Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals
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The Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance.
An investigator-blinded, structured telephone survey of eligible hospitals’ (N = 92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture.
More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p < 0.01), HF (44% vs. 18%, p < 0.01), PN (38% vs. 13%, p < 0.01) and THR/TKR (56% vs. 23%, p < 0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p < 0.05) and HF (93% vs. 69%, p < 0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p < 0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p < 0.05). Finally, more top performers reported having adequate human resources for QI projects (p < 0.01); support of the nursing staff to increase adherence to quality indicators (p < 0.01); and an organizational culture that supported coordination of care (p < 0.01), pace of change (p < 0.01), willingness to try new projects (p < 0.01), and a focus on identifying system errors rather than blaming individuals (p < 0.05).
Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care.
- Centers for Medicare and Medicaid Services. CMS HQI Demonstration Project: Composite Quality Score Methodology Overview. Available at: http://www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalCompositeQualityScoreMethodologyOverview.pdf#search=%22CMS%20HQI%20Demonstration%20Project%22. Accessed April 7, 2009.
- Centers for Medicare and Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration Project. Project Overview and Findings from Year One. April 13, 2006. Available at: http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/hqi-whitepaper041306.pdf. Accessed April 7, 2009.
- Centers for Medicare and Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration Project. Project Findings from Year Two. May 2007. Available at: http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/resources/hqi-whitepaper-year2.pdf. Accessed April 7, 2009.
- Lindenauer PK, Remus D, Roman S, et al. Public reporting and pay for performance in hospital quality improvement. N Engl J Med. 2007;356(5):486–96. CrossRef
- Glickman SW, Ou FS, DeLong ER, et al. Pay for performance, quality of care, and outcomes in acute myocardial infarction. JAMA. 2007;297(21):2373–80. CrossRef
- Jha AK, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals-the Hospital Quality Alliance program. N Engl J Med. 2005;353(3):265–74. CrossRef
- Bradley EH, Herrin J, Mattera JA, et al. Quality improvement efforts and hospital performance: rates of beta-blocker prescription after acute myocardial infarction. Med Care. 2005;43(3):282–92. CrossRef
- Ellerbeck EF, Bhimaraj A, Hall S. Impact of organizational infrastructure on beta-blocker and aspirin therapy for acute myocardial infarction. Am Heart J. 2006;152(3):579–84. CrossRef
- Reingold S, Kulstad E. Impact of human factor design on the use of order sets in the treatment of congestive heart failure. Acad Emerg Med. 2007;14(11):1097–105.
- Fonarow GC, Abraham WT, Albert NM, et al. Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Arch Intern Med. 2007;167(14):1493–502. CrossRef
- Fishbane S, Niederman MS, Daly C, et al. The impact of standardized order sets and intensive clinical case management on outcomes in community-acquired pneumonia. Arch Intern Med. 2007;167(15):1664–9. CrossRef
- Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345(13):965–70. CrossRef
- Dexter PR, Perkins SM, Maharry KS, Jones K, McDonald CJ. Inpatient computer-based standing orders vs. physician reminders to increase influenza and pneumococcal vaccination rates: a randomized trial. JAMA. 2004;292(19):2366–71. CrossRef
- Ozdas A, Speroff T, Waitman LR, Ozbolt J, Butler J, Miller RA. Integrating “best of care” protocols into clinicians’ workflow via care provider order entry: impact on quality-of-care indicators for acute myocardial infarction. J Am Med Inform Assoc. 2006;13(2):188–96. CrossRef
- Butler J, Speroff T, Arbogast PG, et al. Improved compliance with quality measures at hospital discharge with a computerized physician order entry system. Am Heart J. 2006;1513:64(3)–53. CrossRef
- Marciniak TA, Ellerbeck EF, Radford MJ, et al. Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project. JAMA. 1998;279(17):1351–7. CrossRef
- Metersky ML, Galusha DH, Meehan TP. Improving the care of patients with community-acquired pneumonia: a multihospital collaborative QI project. Jt Comm J Qual Improv. 1999;25(4):182–90.
- Chu LA, Bratzler DW, Lewis RJ, et al. Improving the quality of care for patients with pneumonia in very small hospitals. Arch Intern Med. 2003;163(3):326–32. CrossRef
- Ferguson TB Jr., Peterson ED, Coombs LP, et al. Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial. JAMA. 2003;290(1):49–56. CrossRef
- Soumerai SB, McLaughlin TJ, Gurwitz JH, et al. Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial. JAMA. 1998;279(17):1358–63. CrossRef
- Nolan E, VanRiper S, Talsma A, et al. Rapid-cycle improvement in quality of care for patients hospitalized with acute myocardial infarction or heart failure: moving from a culture of missed opportunity to a system of accountability. J Cardiovasc Manag. 2005;16(1):14–9.
- Pines JM, Hollander JE, Lee H, Everett WW, Uscher-Pines L, Metlay JP. Emergency department operational changes in response to pay-for-performance and antibiotic timing in pneumonia. Acad Emerg Med. 2007;14(6):545–8. CrossRef
- Horne M. Involving physicians in clinical pathways: an example for perioperative knee arthroplasty. Jt Comm J Qual Improv. 1996;22(2):115–24.
