Centers of excellence: Are there standards?

Centers of Excellence (CoEs) are intended to label hospitals that have met certain quality, process, volume and infrastructure guidelines. However, there are largely no standardized metrics to designate what qualifies as a CoE, leading to entities across the healthcare spectrum creating their own designations. Empirical studies on the impact of CoEs on quality do not consistently show improved care. Given the variability in definitions and outcomes for CoEs, the study evaluated the current status of defining and using CoE designations. We conducted semi-structured interviews with executives from 10 healthcare organizations (including hospitals, insurers, employers, and benefits managers) who have a role in determining or using CoE designations to make decisions for their organizations. The interviews were conducted in 2016 and 2017. The interviews were audio recorded, transcribed, and de-identified for thematic analysis. We found that there is significant variability in the process for defining CoEs. There are also many operational challenges that hinder the success of a CoE program, including how patients access care at a CoE, the right geographical distribution of CoEs in a network, and coordinating care between the CoE and local providers. The lack of standardization for designating CoEs not only prevents CoEs from fully achieving their intended effects of signaling "excellent" hospitals, but also causes confusion for patients, employers and payers, which dilutes the meaning of the CoE label. We suggest that the designation and implementation of CoEs should be standardized in healthcare.

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Déclaration de conflit d'intérêts

Declaration of competing interest Lee A. Fleisher, MD is an unpaid member of the Board of Directors of the National Quality Forum.