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US Dept of Health & Human Services- CMS

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US Dept of Health & Human Services- CMS

Frequency: Quarterly

Measure Type: Process

The Centers for Medicare & Medicaid Services (CMS) along with the Hospital Quality Alliance (HQA) has developed a database system, which provide reports on the quality of care in hospitals. This is essential information for the public, allowing consumers to attain access on the description of hospitals influencing health care decisions.

Reports are collected voluntarily from hospitals presenting information on the patient’s medical records. Small hospitals such as “acute care” hospitals (inpatient services for short term illness) and “critical access” hospitals (small facilities providing inpatient and outpatient services) were accessed for data intake. Currently for HQA, there are 22 measures used to evaluate the acute care hospitals. The measures for HQA began in October 2003 with the ten “starter set” measures; following seven measures in April 2005. In September 2005, three new measures were added, and another measure in December 2006. A recent measure has been added in June 2007. Critical access hospitals provide acute care but they do not receive financial incentives to report, causing only several hospitals to collect data on hospital quality.

The process of care measures is utilized on patients who have been admitted into the hospital for a heart attack, heart failure, pneumonia, and surgical infection prevention. In December 2007, HQA will have updated reports for the public. Using the QualityNet website some the results that have been submitted for December is available for viewing, but all the data are currently not entered.

HQA also looks at Risk-Adjusted 30 Day Mortality Rates. Information is based on Medicare claims. They anticipate patient deaths for any cause within 30 days of hospital admission. This includes whether or not they are still in the hospital or have been discharged. Only patients with a heart attack or heart failure were used for this measure.

To measure risk-adjust mortality rates, calculations and adjustments have to be made where patients who have a greater illness will not have a higher mortality rate, as opposed to a patient who is not as ill. This creates a subjective measure decreasing validity with its results. Dr. Krumholz in 2006, created a model to measure this scale. He collected data on patients who were over 64 years of age (since they have a higher rate for heart attacks). He also did not include patients who were admitted into the hospital for less than a day. Another conflict with this scale are the resources for the data. The Risk-Adjusted Mortality Rates are only used on patients with Medicare and they do not always mirror the information from the patients’ medical records.

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