The CMS is in only its first year of rewarding hospitals financially under Medicare for reporting clinical information. And legislation to set up a national patient-safety database was signed into law this summer.
But one of the early champions of gathering and sharing sensitive information about how healthcare providers perform -- the Maryland Hospital Association's Quality Indicator Project -- recently celebrated its 20th anniversary.
"The real-world example that started this train down the track is the Maryland Quality Indicator Project," says Jerod Loeb, executive vice president for research at the Joint Commission on Accreditation for Healthcare Organizations. "It was conceived at a time when there wasn't much standardization in this realm."
In 1984, the leaders of seven Maryland Hospital Association member hospitals met and agreed to share data on seven metrics. The QI Project, or QIP, began collecting, slicing and dicing their data the following year and since then, it has adapted and thrived, discarding metrics that didn't work and adding a host of new ones to meet participants' needs.
Using a grant from the Robert Wood Johnson Foundation, the MHA began in 1987 to test its model of indicators and assessment tools for use by hospitals outside the state. Today, the QIP is a registered trademark with more than 225 metrics and more than 1,000 U.S. healthcare organizations using its data-mining services, as well as another 300 healthcare institutions in nine countries abroad.
The project has a full-time staff of 36 and posted operating revenue of $8.1 million for its fiscal year ended June 30, 2004, says Nell Wood, director of marketing and communication for the Maryland QIP.
The QIP was initially set up to distribute data only for internal use by participants, Wood says.
At first it was tough enough getting hospitals to share data with one another, but "it was never intended to be public information," says Richard Davidson, who, before he became president of the AHA in 1991, served 26 years with the Maryland Hospital Association, including 22 years as president. Davidson worked on the QIP at its inception.
"It was intended to be self-help," Davidson says. "You couldn't participate unless you had a plan to do continuous education and improve."
After a brief stint a few years ago with publicly reporting aggregated national data on its process measures, the QIP returned to its roots and no longer publicly discloses data under its own name, Wood says. But the QIP does help clients supply data to numerous state and national accountability programs, such as the Hospital Quality Alliance program and the JCAHO's Oryx core measures initiative.
Of the 50 or so organizations certified by the JCAHO to provide data for the 3,800 hospitals under Oryx, the QIP is the largest, with 460 facilities using its services, Loeb says.
Davidson credits the late Baltimore lawyer and civic leader Eugene Feinblatt, who died in 1998, with being the push behind the data-exchange program. At the time, Feinblatt was a board member and past chairman of the Maryland Hospital Association and past chairman of Sinai Hospital in Baltimore.
His philosophy was that "governance has the ultimate responsibility for everything that goes on in the institution," Davidson says. "He felt that as a trustee, he never really had the tools to answer the questions: Do we do what we do well? Are we doing the right thing?"
From the beginning, the vision was for the QIP to become what it is now, a means to measuring quality across the full continuum of care, which includes outpatient, inpatient, psychiatric and long-term care, Davidson says.
Maggie Eller, director of performance improvement at Calvert Memorial Hospital in Prince Frederick, Md., says her hospital has long recognized the value of the data project. "It is essentially our quality outcomes database," Eller says. "That's how we will be operating probably for the rest of my career. We have a single database and a single vendor that provides all of our needs, and that includes (JCAHO) core measures. They are incredibly responsive to their customers' needs."
Loeb says the future for the QIP and data organizations like it remains bright, even as healthcare adopts more clinical information technology. Half of the hospitals that the JCAHO accredits have 100 beds or fewer, so while a few large, tech-savvy hospitals may be able to handle sophisticated data-mining in-house, most will continue to need services such as those the QIP offers.
"Only when data collection becomes a byproduct of healthcare delivery are you going to see hospitals able to do this on their own," Loeb says. "It's going to take a long time before the value equation enables them to do it."