Quality, accountability and P4P
With the Institute of Medicine’s publication in 2000 of “To Err is Human” the spotlight was placed on hospital quality and safety. Although the report’s claim that errors cause 44,000 to 98,000 hospital deaths each year is controversial it put patient safety initiatives in high gear. Since that time consumer activists have been demanding change. Although there has been some evidence that quality is improving, studies continue to show significant deviation from recommended practices. This study published in NEJM in 2003 suggested that adherence to recommended processes was just over 50% for acute care, suggesting significant room for improvement in hospital quality.
Meanwhile, data on hospital quality indicators is increasingly being made public as in, for example, the department of HHS Hospital Compare project and the independent health care rating company Healthgrades. (Although most of the information in Healthgrades is behind access control the hospital quality reports are open access).
Pay-for-performance (P4P) is one of the latest buzz words in the quality movement. The ultimate impact and sustainability of P4P is unknown, but this recent study in JAMA was not encouraging.
Although the concept of hospital quality is not new, the issue gained considerable momentum and was a major concern for hospitalists in 2005.