PERFORMANCE-MEASUREMENT IN PNEUMONIA CARE - BEYOND REPORT CARDS

Objective: To compare the medical management of bacteremic pneumococca l pneumonia at a university-based and a community-based teaching hospi tal and evaluate strategies for performance measurement and subsequent improvement. Design: We conducted a retrospective cohort study involv ing a 450-bed university hospital in the inner city and a 400-bed priv ate hospital in a rural community. Material and Methods: The medical r ecords of all adults with bacteremic pneumococcal pneumonia admitted t o a university and a community hospital during a 5-year period were re viewed. Information about patient age, sex, underlying medical conditi on, severity of disease, health-care insurance, management, and outcom e was collected and analyzed. Results: Patients at the two hospitals w ere similar in underlying illnesses and severity of disease. In compar ison with the community hospital, resource expenditure was greater at the university hospital, where all 11 identified diagnostic measures a nd treatment resources were used more often. This difference was stati stically significant for sputum cultures, all cultures, and lumbar pun ctures. Despite the greater intensity of care, in-hospital mortality w as higher at the university hospital (26%) than at the community hospi tal (12%) (P>0.1). Conclusion: The outcome of bacteremic pneumococcal pneumonia did not differ significantly at a university hospital in com parison with a community teaching hospital, even though resource expen diture at the university hospital was greater. Our findings suggest th at hospital ''report cards'' based solely on outcome comparisons provi de inadequate information. In contrast, examination of variations in p rofiles of resource utilization can detect important differences in ho spitals and can be used to guide continuous quality improvement effort s and ultimately improve hospital care.