title: Improvements in the distribution of hospital performance for the care of patients with acute myocardial infarction, heart failure, and pneumonia, 2006-2011.
abstract: BACKGROUND
  Medicare hospital core process measures have improved over time, but little is known about how the distribution of performance across hospitals has changed, particularly among the lowest performing hospitals.
  
  
  METHODS
  We studied all US hospitals reporting performance measure data on process measures for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN) to the Centers for Medicare & Medicaid Services from 2006 to 2011. We assessed changes in performance across hospital ranks, variability in the distribution of performance rates, and linear trends in the 10th percentile (lowest) of performance over time for both individual measures and a created composite measure for each condition.
  
  
  RESULTS
  More than 4000 hospitals submitted measure data each year. There were marked improvements in hospital performance measures (median performance for composite measures: AMI: 96%-99%, HF: 85%-98%, PN: 83%-97%). A greater number of hospitals reached the 100% performance level over time for all individual and composite measures. For the composite measures, the 10th percentile significantly improved (AMI: 90%-98%, P<0.0001 for trend; HF: 70%-92%, P=0.0002; PN: 71%-92%, P=0.0003); the variation (90th percentile rate minus 10th percentile rate) decreased from 9% in 2006 to 2% in 2011 for AMI, 25%-8% for HF, and 20%-7% for PN.
  
  
  CONCLUSIONS
  From 2006 to 2011, not only did the median performance improve but the distribution of performance narrowed. Focus needs to shift away from processes measures to new measures of quality.
authors.affiliation: *Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT †Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO ‡University of Oklahoma Health Sciences Center, Oklahoma City, OK §Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine ∥Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
authors.forename: Sudhakar V
authors.initials: SV
authors.lastname: Nuti
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Susannah M
authors.initials: SM
authors.lastname: Bernheim
authors.forename: Karthik
authors.initials: K
authors.lastname: Murugiah
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000628:therapy*; D006742:Hospital Bed Capacity; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010067:Ownership; D011014:Pneumonia / Q000628:therapy*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D014481:United States