Hospital Report Cards Don't Improve Heart-Patient Care

Paying hospitals based on quality would work better, an expert says

TUESDAY, July 19, 2005 (HealthDayNews) -- Increased efforts to make sure heart attack victims always receive the recommended care met with only with limited success, Canadian researchers report.

To improve the quality of health care in hospitals, a team of researchers tried giving doctors and hospitals immediate feedback about their care of heart attack patients. But that feedback did no more to improve care than giving feedback much later did, the team found.

These so-called hospital report cards are becoming more popular in the United States and some parts of Canada as a way to improve the quality of health care, but there is no evidence they work, the researchers said.

Their report appears in the July 20 issue of the Journal of the American Medical Association.

To see if these report cards are effective, Dr. Louise Pilote, from McGill University Health Centre in Montreal, and her team randomly assigned 76 hospitals in Quebec to get immediate feedback on their care of heart attack patients, or to get feedback after 14 months. Each hospital group accounted for more than 3,000 heart attack patients.

Pilote's team found there was no difference in the care given by either group of hospitals. For example, the rate of drugs prescribed for lowering blood pressure and reducing cholesterol was similar in both groups, as was the rate of prescriptions for aspirin.

Moreover, the rates of death, the length of hospital stay, the number of doctor visits after discharge and the waiting times for cardiac procedures and the rate of rehospitalization for heart problems was similar in both groups, the researchers reported.

"Feedback based on one-time, confidential report cards constructed using administrative data is not an effective strategy for quality improvement regarding care of patients with acute myocardial infarction," the researchers wrote. "A need exists for further studies to rigorously evaluate the effectiveness of more intensive report card interventions."

One expert thinks even more intense programs are needed to improve the quality of care.

"There is evidence from other studies that you can have an impact on improving the quality of care," said Dr. Eric David Peterson, a professor of medicine at Duke University Medical Center, and author of an accompanying editorial in the journal. "But it has to be more intensive than the approach they used."

Peterson thinks that if Medicare instituted a pay-for-performance program, under which payments to hospitals were tied to the quality of care, there would probably be a dramatic improvement in quality. "That will reward hospitals that hit very high [quality of care] numbers, and penalize hospitals that don't do well," he said.

In the past, quality improvement was not a priority, Peterson said. "Nobody wanted to be involved in it," he said. "You didn't want to find out there were problems with your institution. It was hard to get people to change their practices if they were not consistent with what should be done."

But hospitals need to invest in measuring the ways they deliver care, Peterson said. The incentive now is money. Pay-for-performance "will engage physicians and hospital administrators all over America like never before," he said. "We need to have systems in place that assure that care is delivered the best way every time."

More information

IPRO can tell you more about quality health care.

SOURCES: Eric David Peterson, M.D., M.P.H., professor, medicine, Duke University Medical Center, Durham, N.C.; July 20, 2005, Journal of the American Medical Association
Consumer News