Quality of care in US hospitals as reflected by standardized measures, 2002-2004

被引:330
作者
Williams, SC [1 ]
Schmaltz, SP [1 ]
Morton, DJ [1 ]
Koss, RG [1 ]
Loeb, JM [1 ]
机构
[1] Joint Commiss Accreditat Healthcare Org, Div Res, Oak Brook Terrace, IL 60181 USA
关键词
D O I
10.1056/NEJMsa043778
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: In July 2002, the Joint Commission on Accreditation of Healthcare Organizations implemented standardized performance measures that were designed to track the performance of accredited hospitals and encourage improvement in the quality of health care. Methods: We examined hospitals' performance on 18 standardized indicators of the quality of care for acute myocardial infarction, heart failure, and pneumonia. One measure assessed a clinical outcome (death in the hospital after acute myocardial infarction), and the other 17 measures assessed processes of care. Data were collected over a two-year period in more than 3000 accredited hospitals. All participating hospitals received quarterly feedback in the form of comparative reports throughout the study. Results: Descriptive analysis revealed a significant improvement (P<0.01) in the performance of U.S. hospitals on 15 of 18 measures, and no measure showed a significant deterioration. The magnitude of improvement ranged from 3 percent to 33 percent during the eight quarters studied. For 16 of the 17 process-of-care measures, hospitals with a low level of performance at baseline had greater improvements over the subsequent two years than hospitals with a high level of performance at baseline. Conclusions: Over a two-year period, we observed consistent improvement in measures reflecting the process of care for acute myocardial infarction, heart failure, and pneumonia. Both quantitative and qualitative research are needed to explore the reasons for these improvements.
引用
收藏
页码:255 / 264
页数:10
相关论文
共 30 条
[1]  
Agency for Healthcare Research and Quality, 2004 NAT HEALTHC QUA
[2]  
*AM HOSP ASS, 2005, HEALTHC QUICK DISK 2
[3]  
[Anonymous], JAMA
[4]  
[Anonymous], 1971, Statistical Principles in Experimental Design
[5]  
Antman Elliott M, 2004, J Am Coll Cardiol, V44, P671, DOI 10.1016/j.jacc.2004.07.002
[6]  
ANTMAN EM, 2005, J AM COLL CARDIOL, V45, P1376
[7]   Community-acquired pneumonia in adults: Guidelines for management [J].
Bartlett, JG ;
Breiman, RF ;
Mandell, LA ;
File, TM .
CLINICAL INFECTIOUS DISEASES, 1998, 26 (04) :811-838
[8]   Data feedback efforts in quality improvement: lessons learned from US hospitals [J].
Bradley, EH ;
Holmboe, ES ;
Mattera, JA ;
Roumanis, SA ;
Radford, MJ ;
Krumholz, HM .
QUALITY & SAFETY IN HEALTH CARE, 2004, 13 (01) :26-31
[9]   A qualitative study of increasing β-blocker use after myocardial infarction -: Why do some hospitals succeed? [J].
Bradley, EH ;
Holmboe, ES ;
Mattera, JA ;
Roumanis, SA ;
Radford, MJ ;
Krumholz, HM .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (20) :2604-2611
[10]  
Braun BI, 1999, EVAL HEALTH PROF, V22, P283, DOI 10.1177/01632789922034310