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Do well-publicized risk-adjusted outcomes reports affect hospital volume?

Patrick S Romano1, Hong Zhou

  • 1Division of General Medicine, Department of Internal Medicine, and the Center for Health Services Research in Primary Care, University of California, Davis School of Medicine, Sacramento, 95817, USA. psromano@ucdavis.edu

Medical Care
|April 13, 2004
PubMed

Insights

Hospital report cards show modest, short-term patient volume changes. Effects were mainly seen in New York for white Medicare patients undergoing coronary artery bypass grafting (CABG).

Area of Science:

  • Health Services Research
  • Health Economics
  • Public Health Policy

Background:

  • Hospital performance report cards are widely used but their actual impact on patient volume is not well understood.
  • Assessing the influence of public performance data on hospital utilization is crucial for healthcare policy.

Purpose of the Study:

  • To investigate if hospitals identified as performance outliers experience changes in patient volume post-report card publication.
  • To determine if favorable outliers attract more patients for related conditions or from wider geographic areas.
  • To examine if disadvantaged patient groups respond differently to hospital performance data.

Main Methods:

  • Time-series analysis using linear and autoregressive models.
  • Studied patient admissions for coronary artery bypass surgery (CABG) mortality in New York and acute myocardial infarction (AMI) mortality and postdiskectomy complications in California.
  • Analyzed observed versus expected hospital volume, stratified by demographics and insurance, adjusting for confounders.

Main Results:

  • No significant volume changes for AMI outliers in California; slight increase for low-complication diskectomy outliers.
  • In New York, low-mortality CABG outliers saw increased volume, while high-mortality outliers saw decreased volume shortly after report card release.
  • Impact was most pronounced among white patients with HMO coverage (California) and white/other patients with Medicare (New York).

Conclusions:

  • Patient volume effects from hospital report cards are generally modest and transient.
  • The impact is largely concentrated among specific demographic groups, such as white Medicare patients in New York.
  • Further research is needed to understand the broader implications for healthcare access and equity.
Abstract

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