Benchmarking and quality improvement: The Harvard Emergency Department Quality Study

PURPOSE: To determine whether feedback of comparative information was assoc iated with improvement in medical record and patient-based measures of qual ity in emergency departments. SUBJECTS AND METHODS: During 1-month study periods in 1993 and 1995, all me dical records for patients who presented to five Harvard teaching hospital emergency departments with one of six selected chief complaints (abdominal pain, shortness of breath, chest pain, hand laceration, head trauma, or vag inal bleeding) were reviewed for the percent compliance with process-of-car e guidelines. Patient-reported problems and patient ratings of satisfaction with emergency department care were collected from eligible patients using patient questionnaires. After reviewing benchmark information, emergency d epartment directors designed quality improvement interventions to improve c ompliance with the process-of-care guidelines and improve patient-reported quality measures. RESULTS: In the preintervention period, 4,876 medical records were reviewed (99% of those eligible), 2,327 patients completed on-site questionnaires ( 84% of those eligible), and 1,386 patients completed 10-day follow-up quest ionnaires (80% of a random sample of eligible participants). In the postint ervention period, 6,005 medical records were reviewed (99% of those eligibl e), 2,899 patients completed on-site questionnaires (84% of those eligible) , and 2,326 patients completed 10-day follow-up questionnaires (80% of all baseline participants). In multivariate analyses, adjusting for age, urgenc y, chief complaint, and site, compliance with process-of-care guidelines in creased from 55.9% (preintervention) to 60.4% (postintervention, P = 0.0001 ). We also found a 4% decrease (from 24% to 20%) in the rate of patient-rep orted problems with emergency department care (P = 0.0001). There were no s ignificant improvements in patient ratings of satisfaction. CONCLUSION: Feedback of benchmark information and subsequent duality improv ement efforts led to small, although significant, improvement in compliance with process-of-care guidelines and patient-reported measures of quality. The measures that relied on patient reports of problems with care, rather t han patient ratings of satisfaction with care, seemed to be more responsive to change. These results support the value of bench-marking and collaborat ion. Am J Med. 1999;107:437-449. (C) 1999 by Excerpta Medica, Inc.