Johns Hopkins Researchers Stand by Study
Researchers Claire Snyder, PhD, and Gerard Anderson, PhD, stand by the methods and conclusions of their study “Do Quality Improvement Organizations Improve the Quality of Hospital Care for Medicare Beneficiaries?” In a letter to the editor of JAMA published in the October 26, 2005, issue, Snyder, an assistant professor in the Department of Medicine at the Johns Hopkins School of Medicine, and Anderson, a professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, responded to criticism of a study they published in the June 15, 2005, edition of JAMA. Their study concluded that hospitals that actively participated with Medicare-sponsored quality improvement organizations did not consistently show any greater improvement than nonparticipating hospitals.
Critics of the researchers’ conclusions claimed that the time frame examined by the study was too brief to draw conclusions and they faulted the distinctions between “participating” and “nonparticipating” hospitals. The limitations of the study that critics have focused on were clearly stated by Snyder and Anderson in their original research article.
Contrary to statements issued by the American Health Quality Association, Snyder and Anderson’s letter to JAMA did not identify any additional flaws.
In their study, Snyder and Anderson analyzed the medical records of over 43,000 Medicare beneficiaries from four quality improvement organizations representing five states and the District of Columbia. They measured improvements in 5 clinical areas—atrial fibrillation, acute myocardial infarction, heart failure, pneumonia and stroke—using 15 quality indicators specifically targeted by the quality improvement organizations. The data for the study were provided by the quality improvement organizations, who were informed of the study’s design and methodology before they agreed to participate.
The researchers found no statistically significant differences in improvement over time on 14 of 15 quality indicators between hospitals participating with the quality improvement organizations and nonparticipating hospitals. Participating hospitals did show greater improvement in the screening and administering of pneumonia vaccination compared to nonparticipating hospitals. Of the 14 remaining, non-statistically significant indicators, the participating hospitals improved more on 8 indicators, while the nonparticipating hospitals improved more on 6 indicators.
"Quality Improvement Organizations and Hospital Care—Reply" JAMA 2005;294:2030