Showing papers by "Kevin J. O'Leary published in 2007"

Hospital quality measurement - Perplexing for professionals, let alone for patients

Abstract: Why measure hospital quality? One popular premise is that measurement and transparency will inform consumer decision making and drive volume to high-quality programs, providing incentives for improvement and raising the bar nationally. In this issue of the Journal of Hospital Medicine, Halasyamani and Davis report that there is relatively poor correlation between the Hospital Compare scores of the Centers for Medicare and Medicaid Services (CMS) and U.S. News and World Report’s “Best Hospitals” rankings. The authors note that this is not necessarily surprising, as the methodologies of these rating systems are quite different, although their purposes are functionally similar. Clearly, these 2 popular quality evaluation systems reflect different underlying constructs (which may or may not actually describe “quality”). And therein lies a central dilemma for health care professionals and academics: we haven’t agreed among ourselves on reliable and meaningful quality metrics; so how can we, or even should we, expect the public to use available data to make health care decisions? The 2 constructs in this particular comparison are certainly divergent in design. For the Hospital Compare ratings, the CMS used detailed process-of-care measures, expensively abstracted from the medical record, for just 3 medical conditions: acute myocardial infarction, congestive heart failure, and communityacquired pneumonia. The U.S. News Best Hospitals rankings used reputation (based on a survey of physicians), severity-adjusted mortality rate, staffing ratio, and “key technologies” offered by hospitals. Halasyamani and Davis conclude that consumers may be left to wonder how to reconcile these discordant rating systems. At the same time, they acknowledge that it is not yet clear whether public reporting will affect consumers’ health care choices. Available evidence suggests that when making choices about health care, patients are much more likely to consult family and friends than an Internet site that posts quality information. There is as yet no conclusive evidence that quality data drive consumer decision making. Furthermore, acute myocardial infarction patients rarely have the opportunity to choose a hospital, even if they had access to the data. The assessment of hospital quality is not only a challenge for patients, it’s still perplexing for those of us immersed in health care. The scope of measures of quality is both broad and incomplete. At the microsystem and individual clinical syndrome level, we have a plethora of process measures that are evidence based (such as the CMS Hospital Compare measures) but appear to E D I T O R I A L