Patients are more likely to receive higher-quality care in not-for-profit hospitals than in for-profit hospitals for three common medical conditions (congestive heart failure, heart attack, and pneumonia), reports a Harvard Medical School analysis published in the Dec. 11 Archives of Internal Medicine. Federal and military hospitals had the highest performance, however, which is likely the result of the Veterans Health Administration’s long experience in quality improvement, say the researchers. In general, hospitals with higher registered nurse staffing levels performed better on all quality measures, but licensed practical nurse staffing was associated with lower performance. Hospitals that served greater proportions of Medicaid patients had low quality of care across all conditions studied. And hospitals in the Midwest and Northeast (not in rural areas) had better performance, as did hospitals with more advanced technology available.
Besides assessing the quality of care in more than 4,000 U.S. hospitals, the researchers examined the relationships between the various quality measures. This analysis suggests that rather than examining quality by disease (e.g., acute myocardial infarction, CHF, or pneumonia), it might be more useful from a quality improvement perspective to examine quality measures according to functional roles in the hospital. They created composite measures in the areas of treatment and diagnosis and counseling and prevention as well for each of the three diseases, but found that quality varied more by functional roles in the hospital than by the particular disease being treated. “Therefore, efforts to improve quality in hospitals should focus on core competencies that can improve care across multiple diagnoses,” the researchers write. Read the news release.