- Weiner BJ, Alexander JA, Shortell SM, Baker LC, Becker M, Geppert JJ. Quality improvement implementation and hospital performance on quality indicators. Health Serv Res. 2006;41(2):307–34. CrossRef
- Shortell SM, Jones RH, Rademaker AW, et al. Assessing the impact of total quality management and organizational culture on multiple outcomes of care for coronary artery bypass graft surgery patients. Med Care. 2000;38(2):207–17. CrossRef
- Shortell SM, Zazzali JL, Burns LR, et al. Implementing evidence-based medicine: the role of market pressures, compensation incentives, and culture in physician organizations. Med Care. 2001;39(7 Suppl 1):I62–78.
- Nelson EC, Batalden PB, Huber TP, et al. Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Jt Comm J Qual Improv. 2002;28(9):472–93.
- Damberg C, Sorbero M, Mehrorta A, Teleki S, Lovejoy S, Bradley L. An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. November 2007. Available at: http://aspe.hhs.gov/health/reports/08/payperform/index.htm. Accessed April 7, 2009.
- Donabedian A. Evaluating the quality of medical care. 1966. Milbank Q. 2005;83(4):691–729. CrossRef
- Bradley EH, Holmboe ES, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM. A qualitative study of increasing beta-blocker use after myocardial infarction: Why do some hospitals succeed? JAMA. 2001;285(20):2604–11. CrossRef
- Cannon CP, Johnson EB, Cermignani M, Scirica BM, Sagarin MJ, Walls RM. Emergency department thrombolysis critical pathway reduces door-to-drug times in acute myocardial infarction. Clin Cardiol. 1999;22(1):17–20. CrossRef
- Pell AC, Miller HC, Robertson CE, Fox KA. Effect of “fast track” admission for acute myocardial infarction on delay to thrombolysis. BMJ. 1992;304(6819):83–7. CrossRef
- Caputo RP, Ho KK, Stoler RC, et al. Effect of continuous quality improvement analysis on the delivery of primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. Am J Cardiol. 1997;79(9):1159–64. CrossRef
- Ward MR, Lo ST, Herity NA, Lee DP, Yeung AC. Effect of audit on door-to-inflation times in primary angioplasty/stenting for acute myocardial infarction. Am J Cardiol. 2001;87(3):336–8, A9. CrossRef
- Cannon CP, Hand MH, Bahr R, et al. Critical pathways for management of patients with acute coronary syndromes: an assessment by the National Heart Attack Alert Program. Am Heart J. 2002;143(5):777–89. CrossRef
- Ranjan A, Tarigopula L, Srivastava RK, Obasanjo OO, Obah E. Effectiveness of the clinical pathway in the management of congestive heart failure. South Med J. 2003;96(7):661–3. CrossRef
- Meehan TP, Weingarten SR, Holmboe ES, et al. A statewide initiative to improve the care of hospitalized pneumonia patients: The Connecticut Pneumonia Pathway Project. Am J Med. 2001;111(3):203–10. CrossRef
- Gregor C, Pope S, Werry D, Dodek P. Reduced length of stay and improved appropriateness of care with a clinical path for total knee or hip arthroplasty. Jt Comm J Qual Improv. 1996; 229: 617–28.
- Dowsey MM, Kilgour ML, Santamaria NM, Choong PF. Clinical pathways in hip and knee arthroplasty: a prospective randomised controlled study. Med J Aust. 1999;170(2):59–62.
- Feldman AM, Weitz H, Merli G, et al. The physician-hospital team: a successful approach to improving care in a large academic medical center. Acad Med. 2006;81(1):35–41. CrossRef
- O’Mahony S, Mazur E, Charney P, Wang Y, Fine J. Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. J Gen Intern Med. 2007;22(8):1073–9. CrossRef
- Ellrodt G, Glasener R, Cadorette B, et al. Multidisciplinary rounds (MDR): an implementation system for sustained improvement in the American Heart Association’s Get With The Guidelines program. Crit Pathw Cardiol. 2007;6(3):106–16.
- Kuperman GJ, Gibson RF. Computer physician order entry: benefits, costs, and issues. Ann Intern Med. 2003;139(1):31–9.
- Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144(10):742–52.
- Beck CA, Richard H, Tu JV, Pilote L. Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, a cluster randomized trial. JAMA. 2005;294(3):309–17. CrossRef
- Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals
Journal of General Internal Medicine
Volume 24, Issue 7 , pp 833-840
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- organizational factors
- organizational culture
- hospital performance measurement
- Industry Sectors
- Author Affiliations
- 1. Zynx Health, 10880 Wilshire Blvd., Suite 300, Los Angeles, CA, 90024, USA
- 2. Cedars-Sinai Medical Center, Department of Medicine, Division of Health Services Research, Los Angeles, CA, USA
- 3. David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, CA, USA