title: Variation in surgical quality measure adherence within hospital referral regions: do publicly reported surgical quality measures distinguish among hospitals that patients are likely to compare?
abstract: OBJECTIVE
  To determine whether surgical quality measures that Medicare publicly reports provide a basis for patients to choose a hospital from within their geographic region.
  
  
  METHODS
  The Department of Health and Human Services' public reporting website, http://www.medicare.gov/hospitalcompare.
  
  
  METHODS
  We identified hospitals (n = 2,953) reporting adherence rates to the quality measures intended to reduce surgical site infections (Surgical Care Improvement Project, 1-3) in 2012. We defined regions within which patients were likely to compare hospitals using the hospital referral regions (HRRs) from the Dartmouth Atlas of Health Care Project. We described distributions of reported SCIP adherence within each HRR, including medians, interquartile ranges (IQRs), skewness, and outliers.
  
  
  RESULTS
  Ninety-seven percent of HRRs had median SCIP-1 scores ≥95 percent. In 93 percent of HRRs, half of the hospitals in the HRR were within 5 percent of the median hospital's score. In 62 percent of HRRs, hospitals were skewed toward the higher rates (negative skewness). Seven percent of HRRs demonstrated positive skewness. Only 1 percent had a positive outlier. SCIP-2 and SCIP-3 demonstrated similar distributions.
  
  
  CONCLUSIONS
  Publicly reported quality measures for surgical site infection prevention do not distinguish the majority of hospitals that patients are likely to choose from when selecting a surgical provider. More studies are needed to improve public reporting's ability to positively impact patient decision making.
authors.affiliation: Yale University School of Medicine, 789 Howard Avenue, PO Box 208051, New Haven, CT 06519.
authors.forename: Kyan C
authors.initials: KC
authors.lastname: Safavi
authors.forename: Feng
authors.initials: F
authors.lastname: Dai
authors.forename: Todd A
authors.initials: TA
authors.lastname: Gilbertsen
authors.forename: Robert B
authors.initials: RB
authors.lastname: Schonberger
mesh_terms: D002755:Choice Behavior; D016208:Databases, Factual; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D033181:Information Dissemination; D006278:Medicare; D057240:Patient Preference; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000592:standards*; D012017:Referral and Consultation; D013503:Surgery Department, Hospital / Q000592:standards; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014481:United States; D014483:United States Dept. of Health and Human Services
keywords: Medicare; Public reporting; hospitals; quality; surgery