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Report Finds Care Varies Among—and Within—Hospitals

JULY 22, 2005 — The quality of medical care delivered in hospitals varies greatly across the country and even within hospitals themselves, according to a new report funded by the Commonwealth Fund.

"These data do not provide support for the notion that 'good' hospitals are easy to identify or consistent in their performance across conditions," the authors state in a news release. They recommend expanding data collection efforts to include more conditions and focusing quality improvement efforts on a larger number of hospitals.

In the study, published Thursday in the New England Journal of Medicine, researchers at the Harvard School of Public Health and Boston's Brigham and Women's Hospital examined hospital quality data from 2004 to examine areas such as how well hospitals perform and how consistence performance is across regions. Researchers analyzed data reported to the Centers for Medicare and Medicaid Services (CMS) under the National Quality Alliance.

The research team looked at 10 measures that reflect quality of care of three major clinical conditions: acute myocardial infarction, congestive heart failure, and pneumonia. The indicators included administering aspirin within 24 hours of arriving at the hospital, use of an angiotensin-converting enzyme, or ACE, inhibitor, and pneumococcal vaccination.

After adjusting for various hospitals and area characteristics, researchers found that academic hospitals had higher performance scores than nonacademic hospitals, while not-for-profit hospitals did a better job than for-profit hospitals. Hospitals in the Midwest and the Northeast outperformed those in the West and South.

Within hospitals, quality also was inconsistent, the authors said. For example, only 33 percent of hospitals in the top one-tenth of performers in treatment of acute myocardial infarction, for example, were in the top one-quarter of hospitals in treatment of pneumonia.

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