Hospital leaders' opinions of the HCFA mortality data

The release of hospital-specific mortality data by the Health Care Financing Administration has stirred controversy about the adequacy of current case-mix adjustment models and about the wisdom in general of public release of outcome data. We surveyed a national sample of hospitals, stratified by measured mortality rate, in the 1987 Health Care Financing Administration data release to determine the reactions of hospital leaders to the data and to learn if hospitals with high mortality had different attitudes from those of hospitals with average or low mortality as measured by the Health Care Financing Administration. Seventy-eight percent (N = 195) responded. All hospitals, regardless of mortality rate, shared an extremely negative view of the accuracy, usefulness, and interpretability of the Health Care Financing Administration's mortality data. The lowest possible rating (poor) was given by 70% of the respondents on the question of usefulness of the data to the hospital, by 54% on accuracy of the data, and by 85% on usefulness of the data to consumers. Only 31% of the respondents said that they had used the data at all for internal purposes and 20% reported that the data release had caused problems for the hospital. Hospitals in the high-mortality group were more likely than others to report both use of the data and problems from its release. Publication of outcome data to encourage quality improvement may face severe and pervasive barriers in the attitudes and reactions of hospital leaders who are potential clients for such data. (JAMA. 1990;263:247-249)