Hospital Quality Performance as Assessed by Ideal Care Measures
Open AccessThe number of programs reporting hospitals' performance on quality measures is growing, and new efforts are tying financial incentives to performance through pay-for-performance programs. As more quality measures are developed, there will be a need to synthesize hospitals' scores on individual measures into composite scores that provide a summary of performance. This study examined hospital performance using one type of composite measure, an ideal care measure, which assesses the completeness of the care delivered by examining whether patients receive all recommended care processes.This study analyzed January - June 2007 performance data on heart attack, heart failure, and pneumonia quality measures from hospitals in Georgia, Indiana, and New York. Hospitals' ideal care scores were compared to their scores on global composites and individual measures. Using multivariable linear regressions, the study examined whether hospital characteristics, such as bed size and teaching status, were associated with hospitals' ideal care scores. The study results showed that, on average, patients were eligible for a relatively small number of measures. At the hospital level, ideal care scores were generally lower than scores on individual and global composite measures, and there was more variation among ideal care scores. Hospitals with a low volume of heart attack or heart failure patients had significantly lower ideal care scores. Among those hospitals that are not part of a hospital system, bed size was related to pneumonia ideal care performance. Ideal care scores for heart attack and pneumonia care and for heart failure and pneumonia care were correlated, but scores between heart attack and heart failure care were not. The findings from this study have important implications for the design of public reporting and pay-for-performance programs. The findings suggest that ideal care scores are a promising option for evaluating hospital quality, as they show more room for improvement and more variation in performance, when compared to individual measures. However, ideal care measures may have some limitations, as many patients are eligible for only a few individual measures. Because hospitals with smaller patient volumes had significantly lower scores, policymakers should determine a minimum volume threshold for participation in any pay-for-performance program.
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Feldpush_gwu_0075A_10164.pdf | 2018-01-16 | Open Access |
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