Is emergency department quality related to other hospital quality domains?

Objectives Systems theory suggests that there should be relatively high correlations among quality measures within an organization. This was an examination of hospital performance across three types of quality measures included in Medicare's Hospital Inpatient Value-Based Purchasing (HVBP) program: emergency department (ED)-related clinical process measures, inpatient clinical process measures, and patient experience measures. The purpose of this analysis was to determine whether hospital achievement and improvement on the ED quality measures represent a distinct domain of quality. Methods This was an exploratory, descriptive analysis using publicly available data. Composite scores for the ED, inpatient, and patient experience measures included in the HVBP program were calculated. Correlations and frequencies were run to examine the extent to which achievement and improvement were related across the three quality domains and the number of hospitals that were in the top quartile for performance across multiple quality domains. Results Achievement scores were calculated for 2,927 hospitals, and improvement scores were calculated for 2,842 hospitals. There was a positive, moderate correlation between ED and inpatient achievement scores (correlation coefficient of 0.50, 95% confidence interval [CI] = 0.47 to 0.53), but all other correlations were weak (0.16 or less). Only 96 hospitals (3.3%) scored in the top quartile for achievement across the three quality domains; 73 (2.6%) scored in the top quartile for improvement across all three quality domains. Conclusions Little consistency was found in achievement or improvement across the three quality domains, suggesting that the ED performance represents a distinct domain of quality. Implications include the following: 1) there are broad opportunities for hospitals to improve, 2) patients may not experience consistent quality levels throughout their hospital visit, 3) quality improvement interventions may need to be tailored specifically to the department, and 4) consumers and policy-makers may not be able to draw conclusions on overall facility quality based on information about one domain.