Issue Brief Mar/Apr 08

Editor's note: Increasingly, quality improvement initiatives emphasize public reporting of hospital performance measures, to encourage providers to improve, to help consumers pick providers, and to determine provider payments. Although these measures are based on compliance with well-established processes of care, it is unknown whether quality measured in this way is correlated with, or predictive of, clinical outcomes. This Issue Brief summarizes studies that examine and quantify the relationship between frequently used measures of hospital performance and hospital mortality. Since 2004, nearly all acute care hospitals have participated in the Hospital Quality Alliance (HQA), a public-private partnership that encourages collection and reporting of data on quality of care. The Centers for Medicare and Medicaid Services (CMS) now links participation in the program to yearly Medicare payment increases, providing a financial incentive for hospitals to report their data. • Participating hospitals report data on the HQA " starter set " of 10 process measures regarding three clinical conditions: heart attack, heart failure, and pneumonia. Recently, data on other clinical conditions and patient satisfaction have been added to list. These data are available through the CMS website, Hospital Compare (www.hospitalcompare.hhs.gov/) • One way that hospital performance measures might lead to improvements in health care quality is if patients and referring physicians use them to choose higher-quality hospitals. However, it is not clear than hospitals that have better performance measures on certain conditions also have better outcomes. It is also not known whether the difference in performance measures among hospitals warrants the distance patients might need to travel, and whether those hospitals could handle the volume of patients who might choose them.