Hospital Mortality Rates Differ Little Despite Rankings
Mortality rates of patients being treated at hospitals that ranked high on a CMS Web site of quality-of-care measures were only slightly better than for patients being treated at the lowest-ranked hospitals, according to a study published Wednesday in the Journal of the American Medical Association, the Washington Post reports (Lee, Washington Post, 12/13).
For the study, researchers from the University of Pennsylvania's School of Medicine examined 2004 data from 3,657 hospitals posted on CMS' Hospital Compare Web site. Researchers compared hospitals' performance on Medicare-mandated quality measures for treating heart attacks, heart failure and pneumonia with mortality rates for the same patients.
Researchers examined whether hospitals gave heart attack patients aspirin and beta blocker medications within 24 hours of arrival, whether such medications were prescribed at discharge and whether patients received ACE inhibitor drugs during their hospital stays. According the study, the percentage of heart attack patients who died was about 7% in both groups of hospitals, with 0.5% fewer patients dying at high-rated hospitals over the course of one year.
Researchers also assessed whether heart failure patients' blood-pumping devices were functioning properly and whether the patients were prescribed ACE inhibitors. The mortality rate for heart failure patients was about 3% for both groups of hospitals, with a difference of about 0.1% between the best and worst ranked hospitals.
In addition, researchers examined whether patients with pneumonia were given antibiotics and vaccinations at the appropriate times and whether blood-oxygen levels were measured. The mortality rate for patients with pneumonia was about 4% for both hospital groups but was 0.5% higher at low-rated hospitals, the study found (Tanner, AP/Seattle Post-Intelligencer, 12/12).
Rachel Werner, an assistant professor of medicine and the study's lead author, said, "Measuring quality is clearly a good idea," adding, "It's a great first step. But at the same time ... there are other things that are making outcomes different at different hospitals, and we are not capturing those differences using these measures. There is a fallacy in assuming that just taking these measures and applying them to hospitals is going to reveal important things about the differences in quality across hospitals" (Washington Post, 12/13).
A JAMA editorial accompanying the study said the results "raise questions about the appropriateness of using Hospital Compare performance measures as the basis either for pay-for-performance systems or for consumers to identify better-quality hospitals."
Michael Rapp, director of CMS' quality measurement and health assessment group, said researchers likely would have found greater differences in quality between high- and low-ranking hospitals had all 22 measures of quality been examined. Rapp added that the agency "is actively working to expand quality measures used on Hospital Compare" (AP/Seattle Post-Intelligencer, 12/12).