- 學位論文
US Hospitals Strive for Quality: A Comparative Study of the Relationship between Hospital Process and Outcome Measures
US Hospitals Strive for Quality: A Comparative Study of the Relationship between Hospital Process and Outcome Measures
並列摘要
Background As a result of the growing concerns related to quality of care in Unites States Hospitals, the centers for Medicare and Medicaid Services began measuring hospital performance and reporting this performance on their Hospital Compare Website. More insight is needed to determine whether these process performance measures are related to hospital –level outcome. This study seeks to determine whether quality measured with process measures used in hospital Compare correlate with hospitals’ risk-adjusted mortality rates outcome measures. Design, Setting and Participants Cross-sectional study of hospitals care between January 1 and December 31, 2008, for Heart Attack (HA), Heart Failure (HF) and Pneumonia (PN) at Acute Care and Critical Access Hospitals in the United States included in the Hospital Compare data. Ten Process performance measures included in Hospital Compare were compared with Hospital 30-day risk-adjusted mortality rates from the Agency for Healthcare Research and Quality outcome data for three condition- specific diseases. Main Outcome Measure was Condition-specific inpatient, 30-day risk-adjusted mortality rates. Results A total of 4451 hospitals were included in this study. Of the total number of hospitals, 3486 (78.3%) were categorized as urban hospitals and 965 (21.7%) as rural hospitals. . The results from this analysis indicates that hospital type, hospital ownership and hospital performance on heart attack and heart failure process measures were statistically significant at P value <0.05. Across all process measures, the absolute reduction risk-adjusted mortality rates between low performing and high performing hospitals was small, indicating little variation. (Heart Attack absolute mortality reduction was 0.006, Heart failure was 0.001 and Pneumonia absolute mortality reduction rate was 0.002. Conclusion Hospital performance measures were shown to have a modest relationship with risk-adjusted mortality rates. However, efforts should be made to develop performance measures that are tightly linked to patient outcomes. Further research is encouraged in assessing not only discrete aspects of care delivery but also overall quality of care.