Project: Research project

Project Details


Information about quality of care is of increasing interest to consumers,
purchasers, and providers of health care. In response, federal and state
agencies, provider organizations, and private coalitions are generating
hospital outcome studies. Yet fundamental questions about these studies
have never been answered. Do consumers use information about hospital
outcomes in choosing physicians and hospitals, if it is available? Do
purchasers use such information in creating provider networks? Do
providers use such information in the quality improvement process? If so,
do outcomes change as a result? What is the relationship between external
and internal review of quality, and how can organizations become receptive
to external review? In short, what are the outcomes of hospital outcome
studies? The specific aims of the proposed research include: (1) to evaluate the
impact of publicly released hospital outcomes data on AMIs, diskectomies,
and deliveries in CA, and data on CABGs and PTCAs in NY, on hospital
volumes and referral patterns; (2) to evaluate whether this impact varies
by age, gender, race/ethnicity, insurance source, diagnostic category,
urgency of admission, or market characteristics; (3) to evaluate the
impact of publicly released outcomes data on hospital-specific outcomes,
coding of clinical risk factors, patient case mix, and statewide outcomes;
(4) to explore how hospitals in CA and NY have used outcomes data, and to
solicit feedback concerning the optimal content and format of outcomes
reports; (5) to explore how other interest groups, such as consumer
organizations and purchasers, have used outcomes data, and to solicit
similar feedback; and (6) to apply these results in designing a new
generation of hospital outcome studies that will be more responsive to the
needs of consumers, providers, and purchasers. The first five questions
will be reevaluated in the final year of the research program. The analyses of consumer behavior will use California's Patient Discharge
Data Set and New York's Statewide Planning and Research Cooperative
System, Cardiac Surgery Reporting System, and Coronary Angioplasty
Reporting System. All admissions to non-federal, non-HMO, acute care
hospitals among adults with conditions other than mental disorders,
injury, poisoning, and rehabilitation between 1/1/94 and 12/31/95 will be
examined. Total and condition-specific hospital volumes and volumes of
longdistance patients will be compared before and after publication of
outcomes data, both overall and stratified as above. The quantitative
analyses of provider behavior will use the same data systems, but will be
limited to patients eligible for inclusion in the relevant outcomes study.
Risk-adjusted outcome rates will be compared before and after publication
of outcomes data. Any observed improvement at hospitals with high outcome
rates will be attributed proportionately to changes in coding practice,
selective out-referral, or improved quality of care. At the same time,
mail and telephone surveys will be conducted to explore how providers and
purchasers have assimilated and responded to risk-adjusted outcomes data.
The results of this research will be used to improve the usefulness of
outcomes reports in CA and NY; the impact of these reports will be
comprehensively reevaluated after some of the recommended changes have
been implemented.
Effective start/end date9/30/9410/31/99


  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health


  • Medicine(all)


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