Setting the Research Agenda for Quality Performance Analyses
*Arlene Sandra Ash, UMass Medical School
Keywords: shrinkage target, quality measurement, health policy
Hospital Compare is a CMS-sponsored website that reports quality measures for individual facilities by comparing their patients' outcomes to those of demographically and medically similar patients nationwide. However, nothing it reports directly addresses pressing policy-relevant questions, such as "what kinds of hospitals, patients, and hospital-patient interactions are associated with better and worse outcomes?" We suggest modifications to current methods to improve policy-relevant learning about quality. These include studying the effects of adding patient characteristics like race, ZIP code--inferred income, and rurality to patient-specific “expecteds,” and of incorporating hospital characteristics (size, staffing ratios, participation in a quality network, use of a surgical check list, etc.) into hospital-specific shrinkage targets. For example, to learn how to improve outcomes for African-American patients, we should first seek to identify the kinds of facilities in which these patients' observed aggregate outcomes systematically exceed what is "expected" based on their nationally determined norms.