Declines in Hospital Mortality Associated with a Regional Initiative to Measure Hospital Performance

Abstract

To determine changes in hospital mortality that oc curred in association with the dissemination of data by a regional initiative to profile hospital performance, we con ducted a retrospective cohort study of patients admitted before and subsequent to dissemination of comparative data in 1992. The analysis included 101,060 consecutive eligible discharges from 30 hospitals in Northeast Ohio with eight diagnoses: acute myocardial infarction, con gestive heart failure (CHF), obstructive airway disease, gastrointestinal hemorrhage, pneumonia, stroke, coronary artery bypass surgery, and lower bowel resection. Baseline (1991, N = 35,629) mortality rates were compared to rates during three subsequent periods (July-December 1992, N = 20,392; January-June 1993, N = 23,070; and July-December 1993, N = 21,969). Mortality rates were risk-adjusted using validated multivariable models based on data abstracted from patients' medical records. For all conditions, risk-adjusted mortality declined from a base line rate of 7.5% to rates of 6.8%, 6.8%, and 6.5%, respec tively, during the three subsequent periods. Using weighted linear regression analysis to estimate trends across peri ods, declines in mortality rates were significant for CHF (0.50% per period; P = 0.002) and pneumonia (0.38% per period; P = 0.03). We conclude that hospital mortality de clined in association with the dissemination of compara tive data. Although changes in hospital care were not directly examined, the results suggest that initiatives to examine provider performance may have a beneficial im pact on quality of care.