The relationship between Medicare's process of care quality measures and mortality.
Using Medicare inpatient claims and Hospital Compare process of care quality data from the period 2004-2006, we estimate two model specifications to test for the presence of correlational and causal relationships between hospital process of care performance measures and risk-adjusted (RA) 30-day mortality for heart attack, heart failure, and pneumonia. Our analysis indicates that while Hospital Compare process performance measures are correlated with 30-day mortality for each diagnosis, after we account for unobserved heterogeneity, process of care performance is no longer associated with mortality for any diagnosis. This suggests that the relationship between hospital-level process of care performance and mortality is not causal. Implications for pay-for-performance are discussed.
Ryan
Andrew M
AM
Department of Public Health at Weill Cornell Medical College, 402 East 67th Street, LA-215, New York, NY 10065, USA. amr2015@med.cornell.edu
Burgess
James F
JF
Tompkins
Christopher P
CP
Wallack
Stanley S
SS
D002317:Cardiovascular Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D006278:Medicare / Q000458:organization & administration* / Q000706:statistics & numerical data*; D009026:Mortality; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D011014:Pneumonia / Q000401:mortality / Q000628:therapy; D017064:Process Assessment, Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D020379:Risk Adjustment; D014481:United States
D002317:Cardiovascular Agents