 30-day mortality (P = .05) to 0.005 for inpatient mortality (P<.001). Differences in mortality rates for hospitals performing in the 75th percentile on all measures within a condition vs those performing lower than the 25th percentile on all reported measures for acute myocardial infarction ranged between 0.008 (P = .06) and 0.018 (P = .008). For pneumonia, the effects ranged between 0.003 (P = .09) and 0.014 (P<.001); for heart failure, the effects ranged between –0.013 (P = .06) and –0.038 (P = .45).

Conclusions  Hospital performance measures predict small differences in hospital risk-adjusted mortality rates. Efforts should be made to develop performance measures that are tightly linked to patient outcomes.

Author Affiliations: Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pa (Dr Werner); and Division of General Internal Medicine, School of Medicine (Dr Werner), Leonard Davis Institute of Health Economics (Dr Werner), and Departments of Marketing, Statistics, and Education (Dr Bradlow), University of Pennsylvania, Philadelphia.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Medicare’s Hospital Compare Performance Measures and Mortality Rates
Joshua Fierer
JAMA. 2007;297(13):1430.
EXTRACT | FULL TEXT  

Medicare’s Hospital Compare Performance Measures and Mortality Rates
Paul Shekelle
JAMA. 2007;297(13):1430-1431.
EXTRACT | FULL TEXT  

Medicare’s Hospital Compare Performance Measures and Mortality Rates—Reply
Rachel M. Werner and Eric T. Bradlow
JAMA. 2007;297(13):1431.
EXTRACT | FULL TEXT  

Identifying and Improving Quality of Care—Reply
Rachel M. Werner and Robert A. McNutt
JAMA. 2009;302(4):383.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Performance Measures and Clinical Outcomes
Susan D. Horn
JAMA. 2006;296(22):2731-2732.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Looking Forward, Looking Back: Assessing Variations in Hospital Resource Use and Outcomes for Elderly Patients With Heart Failure
Ong et al.
Circ Cardiovasc Qual Outcomes 2009;2:548-557.
ABSTRACT | FULL TEXT  

Pay for Performance in Medicare: Evidentiary Irony and the Politics of Value
Tanenbaum
Journal of Health Politics, Policy and Law 2009;34:717-746.
ABSTRACT  

Heart Failure Performance Measures and Outcomes: Real or Illusory Gains
Fonarow and Peterson
JAMA 2009;302:792-794.
FULL TEXT  

Hospitalists and the Quality of Care in Hospitals
Lopez et al.
Arch Intern Med 2009;169:1389-1394.
ABSTRACT | FULL TEXT  

Identifying and Improving Quality of Care--Reply
Werner and McNutt
JAMA 2009;302:383-383.
FULL TEXT  

Full Implementation of Computerized Physician Order Entry and Medication-Related Quality Outcomes: A Study of 3364 Hospitals
Yu et al.
American Journal of Medical Quality 2009;24:278-286.
ABSTRACT  

Hospital Quality And Intensity Of Spending: Is There An Association?
Yasaitis et al.
Health Aff (Millwood) 2009;28:w566-w572.
ABSTRACT | FULL TEXT  

Assessment of Pancreatic Cancer Care in the United States Based on Formally Developed Quality Indicators
Bilimoria et al.
JNCI J Natl Cancer Inst 2009;101:848-859.
ABSTRACT | FULL TEXT  

Shop for Quality or Volume? Volume, Quality, and Outcomes of Coronary Artery Bypass Surgery
Auerbach et al.
ANN INTERN MED 2009;150:696-704.
ABSTRACT | FULL TEXT  

Characteristics and Outcomes of America's Lowest-Performing Hospitals: An Analysis of Acute Myocardial Infarction Hospital Care in the United States
Popescu et al.
Circ Cardiovasc Qual Outcomes 2009;2:221-227.
ABSTRACT | FULL TEXT  

A New Strategy to Improve Quality: Rewarding Actions Rather Than Measures
Werner and McNutt
JAMA 2009;301:1375-1377.
FULL TEXT  

Comparison of US accredited and non-accredited rural critical access hospitals
Lutfiyya et al.
Int J Qual Health Care 2009;21:112-118.
ABSTRACT | FULL TEXT  

Measuring Preventable Harm: Helping Science Keep Pace With Policy
Pronovost and Colantuoni
JAMA 2009;301:1273-1275.
FULL TEXT  

Using Hospital Standardized Mortality Ratios for Public Reporting: A Comment by the Consortium of Chief Quality Officers: Consortium of Chief Quality Officers
Benjamin
American Journal of Medical Quality 2009;24:164-165.
 

