MedicalResearch.com Interview with:
Sameed Khatana, MD
Fellow, Cardiovascular Medicine, Perleman School of Medicine
Associate Fellow, Leonard Davis Institute of Health Economics
University of Pennsylvania
MedicalResearch.com: What is the background for this study?
Response: There has been a growing use of quality metrics and indices in the US healthcare system. Much attention has been paid to quality measurement programs used by public payors, however, the use of such programs by commercial payors is much less studied. “Centers of excellence” are one type of quality designation program that is growing in use by commercial payors where certain hospitals are determined to be “high quality” for a certain disease state or procedure based on meeting certain criteria. For some people, this is even impacting the choice of providers and hospitals they can use by payors.
We evaluated centers of excellence programs from three large commercial payors, Aetna, Cigna and Blue Cross Blue Shield, targeted at cardiovascular diseases and interventions and examined publicly reported outcomes for all hospitals performing percutaneous coronary interventions (cardiac stenting) in New York State.
MedicalResearch.com: What are the main findings?
Response: Our main findings were that overall there was no significant correlation between being designated a center of excellence hospital by one of these three payors and improved outcomes in terms of risk of death or readmission to the hospital after an intervention.
In fact, hospitals designated by one program had a small, but statistically significant, higher mortality rate compared to non-designated hospitals.
MedicalResearch.com: What should readers take away from your report?
Response: The use of such quality designation programs is growing but not well studied. Our study shows that there needs to be greater transparency about the criteria used to select hospitals and that they need to be studied thoroughly before they impact patient choice.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further study examining other disease states, other regions and other programs is needed to see whether these findings could be generalized to all centers of excellence/quality designation programs.
I have no relevant disclosures.
Khatana SAM, Nathan AS, Dayoub EJ, Giri J, Groeneveld PW. Centers of Excellence Designations, Clinical Outcomes, and Characteristics of Hospitals Performing Percutaneous Coronary Interventions. JAMA Intern Med. Published online May 20, 2019. doi:10.1001/jamainternmed.2019.0567
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