Why Look at Quality Data?

Quality data reporting can be useful in understanding more about what kinds of questions to ask when making decisions about healthcare. Various types of quality-related data are available from many different sources, including insurance companies, the federal government, hospitals, employers and other national groups such as Leapfrog. While this is beneficial for consumers, there are challenges in measuring, reporting and understanding quality. When you evaluate the various measures of quality that are available, consider the following questions:

1. How do I define quality? What is important to me in making decisions about healthcare?

St. Vincent Health’s mission is to provide quality care and services that are spiritually centered, holistic and that sustain and improve the health of individuals and communities serviced.  While individuals define quality differently, at St.Vincent Health quality means continually striving to exceed the expectations of those served for excellence in clinical and operational services. (Ascension Health Destination Statement)

Within the last 10 to 15 years, services to assist consumers with health care decisions have increased substantially. The services use a wide variety of methodologies to rank institutions and providers in terms of quality, and results are readily available in magazines or on the Internet. While there is no universal agreement on how quality should be measured, the following criteria are often cited as the best quality indicators: Credentials, Experience, Range of Services, Outcomes

2. What are the guidelines for reporting quality measures?

The Centers for Medicare & Medicaid Services (CMS) announced the guidelines hospitals should use in submitting their quality performance data to comply with Section 501 the Medicare Prescription Drug, Improvement and Modernization Act (MMA). A set of 10 quality measures has gone through years of extensive testing for validity and reliability. These 10 have been chosen because they are related to three serious medical conditions that are common among people with Medicare and that result in hospitalization, which are heart attack (acute myocardial infarction), heart failure and pneumonia. They are endorsed by the National Quality Forum, a voluntary standard-setting, consensus-building organization representing providers, consumers, purchasers and researchers.  An example of these measures in three disease areas are:

• Heart attack (Acute Myocardial Infarction)
  Was aspirin given to the patient when upon arrival at the hospital?
  Was aspirin prescribed when the patient was discharged?
  Was a beta-blocker given to the patient upon arrival at the hospital?
  Was a beta-blocker prescribed when the patient was discharged?
  Was an ACE Inhibitor given for the patient with heart failure?

• Heart failure
  Did the patient get an assessment of his or her heart function?
  Was an ACE Inhibitor given to the patient?

• Pneumonia
  Was an antibiotic given to the patient in a timely way?
  Had a patient received a Pneumococcal vaccination?
  Was the patient's oxygen level assessed?

3. Do different quality reports use the same sources to report on quality?

Different reports use different sources when they measure quality, and often data is more than one year old. It is important to find out exactly how the source determines their findings and what criteria they are using. The following is a list of commonly used quality reports and what they base their results on:

AARP
The American Association of Retired Persons conducts a survey that is published annually in Modern Maturity. Factors used in this survey include reputation, mortality, JCAHO score and training.

America’s Top Doctors
Every year Castle Connolly publishes America’s Top Doctors, which lists the best doctors in each of 41 specialties. The sole factor used in this survey is peer review.

BestDoctors.com
BestDoctors.com is an Internet-based subscription service, where consumers can access lists of “best” doctors according to specific area codes and specialties. Again, this service is strictly based on peer review.

Healthgrades.com
Healthgrades.com is also an Internet-based provider that assigns ratings for the following areas: cardiac, neuroscience, neurosurgery, orthopaedics, pulmonary/respiratory, obstetrics and vascular surgery. The score is derived using outcomes for specific procedures in each specialty.

The Leapfrog Group
Composed of more than 145 public and private organizations that provide healthcare benefits, The Leapfrog Group works with medical experts throughout the United States to identify problems and propose solutions believed to effect outcomes.

Solucient
Solucient conducts a survey of hospital management and publishes its top 100 hospitals. Because Solucient measures the quality of hospital management, the majority of factors are business-related (profitability, productivity, expenses and revenue). The three clinical factors used are length of stay, mortality and complications.

U.S.News & World Report
The most widely used source of quality information is the annual U.S.News & World Report Best Hospitals survey. This survey uses three evenly weighted factors to rank hospitals in 17 specialties. The three factors are reputation, risk-adjusted mortality and technology.

4. Has the data been risk-adjusted to account for hospitals which may see patients with more complicated illnesses?

Risk adjustment is a technique used to take into account the fact that although patients have the same diagnosis, some might have additional conditions or characteristics that could affect how well they respond to treatment. For example, a 45-year-old man admitted to the hospital with a heart attack and history of seizures would be expected to have a greater chance of survival than an 80-year-old woman who has had a heart attack and who also has pneumonia. In this example, pneumonia is assumed to be a risk-increasing variable for that patient.

It is important for data to be risk-adjusted to account for hospitals which see patients with more complicated illnesses, because this leads to data which shows higher mortality rates or higher complication rates. If the data has been risk-adjusted, then this has been taken into account when scoring or ranking the hospitals to produce a more fair comparison.

While this list provides some considerations, we encourage you to talk with your healthcare provider about your questions.