New trends in the management of inpatients in U.S. hospitals--quality measurements and evidence-based medicine in practice.
OBJECTIVE
To summarize and analyze the Premier/CMS Hospital Quality Incentive Demonstration (HQID) Project that is being conducted in the U.S. and to propose acceptance and implementation of similar initiatives in Slovak health care.


BACKGROUND
New trends in the management of hospitalized patients in the United States include standardization of medical care, application of evidence-based medicine in everyday medical practice, introduction and usage of computerized medical documentation (including computerized physician order entry), efficient use of financial resources, detailed measurements of outcomes, and availability of the data to the public. Centers for Medicaid and Medicare Services (CMS), largest third party payer in the U.S., has introduced the pay-for-performance (P4P) initiative, a new pilot program designed to promote high quality medical care based on evidence-based medicine by reimbursing top performing hospitals at a higher level than poor performing hospitals. The primary objectives of this program include increasing clinical quality and saving lives. A secondary objective is to improve the cost-effectiveness of health care delivery.


RESULTS
Data from the first year of the CMS/Premier Hospital Quality Incentive Demonstration Project reflect a significant improvement in the quality of care across five clinical focus areas as measured by 33 nationally standardized and widely accepted quality indicators. The average improvement across the clinical areas was 6.6%. These performance gains have outpaced those of hospitals involved in other national performance initiatives. An evidence-based analysis suggests that the lives of approximately 235 acute myocardial infarction patients were saved as a result of quality improvements in that related focus area alone.


CONCLUSIONS
The author believes that similar programs can have a beneficial impact on the Slovak health care system and can promote and encourage the broader introduction of evidence-based medicine in hospitals in Slovakia (Tab. 2, Fig. 2, Ref. 7).
Mercy Hospital, Iowa City, Iowa, University of Iowa, Iowa City, Iowa 52245, USA. martin.izakovic@mercyic.org
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D019643:Arthroplasty, Replacement / Q000592:standards; D001026:Coronary Artery Bypass / Q000592:standards; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000628:therapy; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D011014:Pneumonia / Q000628:therapy; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D018154:Slovakia; D014481:United States