Volume 51 | Number 6 | December 2016

Abstract List

Lynn Unruh Ph.D., R.N., L.H.R.M., Richard Hofler Ph.D.


To explore predictors of gaps between observed and best possible Hospital Compare scores in U.S. hospitals.

Data Sources

American Hospital Association Annual Survey; Area Resource Files; Centers for Medicare and Medicaid Services Medicare Provider and Analysis Review; and Hospital Compare data.

Study Design

Using Stochastic Frontier Analysis and secondary cross‐sectional data, gaps between the best possible and actual scores of Hospital Compare quality measures were estimated. Poisson regressions were used to ascertain financial, organizational, and market predictors of those gaps.

Data Extraction

Data were cleaned and matched based on hospital Medicare s. All U.S. hospitals that matched on analysis variables in 2007 were in the study (1,823–2,747, depending upon gap variable).

Principal Findings

Most hospitals have a greater than 10 percent gap in quality indicators. Payer mix, staffing, size, case mix index, accreditation, being a teaching hospital, market competition, urban location, and region were strong predictors of gaps, although the direction of the association with gaps was not uniform across outcomes.


A significant percentage of hospitals have gaps between their best possible and observed quality scores. It may be better to use gap scores than observed scores in payments systems. More research is needed to know how to lower gaps through changes in hospital and market characteristics.