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Promoting Hospital Quality for Patients with Heart Attacks: What Should We Measure and Report?

  Time is Muscle.
  Lead author Elizabeth H. Bradley, Ph.D., professor of public health and director of the Health Management Program at the Yale School of Public Health, finds that national measures of quality of care for patients with heart attacks are weakly linked to mortality rates.

In a Yale School of Public Health study published in the Journal of American Medical Association, researchers present provocative findings with implications about how to measure quality of care for patients with heart attacks. The study reveals that the national measures of quality are only weakly linked to mortality rates.

“The implication is not that we should stop measuring the process indicators we currently have but that we should complement those with outcome measures as well for a more full view of hospital quality,” said Elizabeth H. Bradley, Ph.D., Professor of Public Health in the Division of Health Policy and Administration and lead author of the paper. Only about 30% of the hospitals that were the best performers in low mortality rates were also the top performers in processes of care that are commonly used to indicate higher quality, according to the study.

“The study reveals that information about short-term survival rates and the current set of performance measures provide complementary information about how well hospitals are doing,” said Harlan M. Krumholz, M.D., the Harold H. Hines, Jr. Professor of Medicine. “The current measures of heart attack care were not designed to provide information about short-term survival rates. Ideally, we should be reporting both the current performance measures and short-term mortality rates.”

There are many reasons for the modest link of process and outcomes, according to the study. Many of the process measures not publicly reported may improve longer-term, but not 30-day mortality, which was measured in the study. Also, the process measures pertain to only a subset of patients with heart attacks. Mortality, even after accounting for clinical risk factors of the patients, is likely influenced by many hospital factors that are not measured in our current national quality monitoring system. “Some of these might include staffing, available technologies, presence of emergency response teams, and other hospital strategies to improve quality,” said Bradley.

“This study suggests that hospital report cards should be augmented in the future,” said Krumholz, “to let the public know about survival rates. The current publicly reported measures of quality do not tell us much about survival rates.”

The study was funded by the National Heart, Lung, and Blood Institute and the Patrick and Catherine Weldon Donaghue Medical Research Foundation. Co-authors included Jeph Herrin Ph.D., Brian Elbel M.P.H., Robert L. McNamara M.D., M.H.S., David J. Magid M.D., M.P.H., Brahmajee K. Nallamothu M.D., M.P.H., Yongfei Wang M.S., Sharon-Lise T. Normand Ph.D., and John A. Spertus M.D., M.P.H.