Background: Audit and feedback systems have significantly improved medical care in numerous settings, and they appear to work by stimulating competition rather than through command and control.
Methods: The West Virginia Medical Institute (WVMI), a Medicare-designated Quality Improvement Organization (QIO), periodically collected quality information on five common conditions (acute myocardial infarction [AMI], heart failure, pneumonia, stroke, and atrial fibrillation) that cause hospitalization in Medicare beneficiaries. All 44 acute care hospitals in West Virginia were offered written and orally presented reports of quality performance from 1998 through 2001.
Results: All indicators appeared to improve statewide. Several--for example, aspirin at discharge for AMI patients and pneumococcal vaccine for pneumonia patients--improved by more than 10 absolute percentage points. Fourteen of 15 quality indicators showed significant improvement (p < .05, paired t-test) in all hospitals between the before- and after-feedback periods. Seven of 13 indicators assessed during the entire study in the largest hospitals showed no significant trends in quality before feedback but significant increases (p < .05, chi-square for trend) in the after-feedback period.
Discussion: The quality indicator changes reported can represent important health gains for West Virginia Medicare beneficiaries. Most of the improvement did not occur until after hospitals received feedback.