You wouldn’t think about eating at a restaurant that had a poor grade on food quality, so why not hold your hospital to the same standard? Joanne Disch, Clinical Professor at the University of Minnesota School of Nursing, testified before Congress on July 17, 2014 that there are 1,000 deaths and 10,000 serious complications resulting from medical errors each day.1 These medical errors cost the nation a colossal $1 trillion each year.2
These statistics have shaken the confidence of patients in our healthcare system. In an environment of increasing transparency, in which patients are taking an active role in choosing healthcare providers and assuming more financial responsibility, accurate ratings of hospitals are essential. This has fueled calls for greater accountability in the U.S. healthcare system with hospitals facing growing pressure to release performance data to the public.
Over the past decade, a number of hospital rating services have emerged, offering free Web sites aimed at healthcare consumers. The services report on multiple aspects of healthcare quality, including those reflecting structural aspects of care, processes, and outcomes.
Two Major Hospital Data Reporting Services
Hospital Safety Score is a public service provided by The Leapfrog Group, an independent nonprofit organization committed to driving quality, safety, and transparency in the U.S. healthcare system.3 Nine-member Leapfrog Blue Ribbon Expert Panel selected 26 measures of hospital safety and determined the weight of each measure based on evidence, opportunity for improvement, and impact.4 Collectively, those performance measures produce a single composite score representing a hospital’s overall performance in keeping patients safe from preventable harm and medical errors. The Hospital Safety Score methodology has been peer reviewed and published in the Journal of Patient Safety.5
The scores, grades A, B, C, D or F, have been assigned to more than 2,500 U.S. general hospitals on quality and safety metrics. These results are based on surveys submitted voluntarily by hospitals across the country. Information from secondary sources, i.e., publicly available hospital safety data, supplement any missing data.
The Hospital Safety Score measures two domains: (1) Process/Structural Measures or (2) Outcome Measures, each accounting for 50 percent of the overall score.4 Process Measures represent how often a hospital gives patients recommended treatment for a given medical condition or procedure. For example, how often a hospital gives patients an antibiotic within one hour before surgery or adherence to hand hygiene. Structural Measures represent the environment in which patients receive care. For example, if a hospital uses computerized physician order entry to prevent medication errors or if a hospital has appropriate ICU physician staffing levels.
Outcome Measures represent what happens to a patient while receiving care. For example, how many times a patient undergoing surgery had a dangerous foreign object, like a sponge, left in his or her body or death among surgical inpatients.
Past grades are also available alongside current grades on the Web site so patients can determine which institutions consistently achieve high standards of safety and have shown continued improvement. Leah Binder, president and CEO of The Leapfrog Group, said, “We want to turn patients into savvy healthcare shoppers by enabling them to take an active role in selecting a hospital. We all deserve to be in the safest hospital possible.”
According to Hospital Safety Scores released on April 29, 2015:6
- Of the 2,523 hospitals scored: 782 earned an A; 719 earned a B; 859 earned a C; 143 earned a D; and 20 earned an F
- Hospitals have generally improved on some process measures since last fall, but have not improved on outcomes
- Computerized prescribing systems and perioperative safety process measures, among others have shown improvements
- Maine has the highest percentage of hospitals with an A grade
- Washington, D.C., North Dakota and Alaska had no A-grade facilities
Hospital Compare7 was created through the efforts of the Centers for Medicare & Medicaid Services (CMS) in collaboration with organizations representing consumers, hospitals, doctors, employers, accrediting organizations, and other Federal agencies. It is a consumer-oriented Web site that provides information on how well hospitals provide recommended care to their patients. It has information about the quality of care at over 4,000 Medicare-certified hospitals across the country.
Consumers can use Hospital Compare to select multiple hospitals and directly compare performance measure information related to heart attack, heart failure, pneumonia, surgery and other conditions. These results are organized by:8
- Patient Survey Results
- Timely and Effective Care
- Readmissions, Complications, and Deaths
- Use of Medical Imaging
- Linking Quality to Payment
- Medicare Volume
Since its inception, many new measures and topics have been added to Hospital Compare.8