A Wish List for Next Year
An admittedly impressionistic barometer of Web hits, media mentions, E-mails, and phone calls suggests that the just issued "America's Best Hospitals" rankings have again struck a nerve with health consumers and doctors. Much of the attention is coming from potential patients who realize that the more you know, the better the prospect of good care should you need it. And plenty is coming from critics irate about what they think we should add or do differently.
The critics have a point. Patients have a right to know a number of telling details that the rankings leave out: the risk of complications such as medication side effects, of safety slip-ups like patient falls, and of injuries and deaths due to mistakes and sloppy care. There's a movement afoot to get such data out there, and we ache for it—the more hard numbers we can get our hands on, the more useful and authoritative the rankings will be.
But for now, such information is ungettable or unreliable. Bringing down the incidence and severity of hospital-acquired infections, for example, is on every medical center's agenda, but rare is the hospital willing to make public how well it is succeeding. Individual consumers who ask are almost certain to be stonewalled. At the moment, detailed public reporting is mandatory only in Pennsylvania, which issued its first set of findings about infection rates last November (www.phc4.org). Nearly 20 other states are gearing up to follow suit.
Massachusetts has no such requirement, but Boston's Beth Israel Deaconess Medical Center recently began disclosing infection rates anyway; President and CEO Paul Levy, a true maverick among his peers, believes hospitals should be accountable to the public. Among other details posted is caregivers' hand-cleaning diligence based on consumption of soap and sanitizer. The Joint Commission, which accredits hospitals, dropped by Beth Israel last week for a surprise review. The inspectors (the commission prefers "surveyors") combed patient records and roamed the premises with a checklist of more than 250 standards, from medication management to patients' rights. Levy plans to post the entire report.
Proxies. Absent data as rich as we would like, proxies such as mortality rates and procedure volume are meaningful indicators of excellence. We mine those numbers from data that hospitals must provide to the government for all Medicare patients in order to be reimbursed. For the first time this September, we'll refine our rankings of children's hospitals by adding parallel data: deaths, numbers of procedures, and key indicators such as nurse staffing and advanced technologies.
Lots of the grumblers I've heard from this week wonder where patient opinion figures into all this. While the government plans to collect and post that kind of information, we don't think it would be a worthwhile addition. Broadly characterized, patients' views tend to reflect the courtesy and respect with which they were treated. While these are undeniably important virtues, their relationship to the quality of medical care, at least from the studies I've seen, is dubious.
I'll put it this way. At one hospital I know of, patients often complain about being treated like defective widgets returned for warranty service. It is also one of the best anywhere at treating certain rare conditions and for taking on high-risk patients most hospitals would reject as hopeless. If I fell into either group, I'd head there in a heartbeat. And I believe the data we publish would help direct me there.
Avery Comarow's blog on healthcare quality is at health.usnews.com/comarow
This story appears in the August 6, 2007 print edition of U.S. News & World Report.
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