Hospital Ratings May Not Be True Quality Measure

Conventional wisdom holds that one sure way to improve health-care quality is to measure it. A study being published today in the Journal of the American Medical Association comes to the unconventional conclusion that it's not necessarily so.

The study by researchers at the University of Pennsylvania's School of Medicine found that going to a hospital that scored well on Medicare-mandated quality measures did not significantly reduce a patient's risk of dying.

The study examined 2004 data from 3,657 hospitals, comparing their performance on quality-of-care measures for treating heart attacks, heart failure and pneumonia with the death rates for the same patients. The quality measures charted such matters as whether patients who had a heart attack received aspirin within 24 hours of being admitted and how soon patients with bacterial pneumonia were given antibiotics.

Patients at hospitals that scored near the top on the quality-of-care measures did do better than those at hospitals near the bottom -- but not dramatically so.

For every 1,000 heart attack patients, there were about five fewer deaths at the better-performing hospitals than at the lower-performing ones, the study found. The figures were similar for patients with heart failure and pneumonia.

Rachel M. Werner, an assistant professor of medicine and the study's lead author, said the results point up the need for more meaningful quality measures.

"Measuring quality is clearly a good idea," Werner said. "It's a great first step. But at the same time . . . there are other things that are making outcomes different at different hospitals, and we are not capturing those differences using these measures. There is a fallacy in assuming that just taking these measures and applying them to hospitals is going to reveal important things about the differences in quality across hospitals."

-- Christopher Lee