title: Determining hospital performance based on rank ordering: is it appropriate?
abstract: An increasing number of "pay for performance" initiatives for hospitals and physicians ascribe performance by ranking hospitals or physicians on quality of care measures. Payment is subsequently based on where a hospital or physician ranks among peers. This study examines the variability of ranking hospitals on quality of care measures and its impact on comparing hospital performance. Variability in the ranks of 3 quality of care measures was examined: discharge instruction for congestive heart failure, use of beta-blockers at discharge for heart attack, and timing of initial antibiotic therapy within 4 hours of admission to the hospital for pneumonia. The data are available on the Centers for Medicare and Medicaid Services Web site as part of the Hospital Quality Alliance project. We found that considerable uncertainty exists in ranking of hospitals on these measures, which calls into question the use of rank ordering as a determinant of performance.
authors.affiliation: Outcomes Measurement Resources, Mount Carmel Health, Columbus, Ohio 43213, USA. janderson@mchs.com
authors.forename: Judy
authors.initials: J
authors.lastname: Anderson
authors.forename: Mark
authors.initials: M
authors.lastname: Hackman
authors.forename: Jeff
authors.initials: J
authors.lastname: Burnich
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gurgiolo
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019985:Benchmarking / Q000379:methods / Q000592:standards; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000592:standards; D006333:Heart Failure / Q000628:therapy; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy; D010820:Physicians / Q000592:standards*; D011014:Pneumonia / Q000188:drug therapy; D011787:Quality of Health Care / Q000592:standards*; D012052:Reimbursement, Incentive / Q000592:standards; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D000900:Anti-Bacterial Agents