Hospital Report Cards are Growing on the Web, But Can You Use Them to Make a Choice
May not be perfect, but they can
offer clues to the care you might receive
By Becky Ham, Science Writer, Health Behavior News
Service
Oct. 10, 2008 - Consumers are awash in information
they can use to find the best deals on everything from dishwashers to
car insurance. But is it possible to comparison shop for a hospital?
Hospital report cards - which can include
information on everything from how clean the hallways are to how many
patients die after a certain operation - have been touted as a valuable
source of information for savvy hospital shoppers. But these report
cards may not be as useful to you as a Consumer Reports guide.
The information in them can be out of date, hard to
interpret, and aimed more at the hospitals themselves than at patients.
And for many patients, "choosing" a hospital just isn't an option - no
matter what the report card says.
"Most of these reports did not have the patient or
consumer as the primary audience in mind when they were designed," says
Judy Hibbard, D.Ph., of the University of Oregon. She studies how
consumers use health information.
Still, hospitals do differ in the quality of the
care and the patient experiences they offer, and it's wise to know as
much as you can before entering a hospital to deliver your child or have
major heart surgery.
Hospital report cards may not be perfect, but they
can offer clues as to the kind of care you might receive at one
institution compared to another.
For instance, you might discover how well a
hospital provides "evidence-based" care, such as delivering the
recommended dose of aspirin to heart attack patients upon arrival. And
increasingly, the report cards contain feedback surveys from patients
who can talk about the nitty-gritty of their stay: Did the nurses
disappear? Were the rooms warm?
You can find these stats and more in the online
hospital report cards published by the federal government at sites such
as HospitalCompare.gov, for-profit companies such as HealthGrades, and
yes, even catalogued at the Consumer Reports Web site. But most people
aren't aware that their local hospitals are being graded.
The American
Hospital Association is a partner of HospitalCompare.gov, and recommends
the federal report card site to patients. Government report cards such
as HospitalCompare.gov and state sites such as CalHospitalCompare.org
were among the highest-ranked report cards evaluated in a 2008 study by
the Healthcare Association of New York State.
"The last time I went to a hospital was for the
birth of my second child," says Elizabeth Tran of Arlington, Va. "We
went there based on where our doctor was affiliated; we didn't have a
choice in where we went.
"To be honest, where we live in a major urban area,
I might just look at the location of a hospital as a proxy for its
quality," Tran says, noting that hospitals in some wealthier
neighborhoods have a better "word of mouth" reputation.
The "buzz" - negative or positive - about a
hospital also figures into Jennifer Thorson's perception of local
hospitals. But her choice of hospital would be limited to where her
doctor will work. "If he or she had privileges at more than one
hospital, I might ask them if they had a preference," says Thorson, who
lives in Tucson, Ariz.
As she suggests, many patients just go to the
facilities where their doctor practices and where their insurance will
pick up the tab for an emergency or planned procedure. "To the extent
that more than one hospital is covered, you might have some freedom of
choice," her sister Amy Thorson says. "But other than that. . ." she
says with a shrug.
It's not surprising that many people don't consult
hospital report cards or even know about them, says Maribeth Shannon,
director of the California HealthCare Foundation's Market and Policy
Monitor program, which publishes the CalHospitalCompare.org report card.
"A lot of people don't go looking for this information because
fortunately they don't have a need for it yet."
What's the best way to use a report card?
If you do consult a hospital report card, look for
the measurements that suggest a hospital does what it's supposed to do
for your condition, Shannon suggests. For instance, if you're going into
the hospital to have a pacemaker implanted, you might want to know how
often a certain hospital uses the recommended anesthesia during the
procedure. These types of statistics can tell you whether a hospital's
care is in line with what national medical organizations have
recommended, although they are not available for all conditions in all
hospitals.
"Hospitals are pretty complex places. What we've
found in our research is that very few hospitals are very good at
everything, and very few are not good at anything. It may be that it's a
good hospital for cardiac care, but not orthopedic care, for instance,"
Shannon says.
Outcome data - how well patients fared after a
certain hospital procedure - can also give you an idea of how well a
hospital performs, but these data are rare, Shannon says. Some report
cards list "specialty" hospitals-those renowned for their cancer care,
for example.
