Comparing quality of care among hospitals

A few months ago I wrote about the issue of knowing if your child is in a good PICU or not. Recently the federal Department of Health and Human Services began the first halting steps toward allowing ordinary citizens to compare easily how different hospitals perform — they put up an easy-to-use website that lets you compare up to three hospitals at a time with a couple of simple mouse clicks. The site is here. The Commonwealth Fund also has begun a project, aptly termed “Why Not the Best,” that you can find here. The notion, of course, is that transparency of this sort will allow smart healthcare consumers (who in simpler times we called patients) to shop around for hospitals with the best outcomes. There are at present, however, several serious problems with the notion.

One problem is that the data don’t really tell you much about outcomes, which is what we really want to know. Rather, the sites mostly concern process. That is, it measures how many patients received a particular treatment recommended by the experts for a particular condition. The assumption is that if the accepted, correct process is followed, things will turn out better for the patient. This is only an assumption, and it carries with it the possibility that hospitals will be vigilant only about process measures. In effect, they may “teach for the test” mainly to make themselves look good. The only outcome statistics are death rates for three conditions (all in adults) — heart attacks, heart failure, and pneumonia. And they don’t give you the actual numbers, just if the hospital was significantly above or below the national average.

Another issue, one Dr. Bob Wachter well discusses on his excellent blog here, is that no one is paying any attention to these statistics anyway. Most people still choose their hospital based upon recommendations of friends and doctors — word of mouth.

In the long run, though, the site is an example of what is coming in the future. One day hospital performance will be out in the open for all to see and evaluate. Although there is virtually nothing available yet about children’s hospitals (and their PICUs), this, too, is probably coming.