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. 2015 Jun;53(6):485-91.
doi: 10.1097/MLR.0000000000000358.

Improvements in the distribution of hospital performance for the care of patients with acute myocardial infarction, heart failure, and pneumonia, 2006-2011

Sudhakar V Nuti  1 , Yongfei Wang, Frederick A Masoudi, Dale W Bratzler, Susannah M Bernheim, Karthik Murugiah, Harlan M Krumholz
Affiliations

Improvements in the distribution of hospital performance for the care of patients with acute myocardial infarction, heart failure, and pneumonia, 2006-2011

Sudhakar V Nuti et al. Med Care. 2015 Jun.

Abstract

Background: Medicare hospital core process measures have improved over time, but little is known about how the distribution of performance across hospitals has changed, particularly among the lowest performing hospitals.

Methods: We studied all US hospitals reporting performance measure data on process measures for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN) to the Centers for Medicare & Medicaid Services from 2006 to 2011. We assessed changes in performance across hospital ranks, variability in the distribution of performance rates, and linear trends in the 10th percentile (lowest) of performance over time for both individual measures and a created composite measure for each condition.

Results: More than 4000 hospitals submitted measure data each year. There were marked improvements in hospital performance measures (median performance for composite measures: AMI: 96%-99%, HF: 85%-98%, PN: 83%-97%). A greater number of hospitals reached the 100% performance level over time for all individual and composite measures. For the composite measures, the 10th percentile significantly improved (AMI: 90%-98%, P<0.0001 for trend; HF: 70%-92%, P=0.0002; PN: 71%-92%, P=0.0003); the variation (90th percentile rate minus 10th percentile rate) decreased from 9% in 2006 to 2% in 2011 for AMI, 25%-8% for HF, and 20%-7% for PN.

Conclusions: From 2006 to 2011, not only did the median performance improve but the distribution of performance narrowed. Focus needs to shift away from processes measures to new measures of quality.

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Conflict of interest statement

Conflicts of Interest

The other authors report no potential conflicts of interest.

Figures

Figure 1
Figure 1. Trends in National Performance for the Acute Myocardial Infarction (AMI), Heart Failure (HF), and Pneumonia (PN) Composite Measures, 2006–2011
On the x-axis is the rank order of hospitals by performance, and on the y-axis is performance level by percentage on the composite process measure for a given condition. A. Acute Myocardial Infarction B. Heart Failure C. Pneumonia
Figure 1
Figure 1. Trends in National Performance for the Acute Myocardial Infarction (AMI), Heart Failure (HF), and Pneumonia (PN) Composite Measures, 2006–2011
On the x-axis is the rank order of hospitals by performance, and on the y-axis is performance level by percentage on the composite process measure for a given condition. A. Acute Myocardial Infarction B. Heart Failure C. Pneumonia
Figure 2
Figure 2. Trends for the 10th, 50th, and 90th Percentiles for the Acute Myocardial Infarction (AMI), Heart Failure (HF), and Pneumonia (PN) Composite Measures, 2006–2011
There were significant improvements in the 10th percentile rates for all the composite measures from 2006 to 2011 (AMI: 90% to 98%, P<0.0001 for trend; HF: 70% to 92%, P=0.0002; PN: 71% to 92%, P=0.0003). A. Acute Myocardial Infarction B. Heart Failure C. Pneumonia
Figure 2
Figure 2. Trends for the 10th, 50th, and 90th Percentiles for the Acute Myocardial Infarction (AMI), Heart Failure (HF), and Pneumonia (PN) Composite Measures, 2006–2011
There were significant improvements in the 10th percentile rates for all the composite measures from 2006 to 2011 (AMI: 90% to 98%, P<0.0001 for trend; HF: 70% to 92%, P=0.0002; PN: 71% to 92%, P=0.0003). A. Acute Myocardial Infarction B. Heart Failure C. Pneumonia
See this image and copyright information in PMC

References

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