Perils and Opportunities of Comparative Performance Measurement

Profit, Jochen

doi:10.1001/archpediatrics.2011.810

Cited by 7 publications

(8 citation statements)

References 33 publications

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“…Numerous studies have shown the effect of organizational or local efforts on performance indicators; however, fewer studies have looked at the effect of improvement in performance indicators on improvement in either patients’ health outcomes [ 12 , 13 ] or medical costs. A recent publication by the IOM claims that the US healthcare system had become too complex and costly to maintain business as usual.…”

Section: Introductionmentioning

confidence: 99%

The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a “business case” for quality of diabetes care - a time series study

et al. 2014

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BackgroundIn primary health care systems where member’s turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered.The objectives of this study were: (1) to investigate the relationship between improvement in selected measures of diabetes (type 2) care and patients’ health outcomes; and (2) to estimate the association between improvement in performance and direct medical costs.MethodsA time series study with three quality indicators – Hemoglobin A1c (HbA1c) testing, HbA1C and LDL- cholesterol (LDL-C) control - which were analyzed in patients with diabetes, insured by a large health fund. Health outcomes measures used: hospitalization days, Emergency Department (ED) visits and mortality. Poisson, GEE and Cox regression models were employed. Covariates: age, gender and socio-economic rank.Results96,553 adult (age >18) patients with diabetes were analyzed. The performance of the study indicators, significantly and steadily improved during the study period (2003–2009). Poor HbA1C (>9%) and inappropriate LDL-C control (>100 mg/dl) were significantly associated with number of hospitalization days. ED visits did not achieve statistical significance. Improvement in HbA1C control was associated with an annual average of 2% reduction in hospitalization days, leading to substantial reduction in tertiary costs. The Hazard ratio for mortality, associated with poor HbA1C and LDL-C, control was 1.78 and 1.17, respectively.ConclusionOur study demonstrates the effect of continuous improvement in quality care indicators, on health outcomes and resource utilization, among patients with diabetes. These findings support the business case for quality, especially in healthcare systems with relatively low enrollee turnover, where providers, in the long term, could “harvest” their investments in improving quality.

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Section: Introductionmentioning

confidence: 99%

The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a “business case” for quality of diabetes care - a time series study

et al. 2014

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“…1, 2 In other areas of medicine, performance measurement and financial incentives are common. 3-5 In the neonatal intensive care unit (NICU) setting, multi-stakeholder health care organizations (such as the National Quality Forum 6 ) and payers of health care are promoting performance assessments of perinatal care providers.…”

Section: Introductionmentioning

confidence: 99%

Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

Profit¹,

Zupancic²,

Gould³

et al. 2013

JAMA Pediatr

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Objectives To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. Design We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Setting Twenty-two regional NICUs in California. Patients In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Main Outcomes Measures Pneumothorax, growth velocity, health care–associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. Results The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations only 6 were significant (P < .05). Correlations between pairs of quality measures were strong (ρ > .5) for 1 pair, moderate (.3 < |ρ| < .5) for 8 pairs, weak (.1 < |ρ| < .3) for 5 pairs and negligible (|ρ| < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care–associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. Conclusion In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest.

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“…Ensuring that a NICU endorses therapies that reliably improve a broad array of outcomes and demonstrating that such PBPs can be sustained in a cost-effective fashion have thus far remained elusive, an observation noted in recent reviews of CQI. [28][29][30][31][32] Our study is the first investigation, to our knowledge, to find significant individual and group improvement in multiple NICU morbidities that are sustained for years and also includes a measure of resource use.…”

Section: Discussionmentioning

confidence: 99%

A Risk-Adjusted, Composite Outcomes Score and Resource Utilization Metrics for Very Low-Birth-Weight Infants

et al. 2015

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We have created the first, to our knowledge, web-based tool for NICUs to calculate their own composite morbidity and resource utilization scores that estimate NICU CQI proficiency. In our structured group CQI over 12 years, both metrics revealed significant improvement, but increases in length of stay (resource use) blunted value improvement. Why some NICUs improve their scores more successfully than others remains a crucial challenge. Future CQI efforts should explore strategies that cost-efficiently reduce intertwined VLBW infant morbidities, emphasizing whole cultures of proficient care rather than the traditional emphasis on single-morbidity reduction.

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Perils and Opportunities of Comparative Performance Measurement

Cited by 7 publications

References 33 publications

The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a “business case” for quality of diabetes care - a time series study

The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a “business case” for quality of diabetes care - a time series study

Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

A Risk-Adjusted, Composite Outcomes Score and Resource Utilization Metrics for Very Low-Birth-Weight Infants

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