Journal
MEDICAL CARE
Volume 48, Issue 5, Pages 466-471Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MLR.0b013e3181d568f7
Keywords
outcome assessment; quality of care; quality assurance; statistical models; health services research; CABG; report card
Categories
Funding
- Agency for Healthcare and Quality Research [RO1 HS 16737]
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Background: The use of mortality report cards as the basis for hospital choice assumes that a hospital's current performance is predicted by its past performance. Objective: To assess the accuracy of hospital risk-adjusted mortality rates reported in the New York State (NYS) coronary artery bypass graft (CABG) report card for predicting subsequent hospital mortality. Methods: We performed a retrospective study based on hospital mortality measures for CABG surgery (n = 37 hospitals) in NYS, which are publicly reported by the NYS Department of Health. Feasible generalized least squares was used to examine the association between a hospital's past quality ranking (high-quality, intermediate- quality, low-quality) and its subsequent performance, as measured using the ratio of the observed-to-expected mortality rate (O-to-E ratio). Results: Hospitals identified as low-mortality hospitals using 2-year-old data had subsequent O-to-E ratios that were 16.8% lower (95% confidence interval, 8.9-24.8; P < 0.001) than average-mortality hospitals, whereas hospitals identified as high-mortality hospitals had subsequent O-to-E ratios that were 31.8% higher (95% confidence interval, 3.69-59.9; P < 0.05) compared with average-mortality hospitals. Hospitals identified as high-mortality hospitals using 3-year-old data were indistinguishable from average-mortality hospitals. Conclusion: Hospital ranking based on 2-year-old data is a strong predictor of future performance. Report cards based on 3-year-old data may not be useful for identifying low-performance hospitals. We recommend that the CABG report cards in NYS should be based on 2-year-old data, as opposed to the current practice of basing them on either 2- or 3-year-old data.
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