Background In July 2002, the Joint Commission on Accreditationof Healthcare Organizations implemented standardized performancemeasures that were designed to track the performance of accreditedhospitals and encourage improvement in the quality of healthcare.
Methods We examined hospitals' performance on 18 standardizedindicators of the quality of care for acute myocardial infarction,heart failure, and pneumonia. One measure assessed a clinicaloutcome (death in the hospital after acute myocardial infarction),and the other 17 measures assessed processes of care. Data werecollected over a two-year period in more than 3000 accreditedhospitals. All participating hospitals received quarterly feedbackin 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 18measures, and no measure showed a significant deterioration.The magnitude of improvement ranged from 3 percent to 33 percentduring the eight quarters studied. For 16 of the 17 process-of-caremeasures, hospitals with a low level of performance at baselinehad greater improvements over the subsequent two years thanhospitals with a high level of performance at baseline.
Conclusions Over a two-year period, we observed consistent improvementin measures reflecting the process of care for acute myocardialinfarction, heart failure, and pneumonia. Both quantitativeand qualitative research are needed to explore the reasons forthese improvements.
The 2001 report of the Institute of Medicine, Crossing the QualityChasm, indicated that the American health care system "is currentlyfunctioning at far lower levels than it could and should."1To address shortcomings in the health care system, the reportcalled for the "establishment of monitoring and tracking processesfor use in evaluating the progress of the health system." Thereport emphasized the need to improve the effectiveness of healthcare through the consistent provision of services that are basedon current scientific knowledge.
In 2003, the Agency for Healthcare Research and Quality (AHRQ)released the National Healthcare Quality Report (NHQR), whichincluded results on a broad set of 57 performance measures thatprovided data on the trend in the quality of services for severalclinical conditions.2 Although improvement was reported in 20of the 57 measures for which trend data were available, theuse of disparate, preexisting data sources limited the analysisand skewed the representativeness of some samples. In 2003,Jencks et al. reported on the positive changes in care deliveredto Medicare beneficiaries, on the basis of data collected duringtwo periods.3 These results, however, could not be confidentlygeneralized beyond the Medicare population. In addition, neitherthe AHRQ nor the Centers for Medicare and Medicaid Services(CMS) provided feedback to contributing hospitals on their performanceas a tool for continual quality improvement.
In 2002, the Joint Commission on Accreditation of HealthcareOrganizations (JCAHO) implemented evidence-based standardizedmeasures of performance in over 3000 accredited hospitals. Themeasures were designed to track hospitals' performance overtime and encourage improvement through quarterly feedback inthe form of comparative reports to all participating hospitals.Both qualitative and quantitative studies have demonstratedbenefits associated with providing hospitals regular feedbackon their performance on quality measures.4,5,6,7 Comparativefeedback has been particularly useful at an organizational levelas a guide for improvement-oriented activities.4,8,9
While focusing on accredited hospitals, this report expandson the earlier work of the NHQR and CMS in three important ways.First, we did not limit patient populations to Medicare beneficiaries;rather, we included all patients. Second, data collected duringthe study were made available to hospitals through formal quarterlyfeedback reports, allowing hospitals to monitor their performanceover time in comparison to national rates. Third, our use ofhospital-level longitudinal analysis allowed us to compare therates of change between hospitals that began the study witha low level of performance and those that began with a highlevel of performance.
Methods
Participants
JCAHO accreditation accounts for more than 90 percent of theacute care medical–surgical hospital beds in the UnitedStates.10 In July 2002, the JCAHO required 3377 of its 4644accredited hospitals to submit data on standardized performancemeasures on their choice of at least two of the four initiallyavailable sets of measures: acute myocardial infarction, heartfailure, pneumonia, and pregnancy and related conditions. (Thepregnancy measures were not included in this analysis becausetwo of the three measures address rare events and the third[vaginal birth after cesarean] is a subject of controversy.)The 27 percent of accredited hospitals exempted from this requirementeither did not provide services addressed by any of the measuresets (e.g., psychiatric hospitals or specialty hospitals) orhad an average daily census of fewer than 10 patients.
