Thursday, January 22, 2009

California Reports Hospital Quality Data

California is breaking new ground by publishing eight hospital mortality measures so patients can determine which hospitals have the best quality outcomes. The state is using “risk adjusted” measures to better compare how “sick” a patient is and how likely they would be to die from the condition.

The eight measures include death from three medical conditions; acute stroke, hip fracture and gastrointestinal bleeding as well as five surgical procedures: coronary angioplasty, carotid endarterectomy, craniotomy, esophageal resection and pancreatic resection.

The new data offers a snapshot of the quality of care provided by over 400 California hospitals.

"This is the first time for many hospitals that they have been able to benchmark their performance on these procedures against all California hospitals," said Joseph Parker, director of the health care outcomes center for the Office of Statewide Health Planning and Development.

Of the state's 384 such hospitals, 25 performed better than the state average on at least one of the procedures or conditions, and 94 did worse in 2007. In 2006, 33 hospitals scored better than average, and 98 rated worse on at least one of the indicators.

It is hoped that public reporting of quality data will give patients information to make health care decisions. But it would be premature to think that these measures are anything other than a raw beginning. There are a number of problems with the data that patients need to know:

1. The eight conditions it tracks cannot be generalized to looking at how a hospital performs in other aspects of patient care. They are very specific and reflect only that measure and cannot be used to conclude that a hospital is good or bad
2. A hospital can be above average on one measure and below average on another.
3. The data is old (2006,07) and many hospitals have made improvements since that time.
4. The data fails to properly account for patients with multiple conditions or those who do not wish to be resuscitated.
5. The state relied on data used for billing purposes and did not verify to make sure that the coding was correct and that it matched the patient record information.

Most patients don’t plan a stroke or a broken hip so this type of data might even be confusing and make them feel insecure about their community hospital if it scored average or lower on a certain measure.

And finally,
Not everything that matters can be measured and not everything that is measured matters.


Anonymous said...

Interesting blog but sounds like the "risk adjustment" is not a valid way to determine or choose which hospital is better, especially when using the billing as a way of measuring. The billing deparment or bussiness office I have encountered defiantely makes mistakes.

Toni Brayer MD said...

Yes, that is one of the major problems. All of the mortality data comes from physician documentation and coding. If you start wrong there is a cascade effect and all of the data is corrupted.

Of course, in medicine when we don't like something, we always question the "data". In this case, however, just publishing information from 2006 and expecting patients to be able to sift through all of the nuances and make decisions about quality is flawed.

Anonymous said...

This is a complicated issue. We need more transparency and people do want to know if their doctors and hospitals are delivering the best care. But, as you said, there are a number of factors that go into those metrics and understanding all of them is what is hard for the layperson.

We should be able to make it easier and we should be measuring things like "how many people return to their pre-surgery lives after X surgery". Mortality rates are just the tip of the iceberg and don't really tell us where to go for the best care.

Anonymous said...

Dr. Brayer what would you say is the best way to rate o r decide on a hospital besides reading US World & Report yearly rating (which is gathered from satastics)?

Like you said obviously in an emergency aa a stroke or broken hip it is the closed one and who ever is on call deals with the problem so that part is a matter of being lucky or unfortunate not research. When we say what a good hospital seems to really be the physicians and RN's in handling your care and making the diagnosis and quality of care plus what latest technology there is access to like a big city in a area with financial means to attract the higest quality health care professions.
Anon. 1

Evan Falchuk said...

I challenge the premise that this data is useful at all to a patient trying to make a health care decision.

Patients are less worried about where they get treatment than they are about whether it's the right thing for them.

Say you're diagnosed with cancer and need to decide among surgery, chemo, radiation or some other treatment. Your doctor says I'm affiliated with hospital X so that's where you should go, regardless of what you decide. You go to this site to see about the quality of care there. Is the data going to help you in any meaningful way? It won't.

Hospitals are good at collecting and reporting on data, and things like mortality within narrowly defined procedures are wonderfully amenable to that kind of approach. But these data are not a proxy for the quality of care delivered in all of the hundreds of other types of diagnoses and treatments doctors perform at that facility.

From the perspective of the doctor and patient, quality means that the right decisions are made and that the patient gets as well as they can. This is very hard to measure, and harder to implement, especially in a system where we so greatly undervalue the relationship between doctor and patient.

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