Hospital Process of Care Measures and Outcomes

There is some controversy over whether process of care measures are correlated with or causative of improvements in actual health outcomes–mortality, morbidity, functional status, etc.  Research published in Health Affairs explores this issue, and specifically the public reporting of performance on process measures.   (Health Affairs Article) The study looked at hospitals covered by the Medicare Hospital Compare project over a three year period and examined mortality, length of stay, and readmission rates for heart attacks, heart failure and pneumonia.

The study found that in this time period almost all hospitals improved their publicly reported performance on the process of care measures.  Some of this effect may be due to better reporting, or selective reporting, of results.   The improvement in performance was strongly associated with decreases in mortality, length of stay and readmissions for heart attack patients.  It was also correlated with lower readmission rates for heart failure patients and slightly lower mortality rates for pneumonia patients.

The presence of other quality initiatives may explain the results, but as pay for reporting has turned into pay for performance, it actually is fairly likely that there is some degree of causation between better performance on process of care measures and patient outcomes.  One question raised by the researchers is whether pay for performance should focus on improvement, not the absolute level of performance.  Another issue is whether incentives should be continued when a stable level of high performance has been reached.  Overall, the research is encouraging for use of pay for reporting and pay for performance programs.