Impact of Case Volume on Medicare's Quality Care Performance Measures and Mortality Rates for Heart Failure

Abstract

Background: Process performance measures are increasingly used to assess and reward hospital quality. Recent data on acute myocardial infarction have shown the advantages of small case volume on the hospital performance measures. Little is known about how these measures correlate with case volume and mortality in heart failure (HF). Method(s): Using data from U.S. Department of Health&Human Services, we examined hospital performance for 4 publicly reported process measures for heart failure , namely, HF-1 discharge instruction, HF-2 left ventricular function assessment, HF-3 ACE inhibitors or ARB use and HF-4 smoking cessation counseling, from 4138 US hospitals during the reporting period of April 2007 to March 2008. Determination of hospital case volume was based on the median number of cases for the particular quality performance measure. We examined the association between hospital case volume, process performance, and 30 day HF mortality rate. Result(s): Sample sizes available for process performance assessment varied considerably, ranging from 1 patient to 2241 patients per hospital. In aggregate, hospitals with larger HF case volumes had better process performance. (Table presented) We also found that hospitals with larger case volume have lower risk adjusted 30-day heart failure mortality rate. Conclusion(s): Large-volume hospitals had better aggregate performance measures for heart failure. This finding may be explained by the availability of resources available to hospital that handles large volume of HF hospitalization.