Grading hospitals on the quality of care they provide is intended to improve surgical outcomes, but a pair of new studies in JAMA suggests facility report cards have little to no effect on how procedures turn out.

In the first study, researchers at the University of Michigan in Ann Arbor analyzed surgical outcomes and Medicare payments among approximately 1.25 million beneficiaries who underwent general or vascular surgeries at 263 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and 526 non-participating hospitals. According to the findings, surgical outcomes improved in both types of hospitals over the 3-year period with no significant difference with respect to 30-day mortality rates, serious complications, reoperations, readmissions or average total Medicare payments.

"Although NSQIP hospitals are improving over time, so are other non-participating hospitals," says Nicholas Osborne, MD, MS, the study's lead author and a vascular surgeon at the University of Michigan Health System. "Our study suggests that the NSQIP is a good start, but that reporting data back to hospitals is not enough. The next leap from measuring outcomes to improving outcomes is much more difficult."

In the second study, researchers at the Mayo Clinic Arizona in Phoenix compared rates of complications, serious complications and mortality among approximately 345,000 patients, half of whom received care at NSIQ-participating hospitals. During the 4-year study, rates of overall post-op complications and mortality decreased in both participating and non-participating hospitals.

"The findings show that surgical outcomes are improving over time in both groups of hospitals, in ways that are significant but similar," says study lead author David A Etzioni, MD, MSHS, chair of the Mayo Clinic's division of colorectal surgery.

Dr. Etzioni notes that his research team wasn't interested in whether hospitals that participated in the NSQIP did better or worse than non-participating hospitals, but whether the outcomes improved over time in a way that was different.

"The NSQIP represents the culmination of a tremendous amount of technology, methodology and work that very intelligent people have applied to improving quality in surgery," says Dr. Etzioni. "When it comes to really moving the dial on surgical quality improvements, we have to dig deeper and get more creative, potentially becoming much more comprehensive than the approaches we employ today."

Daniel Cook