German hospitals that initially had high mortality rates significantly reduced these rates after implementing a certain quality improvement program, according to a study in Health Affairs.
Researchers studied 18 acute-care German hospitals purchased by the Helios Hospital Group between 2004 and 2009. Each hospital implemented the Helios quality management system based on measurement, analysis and improvement. The intervention included several steps:
1. Hospitals measure outcome, volume and other indicators.
2. The Helios Medical Advisory Board assesses indicators and schedules peer review procedures for hospitals with subpar results, meaning their in-hospital mortality rates were greater than the German average.
3. During peer review, the hospital conducts a self-assessment of selected cases and a team of peers analyzes patient records with local head physicians to identify problems.
4. The hospital implements recommended changes to treatment and care processes based on the peer review.
5. Local and central managers monitor the effects of the changes. If no improvement occurs, the peer review process is repeated.
Three years after the intervention, in-hospital mortality rates for myocardial infarction, heart failure, ischemic stroke and pneumonia at initially sub-par hospitals were significantly reduced from rates one year before the intervention. Hospitals that began with mortality rates at or below the German average did not significantly change their rates.
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