Quality of care for the treatment of acute medical conditions in US hospitals

Background: The Joint Commission on Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services recently began reporting on quality of care for acute myocardial infarction, congestive heart failure, and pneumonia. Methods: We linked performance data submitted for the first half of 2004 to American Hospital Association data on hospital characteristics. We created composite scales for each disease and used factor analysis to identify 2 additional composites based on underlying domains of quality. We estimated logistic regression models to examine the relationship between hospital characteristics and quality. Results: Overall, 75.9% of patients hospitalized with these conditions received recommended care. The mean composite scores and their associated interquartile ranges were 0.85 (0.81-0.95), 0.64 (0.52-0.78), and 0.88 (0.80-0.97) for acute myocardial infarction, congestive heart failure, and pneumonia, respectively. After adjustment, for-profit hospitals consistently underperformed not-for-profit hospitals for each condition, with odds ratios (ORs) ranging from 0.79 (95% confidence interval [CI], 0.78-0.80) for the congestive heart failure composite measure to 0.90 (95% CI, 0.89-0.91) for the pneumonia composite. Major teaching hospitals had better performance on the treatment and diagnosis composite (OR, 1.37; 95% CI, 1.34-1.39) but worse performance on the counseling and prevention composite (OR, 0.83; 95% CI, 0.82-0.84). Hospitals with more technology available, higher registered nurse staffing, and federal/military designation had higher performance. Conclusions: Patients are more likely to receive high-quality care in not-for-profit hospitals and in hospitals with high registered nurse staffing ratios and more investment in technology. Because payments and sources of payments affect some of these factors (eg, investments in technology and staffing ratios), policy makers should evaluate the effect of alternative payment approaches on quality.