Hospitals Participating in "Dizzying Array" of Quality-Reporting Programs
Reporting Programs Elevate Quality on Hospital Leadership Agendas, but Lack of Coordination Among Programs and Sizeable Resource Commitments Stretch Hospitals
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"Despite the dizzying array of hospital quality-reporting programs, there's still a key unanswered question: Does quality reporting affect patient outcomes enough to justify the enormous resources hospitals are investing in it?" said Hoangmai H. Pham, M.D., M.P.H., lead author of the study and a senior researcher at HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.
The Health Affairs article, titled "The Impact of Quality Reporting Programs on Hospital Operations," is based on HSC's 2005 site visits to 12 nationally representative communitiesBoston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets for the past 10 years.
Researchers interviewed 111 health care leaders about hospital quality-reporting programs, including executives at 36 of the largest hospitals in the 12 communities, officials at the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), state hospital associations and state reporting programs.
All 36 hospitals participated in quality-reporting programs sponsored by CMS and JCAHO, which tie increased payment rates and accreditation, respectively, to participation.
"JCAHO and CMS programs have clearly influenced how hospitals prioritize QI [quality improvement] goals. They have improved organizational culture and staff attitudes toward QI and have resulted in hospitals' devoting additional resources toward QI and honing feedback and accountability mechanisms," according to the article by Pham and coauthors Jennifer Coughlan, an HSC consulting research assistant from Mathematica Policy Research; and HSC Senior Researcher Ann S. O'Malley, M.D., M.P.H.
But all 36 hospitals reported participating in additional quality-reporting programs (range 1 to 7), despite little evidence that individual reporting programs help improve care quality, and when there is no evidence on how multiple programs interact. In total, respondents identified 38 unique reporting programs.
The 38 programs varied not only in clinical focus and reporting requirements but also in sponsorship, incentives, mandatory versus voluntary nature, inclusion of outcome measures, and provision of concrete quality improvement support, according to the study.
Hospitals have devoted additional resources and staff to quality measurement and improvement, but inadequate information technology (IT) systems have added to the staffing burden of reporting, the study found.
"All reporting programs could benefit from more deliberate coordination
to decrease reporting burden. Coordination could foster more consistent or complementary
sets of target conditions across programs and standardized technical reporting
formats. Although JCAHO and CMS initiatives were tightly coordinated in design,
this cooperation has not extended to most other programs, particularly private
programs," the article states.
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.
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