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ABSTRACT
The Centers for Medicare and Medicaid Services publicly reports so-called process performance at all U.S. hospitals, such as whether certain recommended treatments are given to specific types of patients. We examined whether hospital performance on key process indicators improved during the three years since this reporting began. We also studied whether or not these changes improved patient outcomes or yielded other quality improvements, such as reduced hospital readmission rates. We found that, from 2004 to 2006, hospital process performance improved and was associated with better patient and quality outcomes. Most notably, for acute myocardial infarction, performance improvements were associated with declines in mortality rates, lengths-of-stay, and readmission rates. Although we cannot conclude that public reporting caused the improvement in processes or outcomes, these results are encouraging, since improving process performance may improve quality more broadly.
Low-quality care has been well documented in U.S. hospitals, where too often patients do not receive the recommended care for common conditions.1 In an attempt to improve that situation, the Centers for Medicare and Medicaid Services (CMS) and other health care organizations participate in the Hospital Quality Alliance, a large-scale collaboration that seeks to make information on hospitals' performance publicly accessible.2 In April 2005 the CMS began publishing information about hospitals' performance and rankings based on these measures on a Web site called Hospital Compare (http:// www.hospitalcompare.hhs.gov/) .
Measuring and reporting hospital performance has two main goals. The first is to provide consumers with the information they need to choose a hospital where they will receive high-quality care. Previous studies have shown that when Hospital Compare was launched, measured performance was indeed associated with differences in hospital mortality rates, although those differences were small.3 The second goal is to spur improvements in quality over time. This study addresses the second goal.
It is unknown whether or not the process performance of hospitals improved after public reporting was initiated and, if it did, whether or not these improvements were correlated with improvements in patient outcomes. Thus, our objective was to examine changes in hospital process performance in the first three years after Hospital Compare was initiated. We also endeavored to test whether these changes in performance were correlated with changes in hospital mortality rates, lengths-of-stay, and readmission rates.
Study...