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Original Investigation
December 2014

Attitudes of Hospital Leaders Toward Publicly Reported Measures of Health Care Quality

Author Affiliations
  • 1Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
  • 2Division of General Medicine, Baystate Medical Center, Springfield, Massachusetts
  • 3Tufts University School of Medicine, Boston, Massachusetts
  • 4Section of General Internal Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 5Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
  • 6School of Public Health and Health Sciences, University of Massachusetts, Amherst
  • 7Department of Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
JAMA Intern Med. 2014;174(12):1904-1911. doi:10.1001/jamainternmed.2014.5161

Importance  Public reporting of quality is considered a key strategy for stimulating improvement efforts at US hospitals; however, little is known about the attitudes of hospital leaders toward existing quality measures.

Objectives  To describe US hospital leaders’ attitudes toward hospital quality measures found on 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.

Design, Setting, and Participants  We mailed a 21-item questionnaire from January 1 through September 31, 2012, to senior hospital leaders from a stratified random sample of 630 US hospitals, including equal numbers with better-than-expected, as-expected, and worse-than-expected performance on mortality and readmission measures.

Main Outcomes and Measures  We assessed levels of agreement with statements concerning quality measures, examined use of measures for improvement activities, and analyzed the association between leaders’ attitudes and hospital performance.

Results  Of 630 hospitals surveyed, 380 (60.3%) responded. For each of the mortality, readmission, process, and patient experience measures, more than 70% of hospitals agreed with the statement that “public reporting stimulates quality improvement activity at my institution”; agreement for measures of cost and volume was 65.2% and 53.3%, respectively. A similar pattern was observed for the statement that “our hospital is able to influence performance on this measure”; agreement for processes of care and patient experience measures was 96.4% and 94.2%, respectively. A total of 89.7% of hospitals agreed that the hospital’s reputation was influenced by patient experience measures; agreement was 77.4% for mortality, 69.9% for readmission, 76.3% for process measures, 66.1% for cost measures, and 54.0% for volume measures. A total of 87.1% of hospitals reported incorporating performance on publicly reported measures into their hospital’s annual goals, whereas 90.2% reported regularly reviewing the results with the hospital’s board of trustees and 94.3% with senior clinical and administrative leaders. When compared with chief executive officers and chief medical officers, respondents who identified themselves as chief quality officers or vice presidents of quality were less likely to agree that public reporting stimulates quality improvement and that measured differences are large enough to differentiate among hospitals.

Conclusions and Relevance  Hospital leaders indicated that the measures reported on the Hospital Compare website exert strong influence over local planning and improvement efforts. However, they expressed concerns about the clinical meaningfulness, unintended consequences, and methods of public reporting.