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Lack of Relationship Between the Cleveland Health Quality Choice Project and Decreased Inpatient Mortality in Cleveland

Cleveland Clinic Foundation, Cleveland, Ohio, Cloughj{at}ccf.org

David Engler, PhD

Data Services, Ohio Hospital Association, Columbus, Ohio

Richard Snow, DO, MPH

Applied Health Services, Columbus, Ohio

Phillip E. Canuto, MA

Cleveland, Ohio

The Cleveland Health Quality Choice (CHQC) project was previously suggested to have been responsible for declines in inpatient mortality in Cleveland hospitals during the first years of the project (1992-1993). We sought to (a) verify this decline in mortality and (b) better understand its possible relationship to CHQC. We employed regression analysis to compare mortality rate trends for Cleveland versus the rest of Ohio using Ohio Hospital Association inpatient mortality data. We found that the rate of decline in mortality in Cleveland (-.218% per 6 months; 95% confidence limits, -.278% to -.159% per 6 months) was statistically indistinguishable from that in the rest of the state (-.188% per 6 months; 95% confidence limits, -.234% to -.143% per 6 months) (P = .35). We could not demonstrate a significant beneficial effect of the CHQC project on hospital mortality in Cleveland. Inpatient mortality was simultaneously declining at a statistically indistinguishable rate throughout the state.

Key Words: Accountability • Mortality • Public reporting • Quality indicators • Report card • Risk adjustment

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