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Related Experiment Videos

The California Hospital Outcomes Project: using administrative data to compare hospital performance

P S Romano1, A Zach, H S Luft

  • 1Medicine and Pediatrics, University of California, Davis, USA.

The Joint Commission Journal on Quality Improvement
|December 1, 1995
PubMed
Summary

The California Hospital Outcomes Project reports on risk-adjusted hospital quality using data from discharge abstracts. Initial reports identified hospitals performing better than expected for acute myocardial infarction and diskectomy procedures.

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Area of Science:

  • Health Services Research
  • Public Health Policy
  • Quality Improvement

Background:

  • Established in 1991, the California Hospital Outcomes Project (CHOP) aims to improve healthcare quality.
  • The California Office of Statewide Health Planning and Development (OSHPD) publishes annual risk-adjusted hospital outcome reports.
  • Key indicators include mortality (acute myocardial infarction), complications and length of stay (diskectomy), and readmissions (delivery).

Purpose of the Study:

  • To assess and report on risk-adjusted hospital outcomes across California.
  • To provide comparative data on hospital performance to providers and the public.
  • To encourage quality improvement initiatives within healthcare facilities.

Main Methods:

  • Utilized discharge abstract data submitted by hospitals and edited by OSHPD.

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  • Employed two risk adjustment models to calculate expected and observed hospital outcome rates.
  • Statistical significance was determined using p values to assess the likelihood of observed outcomes occurring by chance.

    • Main Results:

    • The first report (1993) identified 14 hospitals as "better than expected" for acute myocardial infarction (AMI) and 30 for diskectomy procedures.
    • The second report was distributed in June 1995.
    • Hospitals engaged with the 1993 report findings, evaluating coding and care quality.

    Conclusions:

    • Hospital engagement with outcome reports suggests a positive impact on quality assessment.
    • Media coverage highlighted both the balanced reporting and a perceived lack of "worse" performing hospital identification.
    • OSHPD initiated a validation study to investigate factors contributing to outcome variations, such as coding practices and unmeasured risk factors.