These specialty hospital listings or centers of
excellence, often independently accredited by other medical
organizations, can be found in publications such as the annual U.S.News
& World Report's "Top American Hospitals" guide.
But what if you're reading a report card and none
of the "care" measures are meaningful to you? Hibbard says that the
statistics contained within hospital report cards are not always useful
to patients. "It's burdensome to people to learn about all this stuff,"
she says.
People simply want to know if patients "got the
correct information at the right time, or whether the right things were
done," she argues, instead of scanning a card to find out "what
percentage of people got a beta-blocker upon admission for a heart
attack."
More report cards are now answering the questions
that patients seem to ask most often about hospitals: Were the nurses
friendly? Were the rooms quiet? Was the check-in process chaotic?
Shannon says these data are "core" to a hospital's care. "Patient
experience measures aren't just about the temperature of the food. It's
about important things like, 'Did you feel the doctors and nurses were
listening to you?' or 'Did you understand your discharge instructions?'"
Although it can be difficult for a patient know
whether aspirin or antibiotics were dispensed properly, it's easy for a
patient to know whether they felt their needs were taken care of in a
hospital. "I think of it as like customer service," Tran says. "It's
like the airlines. I sort of assume that all pilots are comparably
trained, so I just go with which one I liked based on past treatment."
Supporters of hospital report cards acknowledge
that the measurements aren't always consumer-friendly. The report cards
"serve a dual purpose," says Rick Wade, senior vice president for
communications at the American Hospital Association.
"They are there for the public, but they are also
there as benchmarks for hospitals to do better." Wade and others say
report cards encourage hospitals to improve their performance, but
several recent studies offer mixed support for this idea. In some cases,
the report cards have not significantly changed a hospital's standard of
care, or driven patients away from poorly performing hospitals.
Still, Shannon says "hospitals care very much how
they look on these report cards. And if quality improves as a result, a
patient's next experience at a hospital is going to be better than their
last experience."
When using a hospital report card, it is important
to remember that "it's all just a snapshot in time," says Wade. The data
for a particular hospital may be at least two years old since the report
card was published, so performance measures may have changed in the
meantime, he noted.
Wade also cautions patients against seeing the
report cards as the final word on a hospital, noting that quality care
measurements are "a relatively new field." The report card is "one of
the many tools that a patient and family should use to choose a
hospital," he says. "But we think that these are the best measures to
start a conversation [about hospitals] between a doctor and patient."
But aren't all hospitals the same?
After glancing through a few report cards comparing
hospitals in her area, Tran is struck by the fact that "a lot of the
ones that would be an option for us rank comparably." It's a common
complaint about hospital report cards from both physicians and patients.
The cards clearly single out the best from the worst, but are less
useful at helping patients decide between hospitals where overall
quality is about the same.
Looking over a report card for her city, Jennifer
Thorson says she might be interested in the measurements showing how
often a hospital performs a certain procedure. "I wouldn't necessarily
be interested in the success rate, but if they do this all the time, I
would think that everybody would know what they were doing," she said.
For some, familiarity will always be most important
than low performance scores. "I'd prefer to go to a hospital I feel
comfortable with, compared to a hospital I don't know - even if it has
an outstanding record," says Greg Reid, the husband of Amy Thorson.
The report cards are constantly evolving, adding
new data such as mortality rates, patient satisfaction surveys and
information on new conditions. Shannon says the CaliforniaCompare site
hopes to add data on conditions "that tend to be more 'shopable,' such
as a hip or knee replacement where patients have time to compare."
Wade says navigation is the missing piece of
hospital report cards, and he hopes to see more efforts to help patients
figure out how to read the cards, get the information they need, "and
understand what this all means."
Although Hibbard feels that there is much work to
be done to improve hospital report cards, "I would look at the
information" she admits, "because it's better than nothing."
For a partial listing of hospital report cards (and
their sources) check out the story sidebar. Talk to your doctor and
health care team about any questions that arise.
Editors Notes:
The Health Behavior News Services of the Center for
the Advancement of Health does not prfovide medical advice or
consultation, but provides information intended to help people make
informed choices about their health care.
Keep up with the latest news for senior citizens, baby
boomers
Oct. 10, 2008 - Consumers are awash in information
they can use to find the best deals on everything from dishwashers to
car insurance. But is it possible to comparison shop for a hospital?