Hospital Quality Resilience in the Pandemic Era

Measuring resiliency in hospital quality performance during the pandemic era

Hospital quality rankings and ratings, such as the U.S. News & World Report's Best Hospitals and Centers for Medicare & Medicaid Services (CMS) Overall Hospital Star Ratings, have faced a challenging question over the past three years: To what extent should hospitals be held accountable for traditional quality measure performance given the unknown effects of the COVID-19 pandemic on hospital operations?

Although several national ranking and rating groups have chosen to withhold reporting from months, or even years, of the pandemic, many health services researchers and hospital quality leaders have stated that hospital quality measurement becomes even more important during times of health system crisis. These researchers believe that patients deserve to continue to receive high-quality care regardless of pandemics or other outside factors.

This conundrum provides an opportunity for quality reporting stakeholders. Specifically, it offers the chance to develop a hospital quality resiliency measure or index. A recent article in the Journal of the American Medical Association (JAMA) discussed four basic criteria for measuring resiliency:

• Continued delivery of high-quality care to patients with COVID-19.
• Continued delivery of high-quality care to patients who do not have COVID-19.
• Continued provision of elective surgery access to the entire community, while mitigating disparities.
• Continued protection of staff well-being.

Already, there are some simple quality measurement options using Medicare claims data that researchers could use to assess three of these four criteria. For example, 30-day mortality or readmissions among patients treated for COVID-19 patients could be used to assess the first criterion. The CMS 30-day readmission and mortality measures could be used to address the second criterion.

As shown in Figure 1, analysts could use Medicare claims data from 2020 to assess interhospital 30-day mortality rates among patients who did not have COVID-19, comparing all months of pandemic-era data versus only the months in which hospitals had below national average COVID-19 burden. Likewise, Medicare inpatient claims could be used to assess volumes of common elective procedures to assess the third criterion.

The fourth criterion, however, would likely need further development, as there are no widely available national staff well-being data available at the hospital level.

Take home point: Evidence-based measurement of resiliency in hospital quality performance during the COVID-19 pandemic is possible and may yield surprising and informative results.

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