Measures and Data Collection
The standardized performance measures for the quality of carefor acute myocardial infarction, heart failure, and pneumonia(Table 1) were composed of precisely defined specificationsand standardized data-collection protocols based on uniformmedical language. The measures were designed to permit validcomparisons of health care organizations through the establishmentof a national comparative database. Measures were identifiedwith respect to published scientific evidence and consistencywith established clinical-practice guidelines, since considerablegaps still exist between the practices described in clinicalguidelines and the degree to which these practices are implementedduring actual treatment.11,12,13,14
Table 1. Core Measures of the JCAHO for the Quality of Care for Acute Myocardial Infarction, Heart Failure, and Pneumonia.
The JCAHO performed a pilot test of the measures from Januarythrough December 2001 through a collaborative effort among fivestate hospital associations and 83 hospitals in nine states.15After the national implementation of these measures, the reliabilityof the approach was reassessed with the use of on-site reabstractionof medical records to evaluate the accuracy of the individualdata elements collected in the third quarter of 2002. The averagerates of agreement exceeded 90 percent.16
The JCAHO required accredited hospitals to collect data on performancemeasures for all eligible patients through the abstraction ofmedical records and, where applicable, the use of administrativeor billing data. In a small number of hospitals (approximately2 percent each of hospitals submitting data on acute myocardialinfarction, heart failure, and pneumonia), patients' recordswere randomly sampled from all eligible patients. Only hospitalswith at least 75 eligible patients per month were allowed touse sampling. Once these data were collected, hospitals submittedpatient-level data to a third-party vendor, which compiled andtransmitted hospital-level data to the JCAHO on a quarterlybasis.17,18 All participating hospitals received comparativefeedback reports meeting standardized specifications on a quarterlybasis. These reports were supplied by the third-party vendorsand included, at a minimum, control charts to track variationsin a hospital's performance over time and comparison chartsto compare a hospital's rates for each measure against the nationalaverages. Vendors often provided additional feedback for theirhospital clients.
Statistical Analysis
For each measure, quarterly rates or means were calculated.Rates were based on a quarterly aggregation of data from alleligible patients. Rate-based measures are presented as a proportionin which the number of patients meeting the criteria for a specificmeasure is divided by the total number of patients. For continuousvariables, national means were based on an aggregation of hospitalmeans, weighted according to the number of patients, ratherthan a simple grand mean. Continuous variables are presentedas a mean value (i.e., the number of minutes) for all patientswho qualified for a given measure. For these measures, 2 percentof the aggregated data were identified as extreme outliers (i.e.,monthly data points exceeding a threshold in which the meantime to thrombolysis was greater than 6 hours, the mean timeto percutaneous coronary intervention was greater than 24 hours,or the mean time to the administration of antibiotics for pneumoniawas greater than 36 hours) and were removed from the analysis.The national trends were analyzed with the use of ordinary least-squaresregression analysis to quantify the linear change over time,expressed as change per quarter on the percent scale. For rate-basedmeasures that have a high overall rate of performance, therewas evidence that rates approached an upper asymptote over time.For these measures, a nonlinear three-parameter logistic curvewas fitted to the data to quantify this upper asymptote. Tocompare the time trend on the measure of smoking-cessation counselingor advice, an analysis of covariance was used.19
For the analysis of hospital temporal trends, a mixed random-coefficientsmodel analysis was used to assess the time trend, with the specificform of the analysis depending on the type of measure beinganalyzed: generalized linear mixed models were used to analyzebinomial counts for the rate-based measures,20 normal mixedrandom-coefficient models were weighted with the use of thevariance of each data point for the continuous variables,21and a Poisson general linear mixed model was used for the risk-adjustedmeasures.22 The influence of baseline values of a measure onthe change in hospitals' performance over time was assessedby adding an independent baseline variable to the model, aswell as an interaction between this baseline variable and thelinear effect of time. The interpretation of this interactionis the change in the linear effect of time per unit change inthe baseline value of the measure. All reported P values aretwo-sided and are not adjusted for multiple testing.
