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American Journal of Medical Quality, Vol. 22, No. 3, 177-185 (2007)
DOI: 10.1177/1062860607300563

Determining Hospital Performance Based on Rank Ordering: Is It Appropriate?

Judy Anderson, MS

Outcomes Measurement Resources, Mount Carmel Health, Columbus, Ohio, janderson{at}mchs.com

Mark Hackman, MD

Mount Carmel East Hospital, Columbus, Ohio

Jeff Burnich, MD

Mount Carmel East Hospital, Columbus, Ohio

Thomas R. Gurgiolo, MA

Outcomes Measurement Resources, Mount Carmel Health, Columbus, Ohio

An increasing number of "pay for performance" initiatives for hospitals and physicians ascribe performance by ranking hospitals or physicians on quality of care measures. Payment is subsequently based on where a hospital or physician ranks among peers. This study examines the variability of ranking hospitals on quality of care measures and its impact on comparing hospital performance. Variability in the ranks of 3 quality of care measures was examined: discharge instruction for congestive heart failure, use of beta-blockers at discharge for heart attack, and timing of initial antibiotic therapy within 4 hours of admission to the hospital for pneumonia. The data are available on the Centers for Medicare and Medicaid Services Web site as part of the Hospital Quality Alliance project. We found that considerable uncertainty exists in ranking of hospitals on these measures, which calls into question the use of rank ordering as a determinant of performance. (Am J Med Qual 2007;22:177-185)

Key Words: hospitals • quality • comparing • pay for performance


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J. Fong, G. M. Marsh, L. A. Stokan, Weilian Sang, C. Vinson, and L. Ruhl
Hospital Quality Performance Report: An Application of Composite Scoring
American Journal of Medical Quality, July 1, 2008; 23(4): 287 - 295.
[Abstract] [PDF]