Measuring The Report Card: The Validity Of Pay-For-Performance Metrics In Orthopedic Surgery
Bhattacharyya et al.
Health Aff (Millwood) 2009;28:526-532.
ABSTRACT | FULL TEXT  

Framework for Patient Safety Research and Improvement
Pronovost et al.
Circulation 2009;119:330-337.
FULL TEXT  

Pay for Performance in the Hospital Setting: What Is the State of the Evidence?
Mehrotra et al.
American Journal of Medical Quality 2009;24:19-28.
ABSTRACT  

Nonprimary Care Physicians' Views on Office-Based Quality Incentive and Improvement Programs
Murphy and Nash
American Journal of Medical Quality 2008;23:427-439.
ABSTRACT  

Choosing The Best Hospital: The Limitations Of Public Quality Reporting
Rothberg et al.
Health Aff (Millwood) 2008;27:1680-1687.
ABSTRACT | FULL TEXT  

Performance indicators in acute myocardial infarction: a proposal for the future assessment of good quality care
Weston
Heart 2008;94:1397-1401.
FULL TEXT  

Dissociation Between Hospital Performance of the Smoking Cessation Counseling Quality Metric and Cessation Outcomes After Myocardial Infarction
Reeves et al.
Arch Intern Med 2008;168:2111-2117.
ABSTRACT | FULL TEXT  

Myocardial infarction and quality of care
Chen and Normand
CMAJ 2008;179:875-876.
FULL TEXT  

Measuring Quality in Heart Failure: Do We Have the Metrics?
Bonow
Circ Cardiovasc Qual Outcomes 2008;1:9-11.
FULL TEXT  

Medical Records and Quality of Care in Acute Coronary Syndromes: Results From CRUSADE
Dunlay et al.
Arch Intern Med 2008;168:1692-1698.
ABSTRACT | FULL TEXT  

Implementation of proven interventions in general medical inpatients: development and evaluation of a new quality indicator for drug therapy
Huang et al.
Qual Saf Health Care 2008;17:269-274.
ABSTRACT | FULL TEXT  

Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries
Holmboe et al.
Arch Intern Med 2008;168:1396-1403.
ABSTRACT | FULL TEXT  

Chronic Conditions and Mortality Among the Oldest Old
Lee et al.
AJPH 2008;98:1209-1214.
ABSTRACT | FULL TEXT  

Relationship of a Quality Measure Composite to Clinical Outcomes for Patients With Heart Failure
Chung et al.
American Journal of Medical Quality 2008;23:168-175.
ABSTRACT  

Challenges and Directions for Nursing in the Pay-for-Performance Movement
Clarke et al.
Policy Politics Nursing Practice 2008;9:127-134.
ABSTRACT  

Assessment of the Scientific Soundness of Clinical Performance Measures: A Field Test of the National Committee for Quality Assurance's Colorectal Cancer Screening Measure
Schneider et al.
Arch Intern Med 2008;168:876-882.
ABSTRACT | FULL TEXT  

Improvement in Oncology Practice Performance Through Voluntary Participation in the Quality Oncology Practice Initiative
Jacobson et al.
JCO 2008;26:1893-1898.
ABSTRACT | FULL TEXT  

The Quality Oncology Practice Initiative (QOPI): An Important Tool for Measuring Quality and Improving Care
Jacobson
Am Soc Clin Oncol Ed Book 2008;2008:501-505.
ABSTRACT | FULL TEXT  

The Year in Epidemiology, Health Services Research, and Outcomes Research
Krumholz and Masoudi
J Am Coll Cardiol 2007;50:2254-2262.
FULL TEXT  

Pay for Performance, Public Reporting, and Racial Disparities in Health Care: How Are Programs Being Designed?
Chien et al.
Med Care Res Rev 2007;64:283S-304S.
ABSTRACT  

Performance Measures in Neuroradiology
Seidenwurm et al.
Am. J. Neuroradiol. 2007;28:1435-1438.
ABSTRACT | FULL TEXT  

Identifying High-Quality Hospitals: Consult the Ratings or Flip a Coin?
O'Brien and Peterson
Arch Intern Med 2007;167:1342-1344.
FULL TEXT  

Pay for Performance Is Growing Up
Profit and Petersen
Arch Pediatr Adolesc Med 2007;161:713-714.
FULL TEXT  

The Inverse Relationship Between Mortality Rates And Performance In The Hospital Quality Alliance Measures
Jha et al.
Health Aff (Millwood) 2007;26:1104-1110.
ABSTRACT | FULL TEXT  

Pay-for-Performance in Pediatrics: Proceed With Caution
Chien and Dudley
Pediatrics 2007;120:186-188.
FULL TEXT  

Medicare's Hospital Compare Performance Measures and Mortality Rates
Fierer
JAMA 2007;297:1430-1430.
FULL TEXT  

Medicare's Hospital Compare Performance Measures and Mortality Rates
Shekelle
JAMA 2007;297:1430-1431.
FULL TEXT  

Update in Critical Care 2006
Milbrandt et al.
Am. J. Respir. Crit. Care Med. 2007;175:638-648.
FULL TEXT  

Performance Measures and Clinical Outcomes
Horn
JAMA 2006;296:2731-2732.
FULL TEXT