Results
To ensure longitudinal comparability, we limited the analysisto hospitals that submitted data from the third quarter of 2002(the first quarter of the study) through the second quarterof 2004 (the eighth and final quarter of the study). As a result,of the 3377 hospitals initially identified as participants,3087 were included in the analysis; 1473 of the 3087 hospitalssubmitted data on acute myocardial infarction (only 1258 submitteddata for the mean time to thrombolysis, and only 688 submitteddata for the mean time to percutaneous coronary intervention,since not all hospitals submitting data on acute myocardialinfarction provided these services), 1946 hospitals submitteddata on heart failure, and 1797 submitted data on pneumonia.The decision to limit our analysis to hospitals with completedata sets led to the removal of 69 hospitals from the analysisof data on acute myocardial infarction, 82 hospitals from theanalysis of data on heart failure, and 95 hospitals from theanalysis of data on pneumonia. These hospitals had very smallsamples, leading to particular quarters in which no cases ofthese conditions were reported.
National Analysis
National rates for each measure are shown according to quarterin Figure 1 and Table 2. Rate-based measures are shown for eachcondition. The three measures expressed as continuous variablesare displayed together in Figure 1D. The national rates andmeans include data from all participating hospitals. On a nationalscale, performance for 15 of the 18 standardized measures demonstrateda significant trend of improvement (change per quarter) overthe eight-quarter period (P<0.01), and no measure showedsignificant deterioration. The overall rates for four of themeasures for acute myocardial infarction and one of the pneumoniameasures approached an upper limit: aspirin at admission (96percent), aspirin at discharge (96 percent), beta-blocker atadmission (95 percent), beta-blocker at discharge (96 percent),and oxygenation assessment (99 percent).
Figure 1. Trends in the Measures of the Quality of Care for Acute Myocardial Infarction (Panels A and D), Heart Failure (Panel B), and Pneumonia (Panels C and D) at U.S. Hospitals from July 2002 to June 2004.
Data in Panels A, B, and C are based on aggregate calculations for rate-based measures (dividing the number of patients who met the criterion by the total number of patients) for all participating hospitals. An improvement is reflected by a positive slope for all rate-based measures except inpatient death after acute myocardial infarction, for which an improvement is reflected by a negative slope. Panel D shows weighted mean values (in minutes) for the continuous variables. Mean values for each hospital were weighted by the total number of patients included by each hospital. For this panel, an improvement is reflected by a negative slope. ACE denotes angiotensin-converting enzyme, LV left ventricular, and PCI percutaneous coronary intervention.
Table 2. Mean Values and Overall Changes in Measures of the Quality of Care during the Eight Quarters.
Among the 18 measures studied, the most dramatic improvementoccurred in the three measures of counseling for smoking cessation.A 19 percent, 32 percent, and 33 percent absolute differencefrom the first to the last quarter studied was observed foracute myocardial infarction, heart failure, and pneumonia, respectively.Interestingly, comparisons of the measures of counseling forsmoking cessation, which were identically defined in the threecategories, revealed significant differences in the nationalperformance rates in each. Performance on the measure of smoking-cessationcounseling for acute myocardial infarction was superior to thatfor heart failure, which was, in turn, better than that forpneumonia (P<0.001). The rates of change (slope) over theeight quarters were also significantly different (P<0.001)between the measures of counseling for smoking cessation foracute myocardial infarction (3 percent per quarter) and themeasures of counseling for smoking cessation for heart failureand pneumonia (4 percent and 5 percent per quarter, respectively).
Hospital-Level Analysis
The analyses involving a mixed random-coefficients model demonstratedthat the degree of hospitals' improvement was significantlypositively associated with baseline performance and linear timefor all rate-based process measures and two of the three measuresexpressed as continuous variables (P<0.05). Only the meantime to thrombolysis did not reveal a significant relationshipbetween baseline performance and linear time. More simply stated,the performance of hospitals generally tended to improve overtime, and hospitals that began the study with lower baselinerates tended to improve at faster rates than hospitals withhigher baseline rates. Table 3 illustrates this trend by stratifyinghospitals into three groups according to their baseline percentileranks for each measure.
Table 3. Average Change in Measures of the Quality of Care over Time, According to Baseline Performance.
Discussion
Our data demonstrate a steady improvement in the performanceof U.S. hospitals over a period of eight quarters in measuresreflecting the quality of care for acute myocardial infarction,heart failure, and pneumonia. Improvement was observed in 15of 18 measures, including 3 measures that already had mean performancerates of over 90 percent in the first quarter (e.g., the ratefor aspirin at admission was 93 percent in the third quarterof 2002). Moreover, hospital-level analysis revealed that, for16 of the 17 process measures, hospitals that began the studyas low-level performers tended to improve at faster rates thanthose that started the study with higher levels of performance.With each passing quarter, low-level performers improved morequickly. In contrast, high-level performers generally maintainedtheir high level of performance or improved at slower rates.
