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Hospital Quality: Mortality Rates Don't Tell the Whole Story

If the lowest-performing U.S. hospitals performed as well as top-performers on specific measures of quality, approximately 2,200 fewer Americans would die each year, according to research published in Health Affairs.

For their study, The Inverse Relationship Between Mortality Rates and Performance in the Hospital Quality Alliance Measures, Commonwealth Fund-supported researchers based at the Harvard School of Public Health and Brigham and Women's Hospital examined the relationship between hospitals' performance on Hospital Quality Alliance (HQA) indicators and mortality rates. For each of three medical conditions—acute myocardial infarction, congestive heart failure, and pneumonia—they found that high performance on the HQA measures was associated with 7 percent to 15 percent lower odds of death.

The Hospital Quality Alliance is a national collaborative effort to encourage hospitals to voluntarily collect and report performance information. The three medical conditions included in the initial set of HQA measures constitute more than 15 percent of Medicare hospital admissions.<?p>

Commenting on recent debate concerning the value of the HQA's so-called "process measures," the Fund's Anthony Shih, M.D., M.P.H., and Stephen C. Schoenbaum, M.D., M.P.H., argue that while additional measures of clinical quality are necessary, providers should not hesitate to take steps to improve their performance on those measures. In a data brief prepared for the Commonwealth Fund Commission on a High Performance Health System, they write: "Although the relationship between the HQA measures and mortality is modest and there are clearly other factors that predict mortality, they nonetheless represent actionable items that can have an impact."

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