TY  - JOUR
T1  - ASsociation between hospital-reported leapfrog safe practices scores and inpatient mortality
AU  - Kernisan LP, Lee SJ, Boscardin W, Landefeld C, Dudley R
Y1  - 2009/04/01
N1  - 10.1001/jama.2009.422
JO  - JAMA
SP  - 1341
EP  - 1348
VL  - 301
IS  - 13
N2  - Context 
                  The Leapfrog Hospital Survey allows hospitals to self-report the steps they have taken toward implementing the Safe Practices for Better Healthcare endorsed by the National Quality Forum. The Leapfrog Group currently ranks hospital performance on the safe practices initiative by quartiles and presents this information to the public on its Web site. It is unknown how well a hospital's resulting Safe Practices Score (SPS) correlates with outcomes such as inpatient mortality.Objective 
                  To determine the relationship between hospitals' SPSs and risk-adjusted inpatient mortality rates.Design, Setting, and Participants 
                  Observational analysis of discharge data for all urban US hospitals completing the 2006 safe practices initiative and identifiable in the Nationwide Inpatient Sample. Leapfrog provided an SPS for each hospital as well as 3 alternative scores based on shorter versions of the original survey. Hierarchical logistic regression was used to determine the relationship between quartiles of SPS and risk-adjusted inpatient mortality, after adjusting for hospital discharge volume and teaching status. Subgroup analyses were performed using data from patients older than 65 years and patients with 5% or greater expected mortality risk.Main Outcome Measures 
                  Inpatient risk-adjusted mortality by quartiles of survey score.Results 
                  Of 1075 hospitals completing the 2006 Safe Practices Survey, 155 (14%) were identifiable in the National Inpatient Sample (1 772 064 discharges). Raw observed mortality in the primary sample was 2.09%. Fully adjusted mortality rates by quartile of SPS, from lowest to highest, were 1.97% (95% confidence interval [CI], 1.78%-2.18%), 2.04% (95% CI, 1.84%-2.25%), 1.96% (95% CI, 1.77%-2.16%), and 2.00% (95% CI, 1.80%-2.22%) (P = .99 for linear trend). Results were similar in the subgroup analyses. None of the 3 alternative survey scores was associated with risk-adjusted inpatient mortality, although P values for linear trends were lower (.80, .20, and .11).Conclusion 
                  In this sample of hospitals that completed the 2006 Safe Practices Survey, survey scores were not significantly associated with risk-adjusted inpatient mortality.
SN  - 0098-7484
M3  - doi: 10.1001/jama.2009.422
UR  - http://dx.doi.org/10.1001/jama.2009.422
ER  -