The faster rate of improvement among low-level performers representsan important finding. Whereas low-level performers have themost room for improvement, one might have expected differentresults, since such hospitals may be less likely to focus onquality or make an effort to improve performance than theircounterparts with a higher level of performance. Our resultssupport the results of previous work and lend support to theuse of these measures as a means for encouraging improvementin hospitals and as tools for monitoring hospitals' performance,as called for by the Institute of Medicine.1,3,7,8,9,23 Receivingquarterly national comparative data may have been an added stimulusfor poor-performing hospitals to improve.
The improvement observed in some measures may have resultedin part from increased attention to documentation, rather thanbetter patient care. Although this possibility cannot be definitivelydiscounted, it could not explain the reductions noted in thetime to thrombolysis and time to percutaneous coronary intervention.
A review of the measures of the quality of care for acute myocardialinfarction reveals an apparent contradiction between improvementin the process measures and the lack of improvement in the inpatient-deathmeasure. This discrepancy is misleading for two important reasons.First, it is highly unlikely that improvements in these processmeasures would have an important effect on inpatient death.In fact, four of the eight process measures for acute myocardialinfarction address discharge activities, and the patient populationstargeted by the measures for the timing of thrombolytic therapyand percutaneous coronary intervention, which one might reasonablyexpect to be correlated with inpatient death, represent onlya small fraction of the patients included in the inpatient-deathmeasure. Second, the process measures were selected becausethey had a scientific evidence base, established through randomizedclinical trials, that demonstrated their relationship to multiplemeasures of outcome. In such instances, process measures canbe more sensitive to differences in quality than comparisonsof outcomes.24 The inpatient-death measure would therefore beexpected to provide important information about an individualhospital's performance but would not be expected to mirror trendsobserved for the process measures.
This study has several limitations. First, it is dependent onself-reported data from hospitals. Although the reliabilityof the data was evaluated twice, once in the pilot test of themeasures and a second time after national implementation ofthe approach,15,16 the nature of self-reported data providesan opportunity to introduce bias into the results. However,the results are consistent with findings reported in studiesthat used data collected by independent sources.3,6,7,23 TheVeterans Affairs health care system, for example, used similarmeasures, collected by independent abstractors, to track changesin performance after the implementation of a systemwide reengineeringprogram. Over a four-year period, dramatic improvements in thequality of care were observed.25 Second, although improvementsmust have been due to hospital-based efforts to upgrade thequality of care, there is no way to determine the degree towhich feedback on performance measures stimulated these improvementinitiatives. Certainly, the national attention directed at thesehigh-risk, problem-prone patient populations by the CMS, theNational Quality Forum, the JCAHO, and others contributed tothe observed improvement, independently of the availabilityof feedback on performance measures. In this issue of the Journal,Jha et al., who analyzed 10 measures from the CMS Hospital QualityAlliance, also reported modest differences in the performanceof hospitals on the basis of specific characteristics, suchas geographic location, teaching status, and for-profit or not-for-profitstatus.26 These easily observable demographic characteristics,however, did not account for the majority of the variation inquality observed on the measures. Both quantitative and qualitativeresearch are needed to evaluate the reasons for differencesin hospital performance and improvement. Our study includedonly hospitals that were accredited by the JCAHO and excludedhospitals with an average daily census of fewer than 10 patients.As a result, our findings may underrepresent the performanceof very small hospitals.
Although the impetus for the improvement cannot be pinpointed,the improvement in measures reflecting the quality of care foracute myocardial infarction, heart failure, and pneumonia remainsvery encouraging. If the current rates of change were to bemaintained (which is by no means a certainty), the mean performancefor hospitals that began the study in the lowest performancequartile would be expected to reach rates of 90 percent for11 of the 14 rate-based process measures by the first quarterof 2006. Given the very low starting point or slow rate of improvementobserved for the remaining three rate-based process measures(discharge instructions, pneumococcal screening or vaccination,and blood cultures), the 90 percent mark would probably notbe reached until 2007 or 2008. It is also important to notethat the data were largely collected before the widespread publicreporting of hospital data or the implementation of pay-for-performanceinitiatives. The role and influence of public reporting is awidely debated subject that varies depending on the intendedaudience and the purpose of the reporting.9,23,27,28 As theJCAHO's database of performance measures expands with each passingquarter, it will offer an opportunity to track the effect ofnational public reporting and pay-for-performance initiativesto a degree that once was not possible.
