Cleveland Health Quality Choice: a Model for Collaborative Community-based Outcomes Assessment

Background: Cleveland Health Quality Choice Coalition was established in 1989 as a voluntary, collaborative effort between hospitals, physicians, and purchasers in the Cleveland metropolitan area to assess the quality and efficiency of care in 31 hospitals. The objective of the project is to produce high-fidelity comparative hospital outcomes data that support market-based health care reform strategies.

Methods: The project reports on a broad spectrum of hospital outcomes, including patient satisfaction, in-hospital mortality, length of stay, hospital-acquired complications, and cesarean section rates for adult medical, surgical, obstetrical, and intensive care patients. Intensive care outcomes and patient satisfaction are assessed using previously validated measurement systems. Outcomes for medical, surgical, and obstetrical patients are examined using a standardized data collection and severity adjustment methodology developed by Cleveland physicians and an independent consultant.

Results: The project released its initial report to purchasers in April 1993, with subsequent reports scheduled for release every six months. Several policies, procedures, and programs have been instituted to ensure data quality and participant buy-in. These include initial testing and rigorous validation of all outcomes measurement systems before release of data, a commitment to continuously refine risk-adjustment methodologies, independent auditing of data reliability, and a series of user-training workshops for project participants and local news media.

Conclusion: The early success of Cleveland Health Quality Choice Coalition demonstrates that it is possible for purchasers and providers to cooperatively assess the quality of health care on a regional basis and to institute a market-based strategy for health care reform. Further evaluation is needed to determine how performance data being reported are used by purchasers in selecting health care and by hospitals for quality improvement.