1031 — Is Better Performance on Leapfrog’s Safe Practices Survey Associated with Lower Inpatient Mortality?

Kernisan LP (San Francisco VA Medical Center), Lee SJ (San Francisco VA Medical Center), Landefeld CS (San Francisco VA Medical Center), Dudley RA (University of California, San Francisco)

Objectives:
The Leapfrog Hospital Survey allows hospitals to self-report the steps they have taken towards implementing the “Safe Practices for Better Healthcare” endorsed by the National Quality Forum. It is unclear how well a hospital’s resulting Safe Practices Score correlates with outcomes such as inpatient mortality. It is also not known whether shorter versions of Leapfrog’s Safe Practices Survey might be as effective in identifying high- or low-quality hospitals. Currently, Leapfrog ranks hospital performance on the Safe Practices Survey by quartiles, and this information is available to the public on Leapfrog’s website. It is likely that most consumers assume that hospitals in the top quartile of performance are safer than hospitals in lower quartiles. This study examined the relationship between hospitals’ Safe Practices Scores and their risk-adjusted inpatient mortality rates.

Methods:
We analyzed the discharge data for all urban U.S. hospitals that completed the 2006 Leapfrog Safe Practices Survey and were identifiable in the Nationwide Inpatient Sample (1,772,064 discharges at 155 hospitals). The Leapfrog Group provided a Safe Practices Score (SPS) for each hospital, as well as three 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. An additional analysis also adjusted for discharge volume and teaching status. Subgroup analyses were done on patients older than 65 years and patients with greater than 5% expected mortality, to assess the relationship between survey performance and inpatient mortality in these higher-risk groups.

Results:
In our models, SPS was not predictive of risk-adjusted inpatient mortality (p = 0.97). Results were similar whether or not we adjusted for hospital volume and teaching status. SPS remained non-predictive of risk-adjusted inpatient mortality in analyses of patients older than 65 or with greater than 5% expected mortality. The three alternative survey scores tested were also not able to predict risk-adjusted inpatient mortality.

Implications:
Scores on the Leapfrog Safety Survey do not appear to correlate with inpatient mortality rates.

Impacts:
Further research is needed to determine whether Leapfrog’s survey scores may correlate with other outcomes of interest to patients and policymakers. It is possible that inviting hospitals to self-report on their patient safety practices is not an effective way to assess hospital quality.