Source Information
From the Joint Commission on Accreditation of Healthcare Organizations, Division of Research, Oakbrook Terrace, Ill.
Address reprint requests to Dr. Williams at the Joint Commission on Accreditation of Healthcare Organizations, 1 Renaissance Blvd., Oakbrook Terrace, IL 60181, or at swilliams{at}jcaho.org.
References
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academies Press, 2001.
Jencks SF, Huff ED, Cuerdon T. Change in the quality of care delivered to Medicare beneficiaries, 1998-1999 to 2000-2001. JAMA 2003;289:305-312. [Erratum, JAMA 2002;289:2649.] [Free Full Text]
Bradley EH, Holmboe ES, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM. Data feedback efforts in quality improvement: lessons learned from US hospitals. Qual Saf Health Care 2004;13:26-31. [Free Full Text]
Bradley EH, Holmboe ES, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM. A qualitative study of increasing beta-blocker use after myocardial infarction: why do some hospitals succeed? JAMA 2001;285:2604-2611. [Free Full Text]
Schade CP, Cochran BF, Stephens MK. Using statewide audit and feedback to improve hospital care in West Virginia. Jt Comm J Qual Saf 2004;30:143-151. [Medline]
Marciniak TA, Ellerbeck EF, Radford MJ, et al. Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project. JAMA 1998;279:1351-1357. [Free Full Text]
Gibberd R, Hancock S, Howley P, Richards K. Using indicators to quantify the potential to improve the quality of health care. Int J Qual Health Care 2004;16:Suppl 1:i37-i43. [Abstract]
Marshall MN, Shekelle PG, Leatherman S, Brook RH. The public release of performance data: what do we expect to gain? A review of the evidence. JAMA 2000;283:1866-1874. [Free Full Text]
Healthcare Quick Disk 2005: AHA annual survey database for fiscal year 2003. Chicago: American Hospital Association, 2005.
Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST elevation myocardial infarction -- executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). J Am Coll Cardiol 2004;44:671-719. [Erratum, J Am Coll Cardiol 2005;45:1376.] [Free Full Text]
Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2001;38:2101-2113. [Free Full Text]
Bartlett JG, Breiman RF, Mandell LA, File TM Jr. Community-acquired pneumonia in adults: guidelines for management. Clin Infect Dis 1998;26:811-838. [Web of Science][Medline]
McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635-2645. [Free Full Text]
Joint Commission on Accreditation of Healthcare Organizations. A comprehensive review of development and testing for national implementation of hospital core measures. (Accessed June 27, 2005, at http://www.jcaho.org/pms/core+measures/cr_hos_cm.htm.)
Watt A, Williams S, Lee K, Robertson J, Koss RG, Loeb JM. Keen eye on core measures: Joint Commission data quality study offers insights into data collection, abstracting processes. J AHIMA 2003;74:20-25. [Medline]
Braun BI, Koss RG, Loeb JM. Integrating performance measure data into the Joint Commission accreditation process. Eval Health Prof 1999;22:283-297. [Free Full Text]
Winer BJ. Statistical principles in experimental design. 2nd ed. New York: McGraw-Hill, 1971.
Breslow NE, Clayton DG. Approximate inference in generalized linear mixed models. J Am Stat Assoc 1993;88:9-25. [CrossRef][Web of Science]
SAS/STAT user's guide, version 8. Cary, N.C.: SAS Institute, 2002.
