Infections, Mortality Don’t Always Tell Hospital Quality,
ICU-acquired infection rates are not an indication
of patients’ mortality risk, according to researchers at the
University of Pennsylvania, undermining a central tenet of many P4P
To examine whether or not publicly-reported
infection rates actually identify the best hospitals based on
mortality, Dr. Kate Courtright, resident physician at the University of
Pennsylvania, and colleagues looked at patients in 158 Pennsylvania
hospitals especially at risk for two types of infections: pneumonia and
blood stream infections.
They calculated hospital death rates, accounting
for differences in illness severity, across 158 hospitals and compared
them to ICU-acquired infection rates obtained from a public state
website. They then used statistical strategies to determine the
relationship between infections and death.
"We found that ICU-acquired infection rates as
reported on a state web site did not correlate with death rates for
at-risk patients," said Courtright, lead author of the abstract. "In
fact, hospitals with lower rates of ICU-acquired infection did not also
have lower death rates for at-risk patients."
Courtright said that ICU-acquired infections rates
are likely to continue to be a part of hospital report cards, despite
the limitations of those report cards.
She cautioned that policy-makers and the public
should realize that these rates "provide limited information about the
quality of the hospital, and may misidentify high and low performers."
More care is needed to make sure that hospital
report cards don’t do more harm than good. This is especially
important because under upcoming health care reform, infection rates
are also to be used for hospital reimbursement – hospitals
with high infection rates will not be reimbursed as well for their
care. Such a strategy may actually penalize good hospitals with low
"Report cards only work if they successfully
identify the best hospitals," concluded Courtright. "We were surprised
to find that many hospitals with good report cards from an infection
standpoint are not that good from a more important standpoint
– patient survival. Additionally, many hospitals with high
infection rates actually had very good survival rates."
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