The New England Journal of Medicine;
July 21, 2005
Care in U.S.Hospitals -
The Hospital Quality Alliance Program
Ashish,
K.Jha, M.D.,M.P.H.,Zhonghe Li,M.A., E. John Orav,Ph.D.,and Arnold
M.Epstein,M.D.
The Hospital
Quality Alliance (HQA) is the first initiative that routinely
reports data on Hospitals’ performance nationally. Heretofore,
such data have been unavailable. Data was collected by the Centers
for Medicare and Medicaid Services on 10 indicators of the quality
of care for acute myocardial infarction, congestive heart failure,
and pneumonia. The main outcome measures were hospitals ’
performance with respect to each indicator and summary scores for
each clinical condition. Predictors of a high level of performance
were determined with the use of multivariable linear regression.
A total of
3558 hospitals reported data on at least one stable measure
(defined as information obtained from discharge data from at least
25 patients) during the first half of 2004. Median performance
scores (expressed as the percentage of patients who satisfied the
criterion) were at least 90 percent for 5 of the 10 measures but
lower for the other 5.Performance varied moderately among large
hospital-referral regions, with the top-ranked regions scoring 12
percentage points (for acute myocardial infarction) to 23
percentage points (for pneumonia) higher than the bottom-ranked
regions. A high quality of care for acute myocardial infarction
predicted a high quality of care for congestive heart failure but
was only marginally better than chance at predicting a high
quality of care for pneumonia. Characteristics associated with
small but significant increases in performance included being an
academic hospital, being in the Northeast or Midwest, and being a
not-for-profit hospital
Analysis of
data from the new HQA national reporting system shows that
performance varies among hospitals and across indicators. Given
this variation and small differences based on hospitals ’
characteristics, performance reporting will probably need to
include numerous clinical conditions from a broad range of
hospitals.
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