Consumer Reports accompaniment to “Hospital Rankings Get Serious”

Guest post by John Santa, MD MPH, accompanying Hospital Rankings Get Serious

Including Consumers In the Safety Journey

For more than a decade, those in health care have known that serious safety problems were present in our health systems. Many of the country’s most prominent health care leaders have done their best to make safety improvement a priority. Patients and families have shared their stories, pleading for more attention to the errors that have become so commonplace. Published research has shown dramatic improvements can occur when the culture of a hospital changes in a way that prioritizes safety and reduction of harm. Many physicians and hospitals have stepped up to these changes, demonstrating that striking improvement can occur. But much of our health care system has not made these improvements, and in many cases has not been transparent with consumers about these risks.

In early July Consumer Reports published its first Hospital Safety Ratings of more than 1,159 hospitals in 44 states across the U.S. Hospital errors and mistakes contribute to the deaths of 180,000 hospital patients a year, according to 2010 figures from the Department of Health and Human Services. And another 1.4 million patients on Medicare are seriously hurt by their hospital care.

But hospital safety information is difficult to come by; the U.S. government doesn’t track it the same way it does say, automobile crashes, and it becomes especially difficult for consumers to know and interpret how well hospitals in their community are doing. Our safety ratings covered just 18 percent of all U.S. hospitals, but included some of the largest and best-known hospital systems. The ratings were focused on six, safety-related categories: infections, readmissions, communication, CT scanning, complications, and mortality. We did not rate hospitals based on how much a consumer liked being there or not, or other hospital experiences they had, or even the benefit a consumer experienced by being at a certain hospital. We focused entirely on safety.

Our safety composite score was developed after several years of working with publicly-reported hospital quality data. Besides using data that was reported to federal or state governments, we selected measures where there was enough information to include as many hospitals as possible, areas that had the greatest effect on patient safety, measures that were focused on outcomes, instead of processes, and that were valid and reliable, as assessed by our internal statisticians and our external experts. All of the information we published was the most currently available and most has been reported for sufficient time for hospitals to implement improvement efforts. Finally, we looked at areas where consumers could take some sort of action to protect themselves. We realize that our safety composite measures some aspects of safety but not all aspects. We are working on developing more safety measures to add to the composite. We envision this work as a long term journey not a set destination.

Why did we focus entirely on safety? Because the amount of accidental harm inflicted upon patients in a hospital setting is nearly epidemic, and in many cases, almost entirely avoidable. We believe that safety should be a top priority for hospitals, and to underscore that point, we set a high bar to determine the cut-offs that defined our Ratings. We included risk adjustments in several areas. But we do not believe making more extensive adjustments in the data is appropriate, especially when an error can always be prevented. For example, in the case of hospital infections, we believe that zero errors is a reasonable goal. And we believe that is the case for other events too, such as pressure sores.

We acknowledge that this challenged hospitals and researchers. Yet given the slow rate of system-wide improvement in safety and errors, we think it is appropriate to stimulate new approaches and more critical thinking.

We think that good science is done by independent teams who are transparent in their methodology and use data accessible to all. We have had multiple interactions, conversations, and presentations involving hospitals, and we know that many hospitals would disagree with our decisions and the subsequent ratings. While we consulted multiple experts and researchers, and reviewed multiple studies, we developed our safety composite independent of any other rating effort, research team or existing strategy. We made all the final decisions.

We think the best science includes input from those who are most likely to benefit and those most at risk. We are fortunate to have input from consumers who understand the benefits and risk of health care. We have urged consumers to use all resources available, including other publications, to assess the benefits and risks of a health care intervention. Our priority was always—and remains—a focus on what can best improve the health of, and reduce the harm to, consumers.