Performance measures – a spur to quality improvement or just busywork?

March 18th, 2015

A study published this week in JAMA Internal Medicine revealed some troubling things how performance measures are viewed by hospital executives.

The researchers sent 21-question surveys to 630 hospitals in 2012 and received responses from 380 of them. The point, according to the abstract, was “To describe US hospital leaders’ attitudes toward hospital quality measures found at the Centers for Medicare & Medicaid Services’ Hospital Compare website, assess use of these measures for quality improvement, and examine the association between leaders’ attitudes and hospital quality performance.”

The good news, I guess, is that a large majority of the respondents (87.1%) said they’re including how the hospital rates on performance measures in their annual goals – which at least indicates that the measures aren’t being disregarded. But are they being taken seriously?

The whole point of public reporting, after all, is to spur performance improvement – to motivate hospitals to make efforts to rise in the rankings in order to better compete for the health care dollars of an informed public.

Some of the survey results suggest that something else may be happening. It’s one thing, after all, to believe the public takes the measures seriously in choosing a provider; it’s quite another for the executives themselves to believe in them. Now, according to the abstract, “more than 70% of hospitals agreed with the statement that ‘public reporting stimulates quality improvement at my institution’” – but that means nearly a third of hospitals didn’t agree with it, an alarming statistic. And, according to a press release on the study, “less than 50 percent of the hospitals agreed with the statement that measured differences among hospitals were clinically meaningful for mortality, readmission, cost and volume measures.”

Most troubling was the study’s finding that the executives closest to the actual quality improvement efforts at the hospital were less likely than CEOs and chief medical officers “to agree that public reporting stimulates quality improvement and that measured differences are large enough to differentiate among hospitals,” according to the abstract.

In a commentary published in the same issue, Lara Goitein, MD, contends that “the tasks of measurement and reporting fully occupy many hospital quality improvement departments, leaving few resources for actually improving medical practice.” If that’s true, it’s deeply concerning.

It’s worth noting, though, that it’s still early days when it comes to public reporting. In many cases, measures themselves may need to be reevaluated and refined, and more efficient data collection and reporting processes may need to be developed before all of this can run smoothly.

But there’s no un-ringing the bell on this. As a society, we’re headed in the direction of ever greater data transparency in every aspect of our lives, whether we like it or not, and health care isn’t going to be exempt from that. What’s important is to acknowledge that, and to honor the fact that the public has a right to be able to make informed choices about their healthcare – but also to do everything possible to ease the burdens being placed on quality personnel who would much rather actually be improving quality of care instead of just reporting on it.