Quality initiatives don't make hospitals safer

Participating in a national quality improvement initiative doesn't make a hospital any safer than those organizations not participating in such programs.

A team of researchers from the University of Michigan Medical School compared the performance of 263 hospitals participating in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) with that of 526 hospitals not involved in the initiative for a study published in the Journal of the American Medical Association.

The study included data from more than 1.2 million Medicare beneficiaries who had undergone one of 11 major operations at the hospitals over a 10-year period.

Under the ACS-NSQIP effort, nurses at participating hospitals record and send to a secure database information on every operation performed at the facilities. ACS-NSQIP then shares quality reports so that hospitals and doctors can see how they compare with other providers.

The researchers found no indication that ACS-NSQIP hospitals performed better than non-participating hospitals.

Participating hospitals saw slight improvements in four areas, but the researchers said that the changes were not statistically significant--12.8 percent of Medicare beneficiaries were readmitted within 30 days before the hospitals enrolled in the program, compared with 13.3 percent after three years of participation; 11 percent of Medicare beneficiaries suffered serious complications before hospitals enrolled, compared with 11.1 percent after three years of participation; 4.5 percent of Medicare beneficiaries died within 30 days before hospitals enrolled, compared with 4.3 percent after three years of participation; and 0.45 percent of Medicare beneficiaries had a second operation before hospitals enrolled, compared with 0.49 percent after three years of participation.

Rates for such adverse events were slightly higher at hospitals that never participated in the program. For example, about 5% of Medicare beneficiaries at non-participating hospitals died within 30 days of their operation. However, rates also dropped at non-participating hospitals over the study period.