Clayton D, Kaldor J. Empirical Bayes estimates of age-standardized relative risks for use in disease mapping. Biometrics 1987;43:671-681. [CrossRef][Web of Science][Medline]
Hibbard JH, Stockard J, Tusler M. Does publicizing hospital performance stimulate quality improvement efforts? Health Aff (Millwood) 2003;22:84-94. [Free Full Text]
Palmer RH. Using health outcomes data to compare plans, networks and providers. Int J Qual Health Care 1998;10:477-483. [Free Full Text]
Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs health care system on the quality of care. N Engl J Med 2003;348:2218-2227. [Free Full Text]
Jha AK, Zhonghe L, Orav EJ, et al. Care in U.S. hospitals -- the Hospital Quality Alliance program. N Engl J Med 2005;353:265-274. [Free Full Text]
Schneider EC, Epstein AM. Influence of cardiac-surgery performance reports on referral practices and access to care: a survey of cardiovascular specialists. N Engl J Med 1996;335:251-256. [Free Full Text]
Schneider EC, Epstein AM. Use of public performance reports: a survey of patients undergoing cardiac surgery. JAMA 1998;279:1638-1642. [Free Full Text]
Quality of Care in U.S. Hospitals
Robbins R. A., Klotz S. A., Bender B. S., Saver B. G., Williams S. C., Loeb J. M., Jha A. K., Epstein A. M.
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[Full Text]
Krumholz, H. M.
(2008). Outcomes Research: Generating Evidence for Best Practice and Policies. Circulation
118: 309-318
[Full Text]
Hollenbeak, C. S., Gorton, C. P., Tabak, Y. P., Jones, J. L., Milstein, A., Johannes, R. S.
(2008). Reductions in Mortality Associated With Intensive Public Reporting of Hospital Outcomes. American Journal of Medical Quality
23: 279-286
[Abstract]
Greenfield, D., Braithwaite, J.
(2008). Health sector accreditation research: a systematic review. Int J Qual Health Care
20: 172-183
[Abstract][Full Text]
Werner, R. M., Goldman, L. E., Dudley, R. A.
(2008). Comparison of Change in Quality of Care Between Safety-Net and Non-Safety-Net Hospitals. JAMA
299: 2180-2187
[Abstract][Full Text]
Williams, S. C., Koss, R. G., Morton, D. J., Schmaltz, S. P., Loeb, J. M.
(2008). Case volume and hospital compliance with evidence-based processes of care. Int J Qual Health Care
20: 79-87
[Abstract][Full Text]
Krumholz, H. M., Bradley, E. H., Nallamothu, B. K., Ting, H. H., Batchelor, W. B., Kline-Rogers, E., Stern, A. F., Byrd, J. R., Brush, J. E. Jr
(2008). A campaign to improve the timeliness of primary percutaneous coronary intervention: Door-to-Balloon: An Alliance for Quality.. J Am Coll Cardiol Intv
1: 97-104
[Abstract][Full Text]
Nallamothu, B. K., Bradley, E. H., Krumholz, H. M.
(2007). Time to Treatment in Primary Percutaneous Coronary Intervention. NEJM
357: 1631-1638
[Full Text]
Nallamothu, B. K., Wang, Y., Bradley, E. H., Ho, K. K.L., Curtis, J. P., Rumsfeld, J. S., Masoudi, F. A., Krumholz, H. M.
(2007). Comparing Hospital Performance in Door-to-Balloon Time Between the Hospital Quality Alliance and the National Cardiovascular Data Registry. J Am Coll Cardiol
50: 1517-1519
[Full Text]
Fonarow, G. C., Abraham, W. T., Albert, N. M., Gattis Stough, W., Gheorghiade, M., Greenberg, B. H., O'Connor, C. M., Pieper, K., Sun, J. L., Yancy, C. W., Young, J. B., for the OPTIMIZE-HF Investigators and Hospitals,
(2007). Influence of a Performance-Improvement Initiative on Quality of Care for Patients Hospitalized With Heart Failure: Results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Arch Intern Med
167: 1493-1502
[Abstract][Full Text]
O'Brien, S. M., Peterson, E. D.
(2007). Identifying High-Quality Hospitals: Consult the Ratings or Flip a Coin?. Arch Intern Med
167: 1342-1344
[Full Text]
Khot, U. N., Johnson, M. L., Ramsey, C., Khot, M. B., Todd, R., Shaikh, S. R., Berg, W. J.
(2007). Emergency Department Physician Activation of the Catheterization Laboratory and Immediate Transfer to an Immediately Available Catheterization Laboratory Reduce Door-to-Balloon Time in ST-Elevation Myocardial Infarction. Circulation
116: 67-76
[Abstract][Full Text]
Jha, A. K., Orav, E. J., Li, Z., Epstein, A. M.
