S. Silow-Carroll, Public Hospital Case Studies Series: Introduction, The Commonwealth Fund, July 2010.
Compared with other hospitals, public hospitals are generally assumed to face multiple barriers to providing high-quality care: lower revenues; sicker patients who may have infrequent contact with the health care system; and an older infrastructure, particularly related to health information technology.
This case study series set out to find how some public hospitals have succeeded in achieving excellence in quality of care, in spite of such challenges. We sought to understand the strategies and factors that contribute to high performance, as well as the barriers and challenges public hospitals face. To do so, researchers examined aggregate quality scores on 23 process-of-care measures reported by CMS, for all hospitals submitting data from July 2007 through June 2008. They selected for case study analysis eight public hospitals from among 14 that performed among the top 10 percent of more than 2,000 public and private hospitals reporting during this period.
For the purposes of this series, we defined "public hospital" as any government-owned hospital or member of the National Association of Public Hospitals. Because of data limitations, neither payer mix nor other definitions of "safety net" status was used in the selection process.
Four of the best-performing public hospitals examined in one case study are members of the Memorial Health System in Florida. These hospitals scored within the top 5 percent of public and private hospitals on the process-of-care, or "core," measures. Another case study examines three public hospitals that are members of the Carolinas Health System; they scored within the top 10 percent of public and private hospitals. A third case study examines Norman Regional Hospital in Oklahoma, which scored in the top 5 percent among public and private hospitals. Other selection criteria are detailed in the individual case studies.
The key findings from this series of case studies are:
These case studies' findings are not meant to generalize to all publicly owned hospitals, many of which face different financial pressures related to disproportionately high rates of uninsured and Medicaid patients, and/or sick patients who do not have regular sources of primary and preventive care. The case studies do illustrate that publicly owned hospitals may fulfill their commitment to serve all patients in the community while pursuing—and attaining—the highest measures of health care quality.