Quality Matters Archive

Quality Matters reported on emerging models and trends in health care delivery reform and interviews with leaders in the field. Please read its successor, Transforming Care.

  • September/October 2008 Issue
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News Briefs

Mortality Rates, Pediatric Asthma Care Data Added to Hospital Compare
The Centers for Medicare and Medicaid Services (CMS) last month posted 30-day mortality rates for patients hospitalized for heart attack, heart failure, and pneumonia for nearly every U.S. hospital on the Hospital Compare Web site. Last year, CMS published comparisons showing whether hospitals' mortality rates were higher than, the same as, or lower than the national average; this year, they published actual mortality rates. In addition, CMS posted two measures of care for children's asthma—the first time the site has included data on children's health care.

Also in August, CMS posted 10 measures of hospital patients' satisfaction with their care, based on the Hospital Consumer Assessment of Healthcare Providers and Systems. This survey examines issues such as whether patients are treated with courtesy and respect by physicians and nurses, whether providers explain treatments clearly, whether the facilities are clean, and whether pain is well managed.

In the early 1990s, CMS' attempt to publish mortality rates was met with widespread criticism from many providers, who argued that the analysis did not account for hospitals' patient mix, including the severity of disease and age of their patients. The new formula for calculating mortality rates examines deaths among 35 million Medicare beneficiaries that occurred within 30 days of hospital admission, accounting for hospitals' patient mix as well as the number of expected deaths.

Report Names 100 'Most-Improved' Hospitals
The information agency Thomson Reuters released a report last month identifying 100 U.S. hospitals showing the most rapid, substantial improvement over the past five years. Many quality improvement experts say that, to be most effective, public reporting and pay-for-performance initiatives must recognize rates of improvement, in addition to hospitals' achievement of benchmark performance levels.

The report, Thomson Reuters 100 Top Hospitals: Performance Improvement Leaders, assessed the performance of 2,867 non-federal hospitals on eight factors: patient mortality, medical complications, patient safety, length of stay, expenses, profitability, cash-to-debt ratio, and use of evidence-based medicine. It identified hospitals that, while initially posting below-average scores across all of the measures, managed to achieve significant improvement over the five-year study period.

The 100 hospitals included on the list of most improved had fewer than expected adverse events, increased profit margins, and reduced their average length of stay. Hospital leadership and team-based care appear to have been key drivers of improvement among the leading hospitals, according to the study authors.

Overall, hospitals in the Midwest performed in the top quintile. The study was based on Medicare cost reports, Medicare Provider Analysis and Review, and information from the CMS Hospital Compare Web site.

Joint Commission to Develop Standards of Culturally Competent Care
The Joint Commission announced in August that it will develop or revise accreditation standards for measuring cultural competency in patient care. With support from The Commonwealth Fund, the Joint Commission will assess whether diversity, culture, language, and health literacy issues should be combined with current standards measuring quality of care or become separate standards.

Previous Joint Commission research has found that hospitals use widely varying practices to promote effective provider–patient communication and other aspects of patient-centered, culturally competent care.

New accreditation standards would establish principles and expectations for the provision of culturally competent care, including efforts to hire or train interpreters or provide technology-based interpreter services. As part of this project, the Joint Commission will establish an expert advisory panel to review evidence-based practices and identify principles that can serve as the basis for the standards.

Consumer Use of Tools to Compare Quality, Costs Limited
Increasingly, health plans have been developing tools to help enrollees compare cost and quality of care information across hospitals and physicians. Yet, according to a report by the Center for Studying Health System Change published last month, the tools have not attracted many consumers and have limited usefulness.

Large employers have been pushing health plans to make information on costs and quality of care available to their employees, regarding transparency as part of a strategy to encourage employees to take on more responsibility for their treatment choices and lifestyle decisions.

Today, most health plans provide some information on the costs of inpatient and outpatient services to enrollees. But the information often does not apply to individual providers or services provided in physicians' offices, and it is limited to certain service regions, the study found. Further, cost information generally is not customized according to enrollees' particular benefit designs, and health plans typically rely on publicly available, third-party sources to provide information on quality of care.

Use of the tools among consumers has been limited, in part because of such shortfalls and in part because there are few incentives to encourage their use.

The study draws on site visits to 12 nationally representative metropolitan communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.
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