Study: Public Reporting of ICU Outcomes Has Unintended Consequences

Public reporting of intensive care unit patient outcomes did not reduce mortality rates, but it did lead to reduced ICU admission of the sickest patients and an increase in transfers of critically ill patients, according to a new study of hospitals and patients in California.

University of Pittsburgh researchers looked at Medicare fee-for-service data from 2005 to 2009 from several states: California — which started requiring ICUs to report severity-adjusted mortality rates in 2007 — and Arizona, Nevada and Texas, which did not require public reporting and were used as controls.

In the first year after public reporting in California started, the state's ICUs had nearly identical changes in mortality rates as the control ICUs, a trend which continued in 2008 as well. Admission of patients with three or more comorbidities was reduced slightly compared to controls, and critically ill patients in California were more likely to be transferred to another hospital than in the control states after reporting began.

"Public reporting is designed to reduce mortality by steering patients towards high-quality hospitals and creating incentives for hospitals to adopt quality improvement programs," Lora Reineck, MD, a postdoctoral scholar at the University of Pittsburgh, said in a news release. "But the reality does not necessarily meet the expectation."

As for the other unintended consequences: "It could be that some hospitals didn't take certain surgical cases, fearing that the patients were at high risk of dying in intensive care after surgery," she said. "Or, it could be that the very sickest patients were not admitted to the ICU because they were not going to get better, and instead were transitioned to care that emphasized comfort rather than prolonging life."

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