Volume 51 | Number 6 | December 2016

Abstract List

Qi Chen M.D., Ph.D., Amy K. Rosen Ph.D., Ann Borzecki M.D., M.P.H., Michael Shwartz Ph.D.


To assess whether hospital profiles for public reporting and pay‐for‐performance, measured by the Agency for Healthcare Research and Quality () Patient Safety for Selected Indicators (‐90) composite measure, were affected by using the recently developed harm‐based weights.

Data Sources/Study Setting

Retrospective analysis of 2012–2014 data from the Veterans Health Administration ().

Study Design

The software (v5.0) was applied to obtain the original volume‐based ‐90 scores for 132 acute‐care hospitals. We constructed a modified ‐90 using the harm‐based weights developed by . We compared hospital profiles for public reporting and pay‐for‐performance between these two ‐90s and assessed patterns in these changes.

Principal Findings

The volume‐based and the harm‐based ‐90s were strongly correlated ( = 0.67,  < .0001). The use of the harm‐based ‐90 had a relatively small impact on public reporting (i.e., 5 percent hospitals changed categorization), but it had a much larger impact on pay‐for‐performance (e.g., 15 percent of hospitals would have faced different financial penalties under the Medicare Hospital‐Acquired Condition Reduction Program). Because of changes in weights of specific s, hospital profile changes occurred systematically.


Use of the harm‐based weights in ‐90 has the potential to significantly change payments under pay‐for‐performance programs. Policy makers should carefully develop transition plans for guiding hospitals through changes in any quality metrics used for pay‐for‐performance.