JR: One thing they should do is drill down into the spreadsheets from Hospital Compare, because there’s a lot more data than CMS puts on its website. For example, CMS publishes only the percentage of patients who rave about their hospitals, but the full data include the percentage of patients who panned their experience.
TL: Anything else?
JR: When you’re working with patient experience data, you want to be very careful in comparing patient satisfaction in very different geographic areas. Patients in some areas like New York, Miami, and New Jersey are more likely to voice their complaints more freely, and hospitals in those areas are more likely to have lower ratings than hospitals in South Dakota.
TL: Should we be using the so-called process measures—like the portion of pneumonia patients receiving a flu vaccine, or the portion of heart attack patients receiving discharge instructions?
JR: I don’t think the process measures make for great stories because they represent the minimal expectation for basic care. Most hospitals are getting a score of 93 or 94 or even 99 percent. It’s not compelling to do a story that says a hospital has a three percent lower compliance on a measure than the average. Very few places are showing up as outlying poor performers.
TL: Then they may not be compelling for consumers either? Would you agree or not?
JR: Process measures aren’t. But if you were considering a hospital that was rated worse than average in readmissions, mortality, infections, or even one of the patient safety indicators—and had the luxury of time to pick a place—you should ask the hospital to explain itself.
TL: What’s your last bit of advice?
JR: If you’re going to critique a hospital based on any of these measures, make sure the hospital is really a statistical outlier.
TL: Look into a crystal ball for a moment. Do you see hospital metrics as a path to journalistic glory in the future?
JR: Much of the good hospital reporting has been about horror stories of the malpractice kind, where patients are killed or maimed. This new age of hospital transparency should give journalists a chance to write about the routine quality of care that most patients are likely to receive. That may not be as sexy as a botched operation, but it’s important to readers and everyone else if we’re going to better understand what we’re actually getting for some of the most expensive care in the world. Hopefully one day we’ll be able to know which hospitals really deliver superior care, and which ones just advertise that they do.
How not to report on data that nobody uses in your stories that nobody reads in deciding to pick a hospital....
Compelling stuff.
In other news, spring arrives, grass grows.
#1 Posted by padikiller, CJR on Mon 12 Mar 2012 at 03:47 PM
I appreciate the nuanced view of the available data--thanks, Jordan Rau!
I'd also say that any public information on hospital-aquired infection rates is valuable, given how difficult lowering HAI rates has been. In some states, the public still can't compare hospitals by their HAI rates -- except for the limited Medicare metrics (limited to certain infection sites).
#2 Posted by Suzanne B, CJR on Tue 13 Mar 2012 at 10:15 PM
It's going to be very interesting to watch how patient surveys influence hospitals and those who work for them. I've know doctors who are focused on getting better scores. They are taking interpersonal communication classes to learn how to talk to their patients. This in turn leads to trust between patient and doctor and could result in patients asking more questions. http://whatstherealcost.org/video.php?post=five-questions
#3 Posted by susan, CJR on Sat 17 Mar 2012 at 02:55 PM