Does the Leapfrog Program Help Identify High-Quality Hospitals?

摘要

Background: Founded in 2000, the Leapfrog Group includes more than 65 employers and agencies that together purchase care for more than 34 million people. It has focused on measuring and reporting hospitals' adoption of evidence-based practices to improve patient safety. Whether this program helps identify high-quality hospitals is unknown. A study was conducted to determine whether hospitals that report patient safety practice activities have better quality of care or clinical outcomes. Methods: Hospitals targeted by Leapfrog for implementation of three sets of patient safety practices-computerized physician order entry (CPOE), intensive care unit physician staffing, and evidence-based referrals (EBRs) for high-mortality surgeries-were examined. Data from the Hospital Quality Alliance (HQA) were used to determine quality of care and outcomes for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia. Results: Among the 1,860 hospitals targeted by Leapfrog, those with substantive efforts implementing three sets of patient safety practices had better quality of care for all three conditions, although the differences were small for pneumonia. For example, hospitals with CPOE had better AMI quality scores than those that either did not have CPOE or those that chose not to report (95.2% versus 92.0% versus 90.1%, respectively;p < .001), Hospitals with CPOE and IPS had lower 30-day mortality rates for AMI and pneumonia. For example, the 30-day AMI mortality rate for hospitals with CPOE was 15.2% compared with hospitals without CPOE (16.7%) or nonreporting hospitals (17.8%; p value for difference = .002). The results for the six EBRs were similar.Discussion: Consumers who choose hospitals identified by Leapfrog as having begun to implement patient safety practices will likely find hospitals with better process quality and lower mortality rates.