Karen E. Joynt, MD, MPH; E. John Orav, PhD; Jie Zheng, PhD; Ashish K. Jha, MD, MPH
Grant Support: Dr. Joynt was funded by grant 1K23HL109177-01 from the National Heart, Lung, and Blood Institute.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1462.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Joynt at firstname.lastname@example.org or Dr. Zheng at email@example.com. Data set: Not available because of data use agreements with CMS.
Requests for Single Reprints: Karen E. Joynt, MD, MPH, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Joynt and Orav: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Drs. Jha and Zheng: Harvard School of Public Health, 43 Church Street, Cambridge, MA 02138.
Author Contributions: Conception and design: K.E. Joynt, A.K. Jha.
Analysis and interpretation of the data: K.E. Joynt, E.J. Orav, J. Zheng, A.K. Jha.
Drafting of the article: K.E. Joynt, E.J. Orav, A.K. Jha.
Critical revision of the article for important intellectual content: K.E. Joynt, E.J. Orav, A.K. Jha.
Final approval of the article: K.E. Joynt, J. Zheng, A.K. Jha.
Statistical expertise: E.J. Orav, J. Zheng.
Administrative, technical, or logistic support: A.K. Jha.
Collection and assembly of data: A.K. Jha.
Joynt KE, Orav EJ, Zheng J, Jha AK. Public Reporting of Mortality Rates for Hospitalized Medicare Patients and Trends in Mortality for Reported Conditions. Ann Intern Med. 2016;165:153-160. doi: 10.7326/M15-1462
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Published: Ann Intern Med. 2016;165(3):153-160.
Published at www.annals.org on 31 May 2016
Public reporting is seen as a powerful quality improvement tool, but data to support its efficacy are limited. The Centers for Medicare & Medicaid Services' Hospital Compare program initially reported process metrics only but started reporting mortality rates for acute myocardial infarction, heart failure, and pneumonia in 2008.
To determine whether public reporting of mortality rates was associated with lower mortality rates for these conditions among Medicare beneficiaries.
For 2005 to 2007, process-only reporting was considered; for 2008 to 2012, process and mortality reporting was considered. Changes in mortality trends before and during reporting periods were estimated by using patient-level hierarchical modeling. Nonreported medical conditions were used as a secular control.
U.S. acute care hospitals.
20 707 266 fee-for-service Medicare beneficiaries hospitalized from January 2005 through November 2012.
30-day risk-adjusted mortality rates.
Mortality rates for the 3 publicly reported conditions were changing at an absolute rate of −0.23% per quarter during process-only reporting, but this change slowed to a rate of −0.09% per quarter during process and mortality reporting (change, 0.13% per quarter; 95% CI, 0.12% to 0.14%). Mortality for nonreported conditions was changing at −0.17% per quarter during process-only reporting and slowed slightly to −0.11% per quarter during process and mortality reporting (change, 0.06% per quarter; CI, 0.05% to 0.07%).
Administrative data may have limited ability to account for changes in patient complexity over time.
Changes in mortality trends suggest that reporting in Hospital Compare was associated with a slowing, rather than an improvement, in the ongoing decline in mortality among Medicare patients.
National Heart, Lung, and Blood Institute.
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