We live in an age of increasing accountability. Safety and “on time” information is available about airports and airlines… public schools are ranked on standardized test performance and other measures… and hospitals now make public all kinds of information on medical errors, safety and infection rates that was once kept behind close doors, if it was recorded at all. The trend toward transparency in health care means consumers can — and should — look at data about a hospital before making a decision to become a patient there. The only problem is it’s hard to know where to look and what to make of the information you find. It’s easier to compare quality and performance data for cars and computers than to weigh the quality and safety of one hospital against another.
I consulted two experts in the field — Jim Conway, senior vice president at the Institute for Healthcare Improvement (IHI), a Cambridge, Massachusetts, nonprofit organization dedicated to the improvement of global health care… and Harlan M. Krumholz, MD, a professor of medicine and epidemiology and public health at Yale University in New Haven, Connecticut, for advice on how to navigate what’s available. Everyone is hard at work trying to figure out how to measure and present this information, they told me. “This kind of measurement is not easy,” Dr. Krumholz said. “As they say, we are still in the first half of the first inning. Yet we do have more information than we’ve had before.”
Thanks to assorted Web sites, we can access data on infection rates, patient experience, safety figures, mortality and how many patients with a particular condition the hospital treats each year, as well as how hospitals stack up when it comes to following recognized standards of care for common medical problems such as heart attacks, congestive heart failure and pneumonia. A tool called Hospital Compare by Hospital Quality Alliance reflects patients’ insights on their hospital care and offers quality information in a format that facilitates straightforward comparison among hospitals (www.HospitalCompare.hhs.gov). Additional options come from the nonprofit National Quality Forum (NQF), www.qualityforum.org and the Agency for Healthcare Research and Quality (AHRG), www.ahrq.gov. Some states have their own Web sites, many of which are in their very early stages.
A study at the Harvard School of Public Health demonstrated that when people go to hospitals ranked high in quality by Hospital Quality Alliance, they have a lower risk of dying than at hospitals that rank lower. Both Conway and Dr. Krumholz acknowledged, however, that it’s not easy to get truly accurate information on a particular hospital. No single set of data will answer all your questions. It’s best to look at several sources before making decisions.
In addition to those listed above, Conway recommended a few more sites that offer helpful information on hospitals around the country…
While inroads are being made, reliable performance data collection and comparison is spotty on the national level. In many cases, advises Conway, you’ll get better, more accurate information by checking sites that provide hospital information state by state. For example, one Minnesota Web site now publishes “never events” (the term used to describe serious adverse events that should never occur, such as surgery on the wrong body part) that have happened in the state’s hospitals or ambulatory surgical centers.
State Web sites that report quality data include:
Other states have Web sites in varying stages of development. Most of these are still in their very early stages and therefore vary in quality. Wisconsin’s site is generally considered the gold standard, and Minnesota and Pennsylvania Web sites are also considered very good by industry professionals. If you can’t find information for your state here, go to your state’s health agency for more information. The FDA provides links at www.fda.gov.
With fewer than 50% of states providing data and the national sites being somewhat inconsistent, there’s still a distance to go in creating truly transparent hospital information. The data is stacking up and steps are being taken in the right direction, such as the release last year of Hospital Compare data listing hospitals with the best and worst mortality rates for heart attack and heart failure patients. But that was just a baby step, since out of nearly 4,453 hospitals examined, 17 were ranked better than expected, seven were worse and the rest were as expected. They used “30-Day Risk-Adjusted Death (Mortality) Rates,” because this time frame is when deaths are more likely to be associated with the care from a hospital. Clearly we need numbers that are more precise than those. Transparency is an excellent goal, but translucent is a better description of how things are right now.
