Is There Value In National Quality Reporting Programs?
Journal Wrap | Does participation in a national quality reporting program make a difference with regard to 30-day mortality, serious complications, reoperation, readmission in 30 days, and costs? This was the question tackled by Nicholas H. Osborne, MD, MS, of the Center for Healthcare Outcomes and Policy and the Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, University of Michigan, Anne Arbor, et al, in a recent study published in the Journal of the American Medical Association.
The study, which used Medicare data from 2003-2012, looked at a total of 1,226,478 patients undergoing general and vascular surgery at 263 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and 526 non-participating hospitals. A quasi-experimental analytics approach—difference-in-differences—was used to evaluate whether participation in ACS NSQIP was associated with improved surgical outcomes and reduced costs compared with non-participating hospitals that were otherwise similar.
After accounting for patient and secular factors, overall results showed no statistically significant differences in outcomes at 1, 2 or 3 years after enrollment in ACS NSQIP. Specifically, there were no statistically significant differences in risk-adjusted 30-day mortality (4.3% after enrollment vs. 4.5% before enrollment), serious complications (11.1% after enrollment vs. 11.0% before enrollment), reoperations (0.49% after enrollment vs. 0.45% before enrollment), or readmissions (13.3% after enrollment vs. 12.8% before enrollment). Mean total Medicare payments were also similar, as were payments for the index admission, hospital readmission, and outliers.
“With time, hospitals had progressively better surgical outcomes, but enrollment in a national quality reporting program was not associated with the improved outcomes or lower Medicare payments in surgical patients,” the authors concluded. “Feedback on outcomes alone may not be sufficient to improve surgical outcomes.”
“This study is from an experienced surgical outcomes group, and I believe it is a fantastic study,” writes Brahmajee K. Nallamothu, MD, in an ACC Journal Scan perspective. “The big take-home (and surprising) message is that little association was found between the national NSQIP QI reporting program and outcomes. This study was elegantly designed, overcoming the biggest Achilles’ heel in contemporary policy evaluation: the lack of adequate control groups. … At the ground level, these findings challenge existing dogma and raise key questions about how reporting efforts in QI may require better designs. They have direct implications for similar registries and programs within cardiology and cardiac surgery.”
Osborne N, Nicholas L, Ryan A, Thumma J, J Dimick. JAMA. 2015;313:496-504.
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