Publicly reporting hospital performance shifted deaths from in-hospital to the early postdischarge period, with 30-day mortality declining significantly only for CHF and COPD.
Observational (n=91,539)
Yes
Does public reporting of hospital performance reduce 30-day mortality in hospitalized Medicare patients?
Public reporting of hospital performance was associated with a shift in deaths from in-hospital to the early postdischarge period, with little net reduction in 30-day mortality for most conditions.
BACKGROUND: It is unclear whether publicly reporting hospitals' risk-adjusted mortality leads to improvements in outcomes. OBJECTIVES: To examine mortality trends during a period (1991-1997) when the Cleveland Health Quality Choice program was operational. RESEARCH DESIGN: Time series. SUBJECTS: Medicare patients hospitalized with acute myocardial infarction (AMI; n = 10,439), congestive heart failure (CHF; n = 23,505), gastrointestinal hemorrhage (GIH; n = 11,088), chronic obstructive pulmonary disease (COPD; n = 8495), pneumonia (n = 23,719), or stroke (n = 14,293). MEASURES: Risk-adjusted in-hospital mortality, early postdischarge mortality (between discharge and 30 days after admission), and 30-day mortality. RESULTS: Risk-adjusted in-hospital mortality declined significantly for all conditions except stroke and GIH, with absolute declines ranging from -2.1% for COPD to -4.8% for pneumonia. However, the mortality rate in the early postdischarge period rose significantly for all conditions except COPD, with increases ranging from 1.4% for GIH to 3.8% for stroke. As a consequence, the 30-day mortality declined significantly only for CHF (absolute decline 1.4%, 95% CI, -2.5 to -0.1%) and COPD (absolute decline 1.6%, 95% CI, -2.8-0.0%). For stroke, risk-adjusted 30-day mortality actually increased by 4.3% (95% CI, 1.8-7.1%). CONCLUSION: During Cleveland's experiment with hospital report cards, deaths shifted from in hospital to the period immediately after discharge with little or no net reduction in 30-day mortality for most conditions. Hospital profiling remains an unproven strategy for improving outcomes of care for medical conditions. Using in-hospital mortality rates to monitor trends in outcomes for hospitalized patients may lead to spurious conclusions.
Baker et al. (2002) conducted an observational in Acute myocardial infarction, congestive heart failure, gastrointestinal hemorrhage, COPD, pneumonia, or stroke (n=91,539). Publicly reporting hospitals' risk-adjusted mortality (Cleveland Health Quality Choice program) was evaluated on Risk-adjusted in-hospital mortality, early postdischarge mortality, and 30-day mortality. Publicly reporting hospital performance shifted deaths from in-hospital to the early postdischarge period, with 30-day mortality declining significantly only for CHF and COPD.