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Figure 1. Comparison of infection rates across hospitals
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Access to care (24/7 in house care)
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Less than 18:1 physician to patient ratio
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Medical records available within 12 hours
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Discharge summary within 24 hours
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Attendance at monthly hospitalist meetings
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JCAHO and National Patient Safety Goals met
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Self Directed Learning through the Society of Hospitalist Medicine membership
Suppose all of the above goals are met. Are there still differences in treatment outcomes? How does
monthly attendance at meetings improve the quality of care? For example, many hospitalists work in
hospital emergency departments. Do the hospitalists have different admission rates? Do they have different
treatment costs for similar patients? None of these outcomes would be reflected in the above inputs.
Because of the problem in assessing the quality of care based upon patient diagnoses, some payers are
considering using clinical lab values such as hematocrit levels to rank the quality of providers.(Thornton
& Hakim, 1997) However, as the above quote in Hayward & Kent suggests, even clinical values can be
“gamed”. In fact, reporting of clinical values gives physicians reasons to exclude patients from report-
ing if these patients do not meet clinical targets.(Doran, Fullwood, Reeves, Gravelle, & Roland, 2008)
Without some measure or definition of patient compliance with treatment, such measures will not truly
reflect the quality of care.
Public reporting of outcomes
Another outcome of interest is the degree and proportion of patients with nosocomial infections and
adverse events that should be preventable. While there are 21 states that require some reporting of
nosocomial infections, only four make the information available to the public: Florida, Pennsylvania,
Missouri, and Vermont. More states, however, are expected to follow. Medicare will no longer pay for
the costs of patient care related to such infections or to medical errors. Therefore, hospitals with high
rates of one or both will have their costs increase significantly since they will not be able to pass them
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