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Hospital Medicare Performance Measures do not Reflect Quality of Care
Written by Jeanne Bohm, Ph.D.   
A comparison of hospitals with high and low Medicare performance measures showed little difference in death rates for three common conditions among hospitals, suggesting that these measures may not accurately reflect patient outcomes, according to a study in the December 13 issue of JAMA.

It has been assumed that measuring quality of care is an important factor in improving patient care which has caused quality measurement to become a prominent factor in quality improvement. It is believed that quality measures can be used as incentive to improve the quality of the care and/or influence consumer choice of hospitals. However, studies have shown limited evidence that hospitals performing better on process measures have better overall quality.

Rachel M. Werner, M.D., Ph.D., of the Philadelphia Veterans Affairs Medical Center, Philadelphia, and Eric T. Bradlow, Ph.D., of the University of Pennsylvania conducted a study to determine whether certain quality measures are predictive of hospitals’ risk-adjusted death rates. The researchers analyzed data from Hospital Compare, a website of the Centers for Medicare & Medicaid Services (CMS).

This study reviewed data on hospital care (Jan. 1 and Dec. 31, 2004) for heart attack, heart failure, and pneumonia at acute care hospitals included on the Hospital Compare website. Ten process performance measures were compared with hospital risk-adjusted death rates with 3,657 acute care hospitals included in the study.

When comparing heart attack performance measures, there was only a 0.005 absolute reduction in risk-adjusted death rates between hospitals performing in the 25th percentile vs. those performing in the 75th percentile. The absolute reduction of inpatient deaths for heart failure in hospitals performing in the 75th percentile of performance measures (compared to hospitals in the 25th percentile) was 0.001. Pneumonia performance in those same hospitals showed an absolute reduction in death rates of 0.005 for inpatient deaths.

The authors concluded that the CMS’s current set of hospital performance measures are not closely correlated to patient outcomes. They went on to indicate that efforts should be made to identify measures of health care quality that are more strongly associated to patient outcomes.


JAMA Media Release

Relationship Between Medicare’s Hospital Compare Performance Measures and Mortality Rates. JAMA. 2006;296:2694-2702.

About the Author

Jeanne Bohm, Ph.D. is a cancer biologist by training, a medical writer and an experienced science educator.

The author has no financial relationship to any of the companies listed in the article.


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