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. Currently Leapfrog ranks hospital performance on the Safe Practices Leap by quartiles, and presents this information to the public on its website. It is unknown how well a hospital's resulting Safe Practices Score correlates with outcomes such as inpatient mortality.
To determine the relationship between hospitals’ Safe Practices Scores and risk-adjusted inpatient mortality rates.
Design, Setting, and Participants
Observational analysis of discharge data for all urban U.S. hospitals completing the 2006 Safe Practices Leap and identifiable in the Nationwide Inpatient Sample (NIS). Leapfrog 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, after adjusting for hospitals’ discharge volume and teaching status. Subgroup analyses were done on patients older than 65 years old and patients with greater than 5% expected mortality.
Main Outcome Measures
Inpatient risk-adjusted mortality, by quartiles of survey score.
155 of 1075 (14%) Leapfrog hospitals were identifiable in the NIS (1,772,064 discharges). Raw observed mortality in the primary sample was 2.09%. Fully adjusted mortality rates (95% confidence intervals in parentheses) by quartile of SPS, from lowest to highest, were 1.97% (1.78-2.18%), 2.04% (1.84-2.25%), 1.96% (1.77-2.16%), 2.00% (1.80-2.22%); p for linear trend =0.99. Results were similar in the subgroup analyses. None of the three alternative survey scores was associated with risk-adjusted inpatient mortality, although p values for linear trends were lower (0.80, 0.20, 0.11).
In this sample of 14% of all hospitals nationally that completed the Safe Practices Leap, survey scores were not significantly associated with risk-adjusted inpatient mortality.