Quality improvement implementation and hospital performance on quality indicators.
OBJECTIVE
To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality.


METHODS
Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance.


METHODS
Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. DATA COLLECTION/ABSTRACTION METHODS: Two-stage instrumental variables estimation in which predicted values (instruments) of four QI scope variables and control (exogenous) variables used to estimate hospital-level quality indicators.


RESULTS
Involvement by multiple hospital units in QI effort is associated with worse values on hospital-level quality indicators. Percentage of hospital staff and percentage of senior managers participating in formally organized QI teams are associated with better values on quality indicators. Percentage of physicians participating in QI teams is not associated with better values on the hospital-level quality indicators studied.


CONCLUSIONS
Results supported the proposition that the scope of QI implementation in hospitals is significantly associated with hospital-level quality indicators. However, the direction of the association varied across different measures of QI implementation scope.
Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA.
Bryan J
BJ
Weiner
Jeffrey A
JA
Alexander
Stephen M
SM
Shortell
Laurence C
LC
Baker
Mark
M
Becker
Jeffrey J
JJ
Geppert
D003430:Cross-Sectional Studies; D006302:Health Services Research / Q000379:methods*; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D010348:Patient Care Team; D010564:Personnel, Hospital; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care