Health consumers now have access to more information about quality and safety at hospitals than ever before. They can use the Internet to find out what percent of surgery patients are given antibiotics at the right time, how many heart attack patients are given aspirin upon arrival, or even what percent die of pneumonia while hospitalized.
What this flood of information cannot tell them, however, is how to make the right decision when choosing a hospital. This process should be a deliberative one instead of an emotional one, say quality and safety experts, who emphasize the importance of looking at available data and other indications of excellence like how staff members interact with patients and the hospital’s appearance.
“The important point is that there is no one metric,” says Dr. Jerod Loeb, executive vice president of quality measurement and research at the Joint Commission, a nonprofit agency that accredits and certifies hospitals and health care programs. Rather, it’s the combination of factors that make a convincing case for a hospital.
Comparing Hospitals
In an effort to help consumers gauge one hospital’s performance against the national average or a local competitor, various nonprofit organizations and private companies and organizations have begun offering consumers a host of rating and comparison tools.
The Joint Commission, for example, tracks performance over dozens of types of care, including addiction, intensive care or podiatry, and allows users to compare six hospitals at once using its Internet database.
The Leapfrog Group, a consortium of corporations and public agencies that purchase health care for their employees, surveys more than 1,300 hospitals across the country on four quality and safety practices, including ICU staffing and computerized records. Consumers can search its online database to see how various hospitals performed on 10 different procedures like weight-loss surgery and high-risk delivery.
While Health Grades, a private company based in Golden, Colo., charges a fee to access performance data at individual hospitals, it tries to distill the many statistics into ratings that reflect safety and quality. In its annual study of mortality and complication rates, for example, the company collects administrative coding from millions of Medicare patient records for 26 common inpatient procedures and diagnoses, to determine which hospitals had the best outcomes. Its ratings are available for free.
Despite the amount of available data, there may be a disconnect between what a patient is looking for and the statistics, says Dr. David Lansky, CEO of the Pacific Business Group on Health, a coalition of health care purchasers. Much of the data is gleaned from the billing codes listed in administrative records instead of from clinical records, which shed more light on a patient’s experience and outcome. This is also the case with Medicare’s comparison tool, Hospital Compare.
A patient undergoing a knee operation, for example, won’t be able to find out when the average patient returned to work or for how long he or she stayed at the hospital.
In order to be a more discerning consumer, says Dr. Loeb of the Joint Commission, it’s important to find out how ratings data are collected and whether they are controlled for things like increased risk among certain populations or variations across age.
Looking Beyond Ratings
But perhaps most important, says Lansky, is a conversation with your doctor. Trying to select the right hospital for a bypass or birth is much easier when you’ve been told what qualifies as optimal care. A physician or specialist will be able to outline what matters to most patients, whether that’s pain management or cutting-edge technology.
Dr. Rick May, a senior physician consultant for Health Grades, says consumers can also judge a hospital based on its environment. “Does the hospital look and smell clean?” he says. “Do the staff members seem to be friendly and relaxed?” Such impressions speak to pride in the facility and a healthy work environment, both of which may help lead to better patient experiences and health outcomes.
Finally, Lansky always insists on asking for internal data from hospitals and physicians. “There’s no reason to be embarrassed to say, ‘How many of these procedures did you do last year? What was the success rate?’ says Lansky. “I wouldn’t go to someone who isn’t willing to have that conversation with me.”
