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Senior Citizen Health & Medicine
Senior Citizens Have Better Chance at Life if
Treated in Top Hospitals
Lower mortality rates at hospitals that rank highest
on quality of care
July 16, 2007 – The evidence continues to mount
that fewer senior citizens would die each year if they went to hospitals most highly rated on specific quality measures. In the latest
study researchers from the Harvard School of Public Health (HSPH)
calculate that if the lowest performing hospitals had similar patient
mortality rates to those of top-performing hospitals, 2,200 fewer
elderly Americans would die each year in the surveyed hospitals from
acute myocardial infarction (AMI), congestive heart failure (CHF) and
pneumonia, three common medical conditions.
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“These findings show that these quality indicators,
which are widely available on the web, are very helpful in identifying
low mortality hospitals,” said Ashish Jha, Assistant Professor of Health
Policy and Management at HSPH and lead author of the study.
The Hospital Quality Alliance (HQA), a
public-private collaboration that includes the Centers for Medicare &
Medicaid Services and the American Hospital Association, aims to improve
the quality of care at the nation’s hospitals by reporting how hospitals
perform on detailed quality measures.
However, little was known about whether hospitals
that perform well on those measures had better patient outcomes. The
researchers set out to determine whether performing well on HQA measures
was associated with lower risk-adjusted mortality rates for AMI, CHF and
pneumonia. (By adjusting for risk, the researchers made sure that
hospitals that took care of sicker patients weren’t penalized.)
The researchers looked at HQA performance scores
from 3,720 hospitals in 2004-2005. For each hospital, a score was
calculated for how it performed treating patients with AMI, CHF and
pneumonia. Examples of performance indicators included whether hospitals
gave aspirin and beta-blockers at arrival and discharge for AMI and, for
pneumonia, how quickly antibiotics were administered.
The results showed that, when compared with
hospitals in the lowest quartile, hospitals in the top quartile of
performance had nearly 1 percent lower mortality among patients with
AMI, 0.4 percent among patients with CHF and 0.8 among patients with
pneumonia. The researchers calculated that 2,200 potential deaths could
have been avoided if the hospitals in the bottom quartile had the same
mortality rates as those in the highest quartile.
“We found that the associations were strong and
consistent across a spectrum of performance for all three conditions,”
said Jha. “This study really provides an important validation of the HQA
efforts and suggests that paying attention to the quality measures
matters.”
Because care varies from hospital to hospital, Jha
says consumers should use publicly available data such as the HQA’s when
choosing a hospital, since getting treated at higher-performing
hospitals can increase their odds of surviving the hospitalization.
“These data are not just for consumers,” said
Arnold Epstein, John H Foster Professor of Health Policy and Management
at HSPH and the study’s senior author. “This program should also
motivate hospitals to improve the care they provide to their patients.”
Editor's Notes:
The study was supported by the Commonwealth Fund.
The findings appear in the July/August 2007 issue
of the journal Health Affairs.
“The Inverse Relationship Between Mortality Rates
and Performance in the Hospital Quality Alliance Measures,” Ashish K.
Jha, John Orav, Zhonghe Li, Arnold M. Epstein, Health Affairs,
July/August 2007, vol. 26, no. 4.
Harvard School of Public Health is dedicated to
advancing the public's health through learning, discovery, and
communication. More than 300 faculty members are engaged in teaching and
training the 900-plus student body in a broad spectrum of disciplines
crucial to the health and well being of individuals and populations
around the world. Programs and projects range from the molecular biology
of AIDS vaccines to the epidemiology of cancer; from risk analysis to
violence prevention; from maternal and children's health to quality of
care measurement; from health care management to international health
and human rights. For more information on the school visit:
www.hsph.harvard.edu
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