Quality of care in U.S. hospitals

Ashish Jha, assistant professor of health policy and management at the Harvard School of Public Health and colleagues from Brigham and Women's Hospital and the Boston Veterans Affairs Healthcare System, have for the first time assessed the quality of care in U.S. hospitals.

Using information gathered from the Hospital Quality Alliance, the first national initiative to report data on hospitals' performance, they found that hospital care varies across medical conditions, and although hospitals seem to be improving, many hospitals fail to provide life saving care consistently to their patients. Further, they found tremendous regional variation in the quality of care across the country: Boston provided the best care in the nation for patients with heart attacks or congestive heart failure but did not do as well in pneumonia care.

The findings appear in the July 21, 2005 issue of the New England Journal of Medicine. An accompanying editorial also appears in this issue of the journal.

Until now, there has been no national database on the quality of care at U.S. hospitals. The Centers for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations, the American Hospital Association and the American Association for Retired Persons joined forces to form the Hospital Quality Alliance (HQA) to gather data on the quality of care provided by U.S. hospitals.

Using HQA data from 3,558 hospitals, the researchers studied 10 quality indicators, tests or treatments that have been shown to reduce death or improve health, for three important medical conditions: acute myocardial infarction, congestive heart failure and pneumonia. They assessed how well hospitals performed and found that for six of the ten indicators, patients failed to receive needed care about 10 to 20 percent of the time. For the other four indicators, performance was much worse. They also examined hospital characteristics that were linked with good performance, such as number of beds, number of nurses, region (West, Midwest, South, Northeast), urban setting, for profit or not-for-profit, and membership in the Council of Teaching Hospitals among others.

Jha and colleagues found that hospitals that provided high quality care for heart attack also did well in providing good care for congestive heart failure. However, high quality care for patients with heart attacks did not necessarily mean high quality care for patients with pneumonia. Boston was the top-ranked region in the country for care for acute myocardial infarction and congestive heart failure but didn't fare as well in pneumonia.

In other categories the researchers found that academic hospitals had higher performance scores than non-academic hospitals for acute myocardial infarction and congestive heart failure, but lower scores for pneumonia. Not-for-profit hospitals consistently had significantly higher scores than for-profit hospitals. The results showed hospitals in the Northeast and Midwest outperformed hospitals in the West and South.

"This is the first step in assessing the quality of care in hospitals across the country," said Jha. "Hospitals scoring high for one medical condition did not necessarily score high in the other conditions. Therefore, we will need to collect more information on a wider range of medical conditions to help us get a better picture of hospital performance. Our results indicate that we will need to focus our attention on quality improvement efforts in a large number of hospitals across the country."