Quality is improving in U.S. hospitals, based on 15 of 18 measures, but there are statistically significant differences in quality between for-profit and not-for-profit hospitals, regionally and within individual hospitals for different clinical conditions, according to two studies published last week in the New England Journal of Medicine.
One study by researchers with the Joint Commission on Accreditation of Healthcare Organizations found notable improvements in the quality of patient care for heart ailments and pneumonia as measured by quality standards that are part of their core-measures reporting program. A feedback mechanism required under the program may be a key reason for the positive changes, according to the study authors.
The other study, by researchers from the Harvard School of Public Health, used data on the same disease states and found wide variability in the quality of care between regions of the country and statistically significant differences attributed to for-profit and not-for-profit hospitals, as well as within individual hospitals by disease state.
"I think it shows that if you force people to measure what they're doing, they will analyze their internal processes of care across the departments of a hospital" said Ann O'Malley, M.D., a senior researcher with the Center for Studying Health System Change in Washington, D.C. "I think it does bode well for the effectiveness for measuring."
In July 2002, the JCAHO required 3,377 of the hospitals it accredited to report data on at least two of its four "core measures" quality improvement data sets: acute myocardial infarction (AMI), heart failure, pneumonia and pregnancy and related conditions. For two years -- from the third quarter of 2002 to the second quarter of 2004 -- the data were centrally collected and reported to the hospitals on a quarterly basis in the form of feedback reports. Data from the first three measure sets, gleaned from 3,087 hospitals, were ultimately used in the study.
Nationally, performance on 15 of the 18 measures "demonstrated a significant trend of improvement" over the eight quarters, according to the authors. No measure showed deterioration.
Study co-author Scott Williams, director of the JCAHO's Center for Public Policy Research, said, "It's always difficult in any kind of a study to point to one thing and say this led to improvement," Williams said. "We'd like to believe that a part of that improvement has been because we've been able to provide quarterly feedback."
The Harvard study used data on 10 quality indicators for the same three clinical conditions -- AMI, heart failure and pneumonia. The data from the first six months of 2004 were drawn from 3,448 hospitals and reported to the CMS under the Hospital Quality Alliance program.
For each of the three clinical conditions, the authors combined the data to create weighted "summary scores," and used them to make comparisons.
Academic medical centers had higher composite scores for the heart conditions, but lower scores for pneumonia, compared with nonacademic medical centers. Not-for-profit hospitals had higher scores for all three conditions than did for-profit hospitals, the researchers concluded. There also were large regional differences, with the Midwest outperforming the East, South and West, according to the authors.
Richard Coorsh, spokesperson for the Federation of American Hospitals, the trade association for 21 for-profit companies that operate about 1,000 hospitals, did not challenge the study's conclusions directly. He characterized it as providing "a peek at preliminary data from the Hospital Quality Alliance."
Coorsh pointed out that the federation was a founder of the alliance in 2002, before the CMS provided financial incentives for quality measurement. "We will continue in our ongoing efforts to improve," he said.