title: Mortality trends during a program that publicly reported hospital performance.
abstract: 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.
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA. dwbaker@northwesern.edu
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.forename: Doug
authors.initials: D
authors.lastname: Einstadter
authors.forename: Charles L
authors.initials: CL
authors.lastname: Thomas
authors.forename: Scott S
authors.initials: SS
authors.lastname: Husak
authors.forename: Nahida H
authors.initials: NH
authors.lastname: Gordon
authors.forename: Randall D
authors.initials: RD
authors.lastname: Cebul
mesh_terms: 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