Quality/Effective Care

Effective care refers to services that are of proven value and have no significant tradeoffs -- that is, the benefits of the services so far outweigh the risks that all patients with specific medical needs should receive them. These services, such as beta-blockers for heart attack patients, are backed by well-articulated medical theory and strong evidence of efficacy, determined by clinical trials or valid cohort studies. Failure to provide effective care can lead to serious consequences; for example, amputation of a leg is an infrequent but devastating complication of peripheral vascular disease and diabetes.

The claims-based analyses of effective care focus on either the entire fee-for-service Medicare population eligible for both Part A and B and between the ages of 65 and 99 or a subset of that population at risk for a specific procedure or service. For example, the analysis of amputations examines the entire Medicare population, while the analyses of testing among diabetics are restricted to Medicare beneficiaries between the ages of 65 and 75 with a diagnosis of diabetes. When appropriate, statistical adjustments are carried out to account for differences in age, race and sex.

We also report quality measures regarding the underuse of effective care derived from the consensus measure set of the Hospital Quality Alliance (HQA), the first initiative to routinely report data on U.S. hospitals nationally. Data are posted on the CMS Hospital Compare web site. We provide summary scores on five measures for treating acute myocardial infarction (AMI); two for congestive heart failure (CHF); and three for pneumonia, for all reporting hospitals located within each hospital referral region. In addition, we report a composite score, which is the weighted average of the three condition-specific summary scores. For individual hospitals, summary scores are based on measures for which there are 25 or more eligible patients.

CMS also posts on the Hospital Compare web site the results of a national survey of the patient experience: the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS survey provides measures of patient experience based on a sample of patients recently discharged from a participating hospital. The results of each survey question are given for participating hospitals. For all measures from CMS Hospital Compare, hospital measures were aggregated to the hospital referral region and state levels based on hospital location.


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The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation, including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.