The association between the hospital quality alliance's pneumonia measures and discharge costs

OBJECTIVE This article examines the association between performance on the Hospital Quality Alliance's (HQA's) pneumonia measures and costs associated with pneumonia discharges. STUDY POPULATION Patients with pneumonia discharges (primary pneumonia diagnosis, ICD-9 codes 480-487) in New York hospitals (n = 189) during 2005 (n = 48,574). Discharges were excluded if the patient was younger than 18, discharged dead, or was transferred in from or out to an acute care facility. STUDY DESIGN The study is cross-sectional. MEASURES The study outcome measure was hospital-level pneumonia discharges-related costs. The main independent variable comprised hospitals' performance on the three HQA pneumonia measures that are part of the "starter set." The hospital was the unit of analysis. RESULTS The use of a composite score measure, as well as the three individual measures, allowed for the identification of some differential impact among the measures. For example, optimal performance on the oxygenation assessment measure was found to be negatively associated with discharge costs, whereas there was no significant association between the composite scores or each of the other two measures and costs. An observation worth noting is the borderline, significant inverse relationship between being in the top 10 percent performance category of the oxygenation assessment measures and reduced discharge costs, which persisted even after controlling for length of stay. CONCLUSIONS Providers should not be dissuaded from actively engaging in quality improvement efforts due to concerns over the costs required to provide high quality care. There is some evidence, albeit modest, that top performers may actually witness cost savings.