(2007). The Inverse Relationship Between Mortality Rates And Performance In The Hospital Quality Alliance Measures. Health Aff (Millwood)
26: 1104-1110
[Abstract][Full Text]
Coons, J. C., Fera, T.
(2007). Multidisciplinary team for enhancing care for patients with acute myocardial infarction or heart failure. Am J Health Syst Pharm
64: 1274-1278
[Abstract][Full Text]
Jha, A. K., Orav, E. J., Li, Z., Epstein, A. M.
(2007). Concentration and Quality of Hospitals That Care for Elderly Black Patients. Arch Intern Med
167: 1177-1182
[Abstract][Full Text]
Werner, R. M., Bradlow, E. T.
(2007). Medicare's Hospital Compare Performance Measures and Mortality Rates--Reply. JAMA
297: 1431-1431
[Full Text]
Rosamond, W., Flegal, K., Friday, G., Furie, K., Go, A., Greenlund, K., Haase, N., Ho, M., Howard, V., Kissela, B., Kittner, S., Lloyd-Jones, D., McDermott, M., Meigs, J., Moy, C., Nichol, G., O'Donnell, C. J., Roger, V., Rumsfeld, J., Sorlie, P., Steinberger, J., Thom, T., Wasserthiel-Smoller, S., Hong, Y., for the American Heart Association Statistics Comm,
(2007). Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation
115: e69-e171
[Full Text]
Lindenauer, P. K., Remus, D., Roman, S., Rothberg, M. B., Benjamin, E. M., Ma, A., Bratzler, D. W.
(2007). Public Reporting and Pay for Performance in Hospital Quality Improvement. NEJM
356: 486-496
[Abstract][Full Text]
Krumholz, H. M., Normand, S.-L. T., Spertus, J. A., Shahian, D. M., Bradley, E. H.
(2007). Measuring Performance For Treating Heart Attacks And Heart Failure: The Case For Outcomes Measurement. Health Aff (Millwood)
26: 75-85
[Abstract][Full Text]
Masoudi, F. A., Foody, J. M., Havranek, E. P., Wang, Y., Radford, M. J., Allman, R. M., Gold, J., Wiblin, R. T., Krumholz, H. M.
(2006). Trends in Acute Myocardial Infarction in 4 US States Between 1992 and 2001: Clinical Characteristics, Quality of Care, and Outcomes. Circulation
114: 2806-2814
[Abstract][Full Text]
Werner, R. M., Bradlow, E. T.
(2006). Relationship Between Medicare's Hospital Compare Performance Measures and Mortality Rates. JAMA
296: 2694-2702
[Abstract][Full Text]
Landon, B. E., Normand, S.-L. T., Lessler, A., O'Malley, A. J., Schmaltz, S., Loeb, J. M., McNeil, B. J.
(2006). Quality of Care for the Treatment of Acute Medical Conditions in US Hospitals. Arch Intern Med
166: 2511-2517
[Abstract][Full Text]
McKalip, D., Harbaugh, R. E.
(2006). Process Measures and Short-term Mortality for Acute Myocardial Infarction. JAMA
296: 2557-2557
[Full Text]
Bradley, E. H., Krumholz, H. M.
(2006). Process Measures and Short-term Mortality for Acute Myocardial Infarction--Reply. JAMA
296: 2557-2558
[Full Text]
Bradley, E. H., Herrin, J., Wang, Y., Barton, B. A., Webster, T. R., Mattera, J. A., Roumanis, S. A., Curtis, J. P., Nallamothu, B. K., Magid, D. J., McNamara, R. L., Parkosewich, J., Loeb, J. M., Krumholz, H. M.
(2006). Strategies for Reducing the Door-to-Balloon Time in Acute Myocardial Infarction. NEJM
355: 2308-2320
[Abstract][Full Text]
Nissen, S. E., Brush, J. E. Jr, Krumholz, H. M.
(2006). President's Page: GAP-D2B: An Alliance for Quality. J Am Coll Cardiol
48: 1911-1912
[Full Text]
Gjini, A.B., Stuart, J.M., Cartwright, K., Cohen, J., Jacobs, M., Nichols, T., Ninis, N., Prempeh, H., Whitehouse, A., Heyderman, R.S.
