Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120

 

Presentation

Reductions in Mortality Associated with Intensive Public Reporting of Hospital Outcomes

Authors: Christopher P. Gorton (Pennsylvania Healthcare Cost Containment Council); Ying P. Tabak (Clinical Research Services (MediQual), Cardinal Health); Jayne L. Jones (Pennsylvania Healthcare Cost Containment Council); Arnold Milstein (Pacific Business Group on Health); Richard S. Johannes (Clinical Research Services (MediQual), Cardinal Health); Christopher S. Hollenbeak (Penn State College of Medicine)

Presenter: Christopher S. Hollenbeak (Penn State College of Medicine)

Discussant: Jayani Jayawardhana (Medical University of South Carolina)

Session: Public Information

Room: Classroom G

When: Monday 5:15 p.m. - 6:45 p.m.

Background. Although public reporting of hospital and physician outcomes is common, it is unclear whether public reporting has had an effect on outcomes for the conditions being reported. Using data from hospitals operating in states with varying reporting environments, we studied the effect of intensive public reporting on hospital outcomes for six high frequency, high mortality medical conditions.

Methods Outcomes of patients receiving care for acute myocardial infarction, congestive heart failure, hemorrhagic stroke, ischemic stroke, pneumonia, and sepsis in Pennsylvania, which had intensive public reporting between 2000-2003, were compared to those of patients in hospital of states without public reporting or with only limited public reporting in the same period of time. We also compared outcomes for patients in Pennsylvania during 1997 to 1999 when there was only limited public reporting with patients in states that had limited public reporting in the same period of time. Finally, we compared mortality outcomes for patients treated in Pennsylvania versus California, Colorado, and Texas where the mortality outcomes for pneumonia, AMI, and CHF were also reported publicly. Patients were matched using propensity score methods and the effect of public reporting was estimated using a difference in differences approach.

Results. Patients treated in intensive public reporting environments had significantly better outcomes. Overall, the 2000-2003 in-hospital mortality odds ratio for Pennsylvania patients vs. non-Pennsylvania patients ranged from .59 to .79 across 6 clinical conditions (all p<0.0001). For the same comparison using the 1997-1999 period, odds ratios ranged from .72 to .90, suggesting improvement within Pennsylvania hospitals when intensive public reporting occurred. In comparing outcomes for Pennsylvania hospitals to a group of hospitals with intensive public reporting in California, Colorado, and Texas for the 2000-2003 period, the odds ratios for all three conditions were not significantly different.

Conclusion. Patients treated at hospitals subjected to intensive public reporting had significantly lower odds of in-hospital mortality when compared to similar patients treated at hospitals in the environments with no public reporting or only limited reporting.