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Cleveland Health Quality Choice was a failure, not a martyr
  1. J D Clough1,
  2. D Engler2,
  3. P E Canuto3
  1. 1Director of Health Affairs, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Vice President, Data Services, Ohio Hospital Association, Columbus, Ohio, USA
  3. 3Executive Editor, Cleveland Clinic Journal of Medicine, Cleveland Clinic
  1. Correspondence to:
    Dr J D Clough, Director of Health Affairs, Cleveland Clinic/W14, 9500 Euclid Ave, Cleveland, Ohio 44195;

Statistics from

We read with interest the article entitled “Too good to last: did Cleveland Health Quality Choice leave a legacy and lessons to be learned?” published recently in QSHC.1 Perhaps relevant in this regard is our study of the claim, repeated by Neuhauser and Harper, that the Cleveland Health Quality Choice (CHQC) project may have improved mortality rates in Cleveland at a faster rate than they were improving elsewhere.2 Using OHA data we found that not to be the case. The rate of improvement in inpatient mortality in Cleveland was the same as that in the rest of the state and would therefore have to be attributed to other factors.3

CHQC’s bright promise unfortunately went largely unfulfilled as it never got much beyond mortality and length of stay, neither of which is a very good surrogate for quality. Although CHQC’s risk adjustment may have been the best available, it was only marginally better than simpler, far less expensive methods. That was just one of the many problems with this project, which seemed incapable of improvement almost from the moment it began releasing reports.

In their article Neuhauser and Harper allude to the Cleveland Clinic’s intent to focus the money previously being spent on CHQC to improve quality in its system of hospitals. We have been doing that on a disease-by-disease basis through the Cleveland Clinic Health System’s Quality Institute, actually spending about the same amount as on CHQC. This program measures well proven indicators of quality care, producing demonstrable, credible, timely results that lead to productive actions. The Joint Commission recognized this activity with the 2001 Codman Award.

Although we certainly agree that CHQC was a pioneering project, we disagree that anyone ever used the data for its original purpose—to influence the medical marketplace. We were able to find no evidence that this ever occurred. The “business model” as it applies to health care did not work in Cleveland, nor has it worked in other areas such as Pennsylvania and New York where report cards have been published. The production of academic articles was never the purpose, and research grants rather than operational money should support such activities.

We are aware of another 5 year ongoing study in Dayton, where a collaboration of business and hospital leadership has led to substantial improvement in both outcomes and processes of care. The Dayton project has been successful because its goal is to improve health care in the community, not to reward or punish providers based on their outcomes.

We doubt that the loaded word “martyrdom” accurately describes the fate of this failed program. We need, either as communities or as individual institutions, to move on to new approaches as we learn from the failures of the past.


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