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The association between the hospital quality alliance's pneumonia measures and discharge costs
Shadi Saleh1, Mark Callan, Kassem Kassak
1Department of Health Management and Policy, American University of Beirut. USA.
Insights
Improving hospital quality for pneumonia care, specifically oxygenation assessment, may lead to reduced patient discharge costs. Top performers in quality initiatives might see cost savings, encouraging continued efforts.
Area of Science:
- Healthcare Management
- Health Economics
- Quality Improvement
Background:
- Hospital performance on quality measures is increasingly scrutinized.
- The financial implications of adhering to quality standards require investigation.
Purpose of the Study:
- To examine the association between hospital performance on Hospital Quality Alliance (HQA) pneumonia measures and the costs of pneumonia discharges.
- To determine if quality improvement in pneumonia care impacts healthcare costs.
Main Methods:
- Cross-sectional study analyzing data from 189 New York hospitals in 2005.
- Included 48,574 pneumonia discharges (ICD-9 codes 480-487), excluding specific patient groups.
- Hospital-level costs were the outcome, with HQA pneumonia measures as the independent variable.
Main Results:
- Optimal performance on the oxygenation assessment measure showed a negative association with discharge costs.
- No significant association was found between composite HQA scores or other individual measures and costs.
- Top 10% performance in oxygenation assessment was borderline significantly linked to reduced costs, even after controlling for length of stay.
Conclusions:
- Quality improvement efforts in pneumonia care, particularly oxygenation assessment, may not increase costs and could potentially reduce them.
- Healthcare providers should continue quality improvement initiatives, as there is evidence of potential cost savings for top performers.
Objective:
This article examines the association between performance on the Hospital Quality Alliance's (HQA's) pneumonia measures and costs associated with pneumonia discharges.
Study Population:
Patients with pneumonia discharges (primary pneumonia diagnosis, ICD-9 codes 480-487) in New York hospitals (n = 189) during 2005 (n = 48,574). Discharges were excluded if the patient was younger than 18, discharged dead, or was transferred in from or out to an acute care facility.
Study Design:
The study is cross-sectional.
Measures:
The study outcome measure was hospital-level pneumonia discharges-related costs. The main independent variable comprised hospitals' performance on the three HQA pneumonia measures that are part of the "starter set." The hospital was the unit of analysis.
Results:
The use of a composite score measure, as well as the three individual measures, allowed for the identification of some differential impact among the measures. For example, optimal performance on the oxygenation assessment measure was found to be negatively associated with discharge costs, whereas there was no significant association between the composite scores or each of the other two measures and costs. An observation worth noting is the borderline, significant inverse relationship between being in the top 10 percent performance category of the oxygenation assessment measures and reduced discharge costs, which persisted even after controlling for length of stay.
Conclusions:
Providers should not be dissuaded from actively engaging in quality improvement efforts due to concerns over the costs required to provide high quality care. There is some evidence, albeit modest, that top performers may actually witness cost savings.
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