Abstract
BackgroundHospital performance quality assessments inform patients, providers, payers, and purchasers in making healthcare decisions. These assessments have been developed by government, private and non-profit organizations, and academic institutions. Given the number and variability in available assessments, a knowledge gap exists regarding what assessments are available and how each assessment measures quality to identify top performing hospitals. This study aims to: (a) comprehensively identify current hospital performance assessments, (b) compare quality measures from each methodology in the context of the Institute of Medicine’s (IOM) six domains of STEEEP (safety, timeliness, effectiveness, efficiency, equitable, and patient-centeredness), and (c) formulate policy recommendations that improve value-based, patient-centered care to address identified gaps.MethodsA scoping review was conducted using a systematic search of MEDLINE and the grey literature along with handsearching to identify studies that provide assessments of US-based hospital performance whereby the study cohort examined a minimum of 250 hospitals in the last two years (2017–2019).ResultsFrom 3058 unique records screened, 19 hospital performance assessments met inclusion criteria. Methodologies were analyzed across each assessment and measures were mapped to STEEEP. While safety and effectiveness were commonly identified measures across assessments, efficiency, and patient-centeredness were less frequently represented. Equity measures were also limited to risk- and severity-adjustment methods to balance patient characteristics across populations, rather than stand-alone indicators to evaluate health disparities that may contribute to community-level inequities.ConclusionsTo further improve health and healthcare value-based decision-making, there remains a need for methodological transparency across assessments and the standardization of consensus-based measures that reflect the IOM’s quality framework. Additionally, a large opportunity exists to improve the assessment of health equity in the communities that hospitals serve.
Highlights
Hospital performance quality assessments inform patients, providers, payers, and purchasers in making healthcare decisions
Inclusion criteria were limited to identifying published studies from 2017 to 2019 that included methodologies examining performance of 250 or more hospitals, which allowed for generalizable synthesis
Summary of included assessments From 3058 unique records screened, 19 hospital performance assessments described in the literature met inclusion criteria (Fig. 1)
Summary
Hospital performance quality assessments inform patients, providers, payers, and purchasers in making healthcare decisions. This study aims to: (a) comprehensively identify current hospital performance assessments, (b) compare quality measures from each methodology in the context of the Institute of Medicine’s (IOM) six domains of STEEEP (safety, timeliness, effectiveness, efficiency, equitable, and patient-centeredness), and (c) formulate policy recommendations that improve value-based, patient-centered care to address identified gaps. Used domains for understanding quality are the Institute of Medicine’s (IOM) framework (safety, timeliness, effectiveness, efficiency, equitable, and patientcenteredness; the acronym referred to as “STEEEP”). Using these domains may help balance quality with value for particular measures. Employing the domains of STEEEP may reduce variation in how care is delivered and practiced, revealing differences that exist across geographic, cost, and personal (e.g. racial) characteristics [6, 7]
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