About Quest, Jha says "the problem is it's really hard to know whether it improved care and reduced costs. We have no idea. Because we don't have good controls. They say they're compared to matched controls, but it would be nice to see how those were picked, and how they looked at data over time. Those things can make a huge difference."
"And until there is peer review and careful evaluation, it's very hard to know."
Premier's chief medical officer, Richard Bankowitz, MD, says that Premier's method is to
"rigorously define and consistently collect measures from all 350 hospitals that are members of the collaborative, and then to objectively analyze the data. We understand there will always be skeptics, but the results are what they are.
"We have researched this and learned that consistent, transparent measurement; sharing of best practices across the cohort; and helping hospitals to effectively execute, all combine to create a sense of urgency and to facilitate improvement. We are continuing to undertake research to better understand which particular interventions work best, and under what circumstances."
But Premier officials acknowledge that many of the hospitals in its Quest program also participate in HENs other than that run by Premier, and in other programs. So how can improvement definitively be attributed to the HEN initiative or to Quest, or to anything at all?
Keep in mind that apart from any of these federal or private quality improvement initiatives, there's the federal sledgehammer of financial penalties for higher rates of readmissions and negative payment adjustments for higher 30-day mortality rates, low patient experience scores, and hospital-acquired conditions.
Might those incentives be prompting improvements over baseline rates all by themselves?