U.S. Hospital Care Better, But Gaps Remain

Quality varies widely between cities and centers, studies find

WEDNESDAY, July 20, 2005 (HealthDayNews) -- Americans headed to the hospital expect the best care available, but that expectation is not always met: Experts say the quality of the care patients receive varies widely by city and hospital.

And despite an overall trend of improving quality of care in the nation's hospitals, there is still room for improvement, according to two reports in the July 21 issue of The New England Journal of Medicine.

In the first report, researchers led by Scott C. Williams, director of the Center for Public Policy Research at the Joint Commission on Accreditation of Healthcare Organizations, looked at 18 areas of care in more than 3,000 hospitals to determine how well hospitals adhered to treatment guidelines. The areas they focused on included heart attacks, heart failure and pneumonia.

"We noticed that, in general, hospitals were improving at a pretty steady rate for the vast majority of the measures," Williams said. "We also found the hospitals that started the study performing at lower levels than their peers improved at a much faster rate than those who were performing at higher levels."

Specifically, the researchers found significant improvement in the performance of U.S. hospitals on 15 of 18 measures, and no measure showed a significant decline over the two years of the study.

Improvement in the 15 measures ranged from 3 percent to 33 percent, the researchers found. In addition, for 16 of the 17 process-of-care measures, hospitals that started the study with a low level of performance showed greater improvements compared to hospitals who had a high level of performance to begin with.

Williams believes hospital performance measurements like this need to be carried on. "As we continue to expand the measures we study, hopefully there will be the same performance trends replicated in those other sets," he said.

He pointed out that Medicare tests hospitals on pay-for-performance measures, and then pays centers based on the quality of their care. That, combined with public reporting, should drive a continued increase in the quality of care offered by hospitals, Williams said.

"We hope that 100 percent compliance would be the goal for each of the quality measures," Williams said. "But no measure is perfect, and there are going to be some kinds of extenuating circumstances that prevent 100 percent compliance all the time."

In the second report, a team led by Dr. Ashish Kumar Jha, an assistant professor of medicine at the Harvard School of Public Health, collected data on 3,558 hospitals nationwide. The team also looked at the quality of care for patients admitted for heart attack, congestive heart failure and pneumonia.

"It seems that the quality of care in American hospitals is improving, but for many lifesaving therapies we still have a long way to go," Jha said. "There is extensive variation in quality, so where you live and the hospitals you go to has a very important effect on whether you are going to receive these lifesaving therapies or not," he added.

For example, Jha's team found that if a hospital had a high quality of care for heart attack, it also had a high quality of care for congestive heart failure. However, the high quality of care for heart conditions didn't predict that these hospitals would have a high quality of care for pneumonia.

Moreover, hospitals that tended to offer the highest quality of care were academic hospitals, hospitals in the Northeast and Midwest and nonprofit hospitals, the researchers found. "Hospitals in the West and the South consistently performed poorly," Jha said.

Jha noted that all this information is available on the Web. "So people can look up information about the quality of hospital care and make informed choices," he said.

For many hospitals, compliance with standard clinical guidelines ranges from 80 percent to 85 percent, Jha said. "I'm pleased. That's a big improvement from where we were," he said. "But I don't think anybody would look at that and say we're there. Improvement is good, but for things that are truly lifesaving we need to be close to 100 percent."

Jha believes improvements in quality of care rely on hospitals being proactive. "It takes hospital leadership, clinicians recognizing that there are gaps in quality, and becoming committed to trying to improve quality for everyone."

One expert interpreted the results of these studies with caution. "We are only looking here at a few conditions," said Dr. Patrick S. Romano, a professor of general medicine and pediatrics at the University of California at Davis and the author of an accompanying editorial in the journal.

"There are a lot of other reasons that people are in the hospital that weren't evaluated in these studies," Romano said. "We can't say that simply because hospitals are doing better on these measures that they are doing better across the board."

In addition, Romano thinks that while quality has generally improved, there is a way to go to bring all hospitals up to a uniform level of care. "There are still some significant differences between types of hospitals and particularly between different areas. This is one country, and we should be providing the same level of care no matter what state or city you're in."

Another recent study found that a common mechanism used to assess and improve the quality of care in hospitals doesn't work. This study, which appeared in the July 20 issue of the Journal of the American Medical Association, found that hospital report cards, which are becoming a standard for measuring the quality of care, don't by themselves improve the quality of care.

More information

The Joint Commission on Accreditation of Healthcare Organizations can tell you more about the quality of hospitals in your area.

SOURCES: Scott C. Williams, Psy.D., director, Center for Public Policy Research, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Ill.; Ashish Kumar Jha, M.D., assistant professor, medicine, Harvard School of Public Health, Boston; Patrick S. Romano, M.D, M.P.H., professor, general medicine and pediatrics, University of California at Davis; July 21, 2005, New England Journal of Medicine, July 20, 2005, Journal of the American Medical Association
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