Study Shows Improved Performance on Quality Measures is Accompanied by Increased Racial/Ethnic Equity in Care
BACKGROUND:
In 2004, a coalition of public and private entities led by the Centers for Medicare & Medicaid Services (CMS) launched a comprehensive effort to measure and publicly report the quality of care delivered by U.S. hospitals. This initiative – the Inpatient Quality Reporting (IQR) Program – assessed adherence to recommended processes of care for three common and costly medical conditions: acute myocardial infarction (AMI), heart failure (HF), and pneumonia. This study examined the quality and equity of hospital care during the six years following initiation of the IQR Program (2005 to 2010), focusing on 17 process-of-care quality indicators publicly reported by the program for white, black, and Hispanic patients hospitalized for AMI, HF, and pneumonia in non-VA hospitals. Equity in care was defined as the difference in quality measure performance rates between white and minority patients. Patient-level variables included age, sex, education, poverty level (determined by zip code), comorbid medical conditions, and admission to an intensive care unit (pneumonia only). Hospital-level variables included urban location, bed size, teaching status, Census region, and number of annual admissions for AMI, HF, and pneumonia. Using CMS data, investigators identified the following numbers of hospitalizations during the study period: 2,831,343 for AMI; 4,718,790 for pneumonia; and 4,897,021 for HF.
FINDINGS:
- From 2005 to 2010 – following an ambitious public reporting initiative among U.S. acute care hospitals – improved performance on quality measures for white, black, and Hispanic adults hospitalized with AMI, HF, and pneumonia was accompanied by increased racial/ethnic equity in performance rates both within and between U.S. hospitals. Over this time period, adjusted performance rates for the 17 quality measures improved by 3.4 to 57.6 percentage points for white, black, and Hispanic patients.
- In 2010, unadjusted performance rates exceeded 90% for all subgroups for 14 of 17 measures.
- Declining racial/ethnic differences occurred through more equitable care for white and minority patients treated in the same hospital, as well as greater performance improvements among hospitals that disproportionately serve minority patients.
LIMITATIONS:
- Investigators could not ascribe a causal relationship between the IQR Program and improvements in healthcare quality or equity.
- Race/ethnicity data were based on secondary (administrative) sources.
- This study did not determine whether improved performance on IQR process-of-care measures produced better clinical outcomes or improvements in patients' healthcare experiences.
- Study data do not explain mechanisms by which healthcare improved or disparities narrowed.
AUTHOR/FUNDING INFORMATION:
Dr. Hausmann was supported by an HSR&D Research Career Development award. Dr. Trivedi is part of HSR&D's Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans in Providence, RI, and Dr. Hausmann is part of HSR&D's Center for Health Equity Research & Promotion in Pittsburgh, PA.
Trivedi AN, Nsa W, Hausmann L, et al. Quality and Equity of Care in U.S. Hospitals The New England Journal of Medicine. December 11, 2014;371(24):2298-308.