(2006). Quality of in-hospital care for adults with acute bacterial meningitis: a national retrospective survey.. QJM
99: 761-769
[Abstract][Full Text]
Emanuel, E. J.
(2006). Changing premed requirements and the medical curriculum.. JAMA
296: 1128-1131
[Full Text]
Rollow, W., Lied, T. R., McGann, P., Poyer, J., LaVoie, L., Kambic, R. T., Bratzler, D. W., Ma, A., Huff, E. D., Ramunno, L. D.
(2006). Assessment of the Medicare Quality Improvement Organization Program. ANN INTERN MED
145: 342-353
[Abstract][Full Text]
Pham, H. H., Coughlan, J., O'Malley, A. S.
(2006). The Impact Of Quality-Reporting Programs On Hospital Operations. Health Aff (Millwood)
25: 1412-1422
[Abstract][Full Text]
Williams, S. C., Koss, R. G., Morton, D. J., Loeb, J. M.
(2006). Performance of Top-Ranked Heart Care Hospitals on Evidence-Based Process Measures. Circulation
114: 558-564
[Abstract][Full Text]
Jha, A. K.
(2006). Measuring hospital quality: what physicians do? How patients fare? Or both?. JAMA
296: 95-97
[Full Text]
Shorr, A. F., Bodi, M., Rodriguez, A., Sole-Violan, J., Garnacho-Montero, J., Rello, J., for the CAPUCI Study Investigators,
(2006). Impact of antibiotic guideline compliance on duration of mechanical ventilation in critically ill patients with community-acquired pneumonia.. Chest
130: 93-100
[Abstract][Full Text]
Wang, C. J., McGlynn, E. A., Brook, R. H., Leonard, C. H., Piecuch, R. E., Hsueh, S. I., Schuster, M. A.
(2006). Quality-of-Care Indicators for the Neurodevelopmental Follow-up of Very Low Birth Weight Children: Results of an Expert Panel Process.. Pediatrics
117: 2080-2092
[Abstract][Full Text]
Waikar, S. S., Curhan, G. C., Wald, R., McCarthy, E. P., Chertow, G. M.
(2006). Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002. J. Am. Soc. Nephrol.
17: 1143-1150
[Abstract][Full Text]
Davis, R. M.
(2006). Measuring the health impact of smoking and health care providers' performance in addressing the problem.. ANN INTERN MED
144: 444-446
[Full Text]
Nolan, T., Berwick, D. M.
(2006). All-or-None Measurement Raises the Bar on Performance. JAMA
295: 1168-1170
[Full Text]
Thom, T., Haase, N., Rosamond, W., Howard, V. J., Rumsfeld, J., Manolio, T., Zheng, Z.-J., Flegal, K., O'Donnell, C., Kittner, S., Lloyd-Jones, D., Goff, D. C. Jr, Hong, Y., Members of the Statistics Committee and Stroke Sta, , Adams, R., Friday, G., Furie, K., Gorelick, P., Kissela, B., Marler, J., Meigs, J., Roger, V., Sidney, S., Sorlie, P., Steinberger, J., Wasserthiel-Smoller, S., Wilson, M., Wolf, P.
(2006). Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation
113: e85-e151
[Full Text]
Bach, P. B.
(2005). Using Practice Guidelines to Assess Cancer Care Quality. JCO
23: 9041-9043
[Full Text]
Robbins, R. A., Klotz, S. A., Bender, B. S., Saver, B. G., Williams, S. C., Loeb, J. M., Jha, A. K., Epstein, A. M.
(2005). Quality of care in U.S. hospitals.. NEJM
353: 1860-1861
[Full Text]
Kressin, N. R.
(2005). Separate but Not Equal: The Consequences of Segregated Health Care. Circulation
112: 2582-2584
[Full Text]
(2005). Quality of AMI and HF Care. Journal Watch Cardiology
2005: 3-3
[Full Text]
Jha, A. K., Li, Z., Orav, E. J., Epstein, A. M.
(2005). Care in U.S. Hospitals -- The Hospital Quality Alliance Program. NEJM
353: 265-274
[Abstract][Full Text]
Romano, P. S.
(2005). Improving the Quality of Hospital Care in America. NEJM
353: 302-304
[Full Text]
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