Mortality trends during a program that publicly reported hospital performance.
BACKGROUND
It is unclear whether publicly reporting hospitals' risk-adjusted mortality leads to improvements in outcomes.


OBJECTIVE
To examine mortality trends during a period (1991-1997) when the Cleveland Health Quality Choice program was operational.


METHODS
Time series.


METHODS
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).


METHODS
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%).


CONCLUSIONS
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
David W
DW
Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA. dwbaker@northwesern.edu
Einstadter
Doug
D
Thomas
Charles L
CL
Husak
Scott S
SS
Gordon
Nahida H
NH
Cebul
Randall D
RD
D000368:Aged; D030881:Disclosure; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D033181:Information Dissemination; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000592:standards; D009203:Myocardial Infarction / Q000401:mortality; D009820:Ohio / Q000453:epidemiology; D011014:Pneumonia / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D020379:Risk Adjustment; D020521:Stroke / Q000401:mortality; D015996:Survival Rate