USE OF RISK-ADJUSTED OUTCOME DATA FOR QUALITY IMPROVEMENT BY PUBLIC HOSPITALS

In 1993 the California Office of Statewide Health Planning and Develop ment (OSHPD) began public release of risk-adjusted monitoring of outco mes (RAMO) under the California Hospital Outcomes Project. We studied how 17 acute care public hospitals in California used these RAMO data for quality improvement purposes following their initial distribution, first, by analyzing the outcome data for San Francisco General Hospit al Medical Center as recommended by OSHPD and, second, by querying the departments at the other 16 public hospitals to determine how their o wn analyses compared. We found that the hospitals generally did minima l analyses of the OSHPD RAMO data and considered the data of little va lue to them. Only 3 hospitals initiated quality improvement activities based on their data review. The major reasons given by the hospitals for not using the RAMO data were that their outcomes were adequate, as verified by a comparison of their observed outcomes and those expecte d after risk-adjustment; that the hospitals had too few patients in th e diagnostic categories; that they had too few resources; and that the y were not concerned with the data's public release. Other possible ex planations were that awareness of the California Hospital Outcomes Pro ject was not widespread at the time of the study, that the RAMO data w ere not distributed in a way that encouraged their use, and that publi c hospitals were not inclined to use the outcome data because the proj ect was imposed on them. Whatever the explanation, our study suggests that the California Hospital Outcomes Project has had little effect on quality improvement in public hospitals.