Hospitals that reported higher scores on measures of safe practices did not have a significantly lower rate of in-hospital deaths compared to hospitals that reported lower scores on these measures, according to a study in the April 1 issue of JAMA, the Journal of the American Medical Association.
The Leapfrog Group is a nonprofit business coalition that provides information regarding hospital safety and quality to its members (large companies that purchase health care) and to consumers. Its primary method of evaluating hospitals is via voluntary participation in the Leapfrog Hospital Survey. Initially, these annual surveys assessed hospitals' adoption of 3 initiatives. In 2004, a fourth initiative was added, the Safe Practices Survey (consisting of hospitals' self-report of structural and process measures). Approximately 1,100 urban hospitals have completed this survey in recent years, with results reported to the public on the Internet. "… to our knowledge it is not yet confirmed that higher scores on the survey correlate with actual outcomes. This issue is pertinent, because survey scores reported on the Internet are ranked by quartiles, which likely suggests to consumers that hospitals in the highest quartile provide safer care than those in lower quartiles," the authors write.
Leslie P. Kernisan, M.D., of the University of California, San Francisco, and colleagues examined the relationship between scores reported by urban hospitals on the 2006 Safe Practices Survey and risk of in-hospital death. A Safe Practices Score (SPS) was determined for each hospital as well as 3 alternative scores based on shorter versions of the original survey. Analysis determined the relationship between quartiles of SPS and risk-adjusted inpatient mortality, after adjusting for hospital discharge volume and teaching status.
Mortality data were obtained from the Nationwide Inpatient Sample, a database that includes information on inpatient discharge. Of 1,075 hospitals completing the 2006 Safe Practices Survey, 155 (14 percent) were identifiable in the National Inpatient Sample (1,772,064 discharges). Of these discharges, 37,033 resulted in an inpatient death (2.09 percent).