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Quality of Care

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Hospital grades on quality-of-care report cards may not truly reflect actual quality at a specific hospital

Hospital quality of care report cards grade hospital care based on the outcomes of patients compared with the outcomes of similar patients cared for at other hospitals. These report cards are being used more often by managed care organizations, health care consultants, and other groups when assessing hospitals. However, a recent study suggests that the validity of these report cards may depend on the methods used to adjust for patient severity of illness (risk of poor outcomes) and may not truly reflect the quality of care at a specific hospital. The study was supported by the Agency for Healthcare Research and Quality (HS06274, Wally R. Smith, principal investigator).

Roy M. Poses, M.D., of Brown University, and colleagues compared the outcomes of congestive heart failure (CHF) patients arriving at the emergency departments of three hospitals: a university hospital, a Veterans Affairs (VA) medical center, and a community hospital. Before they accounted for differences in patients' initial levels of sickness at each hospital, it appeared that patients at the university hospital were more likely to be alive 30 days (93 percent) and 1 year (68 percent) after leaving the hospital than the patients at the community hospital (85 percent at 30 days) and VA hospital (61 percent at 1 year). However, after accounting for the initial levels of patient sickness at the three hospitals using different methods to adjust for illness severity, it was unclear which hospital's patients did better.

Hospital rankings depended on the method used to adjust for patient severity of illness, which included four disease-specific survival prediction models and four generic models appropriate for CHF patients. No model was clearly superior to the others in the ability to discriminate among patients with different actual rates of survival. The authors conclude that relying on survival outcome report cards that use one of the currently available risk-adjustment methods may lead to seriously flawed conclusions about the quality of care at particular hospitals.

See "Results of report cards for patients with congestive heart failure depend on the method used to adjust for severity," by Dr. Poses, Donna K. McClish, Ph.D., Wally R. Smith, M.D., and others, in the July 4, 2000, Annals of Internal Medicine 133 (1), pp.10-20.

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