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Is Mine Better Than Yours?

August 16, 2009
by Mark Hagland
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It’s human nature to compare ourselves with others; and it’s American consumer nature to want to compare goods and services according to some kind of ratings standard or other. Indeed, a whole industry has sprung up to meet such needs, across broad areas of interest—think of Consumer Reports, J.D. Power, and even the guest-ratings capabilities within Hotels.com. So why should it still seem a surprising in healthcare?

Yet it amazes me that, while a number of pioneering hospital organizations around the country have plunged headfirst into the emerging new world of publicly comparative data, many others are clearly still lagging behind. The laggards had better watch out, though: every day, the tools for comparison are getting a bit better, and every day, new public, private, and public-private organizations get involved, or become more involved, in the whole process.

Take for example the Centers for Medicare and Medicaid Services (CMS). Last month, CMS released national statistics for the first time on readmission rates within 30 days following discharge for care for heart attack, heart failure, and pneumonia. Medicare Hospital Care data shows that 18.2% of patients admitted for pneumonia will be readmitted within 30 days of discharge; 19.9% of heart attack patients will be readmitted within 30 days; and fully 24.5% of heart failure patients will end up back in the hospital within a month (http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3477&intNumP...). And depending on how one looks at such statistics, they could be seen either as discouraging or perhaps simply illuminating.

Meanwhile, CMS is making it ever easier to compare hospitals with regard to a number of process measures, from giving patients the right antibiotic at the right time (within one hour prior to surgery), to the percentage of heart attack patients being given a beta blocker at discharge, all available at the Medicare Compare website (http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp?version=d...|3.5|WinXP&language=English&defaultstatus=0&pagelist=Home). Just as an example (and please note, that’s all this is, an illustrative example), I’ve just clicked to compare outcomes at nine hospitals local to me in Chicago (I won’t name the hospitals, but you could go in and noodle around and figure them out, if you really wanted to do so). Under the measure, “percent of heart failure patients given discharge instructions,” the rates varied dramatically, from a high of 98 percent (two of them), to 97, 91 (two of them), 90, 80 percent, and down to 54 percent. How about “percent of all heart surgery patients whose blood sugar (blood glucose is kept under good control in the days right after surgery”? 97, 95 (two hospitals), 94 (two hospitals), 85, 84, and 82 percent, respectively (with one of the nine hospitals having no patients with that condition). Interesting, very interesting. Now, the blood glucose control measure for heart surgery patients is of particular interest to me, as my past research and reporting have indicated to me that this is a measure that strongly points to good patient care management generally.

Of course, some of the measures that are available now, are being criticized by some as being too simple to paint a full portrait of the complexity of care at various organizations. And certainly, over time, Medicare and other organizations will increase the sophistication of some of the measures being presented at the Medicare Compare website and elsewhere. But even now, I have to say that, through a careful series of comparisons, I can get some interesting insights into important indicators among the local hospitals I might choose to be admitted to for, say, non-emergency heart surgery, even now. To me, that very fact speaks to the need for hospital CIOs to work with the clinician and executive leaders in their organizations to begin to make significant improvements in their organizations’ patient care outcomes and patient safety outcomes, with strong clinical IT facilitating performance improvement work all along.

And though most healthcare consumers aren’t yet at the point where they understand that blood glucose control among surgical patients is potentially quite a good measure of patient care management, the time is not far off when a significant plurality of consumers do get to the point of using some of this easily available information to make certain decisions about their care. Indeed, “how’s my public outcomes data looking?” will soon—much sooner than some might suspect—be a very serious and market-moving question for hospital executives and clinician leaders.

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