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Quality and Patient Safety

Quality Reporting by Third Parties

The organizations listed below provide online information that consumers may wish to review in researching aspects of quality and safety at hospitals across the country. They represent a mixture of governmental, non-profit and for-profit entities. Texas Health Resources provides this listing as a public service, adding a brief assessment of the limitations we believe to be inherent in the data or methodologies associated with each one.

Quality measurement in health care is an evolving process. Various agencies differ in the methodologies, philosophies and data sets used, resulting in a lack of uniform health industry standards for measuring the quality of hospital and physician care. However, it is believed that U.S. health care providers will reach consensus on consistent quality measures in the future.

Furthering the evolution of a common definition for Quality requires significant additional investments in information systems infrastructure on a national scale. Texas Health has committed to investing more than $100 million toward this goal through 2010.

Governmental

Non-profit 

For Profit 

Centers for Medicare & Medicaid Services (CMS)

Sponsor
Centers for Medicare & Medicaid Services (CMS)

Sponsor Type

Government (Federal and State)

Cost

There is no cost to access the reports on this website.

Information Reported

  • The CMS site, operated by the federal government, provides data on three patient populations. The project is called the Hospital Quality Alliance (HQA). The indicators are:
    • Heart attack
    • Heart failure
    • Pneumonia

In December 2002, the American Hospital Association (AHA), Federation of American Hospitals (FAH), and Association of American Medical Colleges (AAMC) launched the HQA, a national voluntary initiative to collect and report hospital quality performance information.

  • The HQA provides inpatient data from all payers, voluntarily reported by 4,000 hospitals across the country.
  • The CMS data show rates for the top 10 percent of participating hospitals and the top 50 percent of participating hospitals, and compares them to a specific hospital's rate.

Usefulness

  • The data are a reflection of information that is collected by other regulatory agencies and consumer groups not associated with the federal government.
  • The information may be a valuable resource for consumers as a proxy for the quality of care provided at a hospital for the specified conditions.
  • Additionally, it can be used for comparative benchmarking with other groups reporting similar data.

Limitations

  • Consumers should be aware that there are some concerns with the data as they are a combination of administrative and abstracted clinical data. Administrative data are demographic and billing information collected before or during the patient's visit to the facility. Abstracted data are clinical information collected from individual patient records.
  • Abstracted data are prone to human error, and administrative data are based on coded information determined by a collector who may have limited clinical knowledge. Both abstracted data and administrative data are subject to variability between facilities.
  • Vendor failures can result in incorrect data submissions, causing inaccurate information. Other extrinsic factors outside the control of a hospital or health care system, such as insufficient supplies of vaccine, may not be adjusted for in the reports.

Link
www.hospitalcompare.hhs.gov

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Texas Health Care Information Council (THCIC)

Sponsor
Texas Healthcare Information Council (THCIC)

Sponsor Type
Government (State)

Cost
There is no cost to access the reports on this website.

Information Reported

  • Submission of hospital inpatient demographic and billing data to THCIC is mandated by state law. (Chapter 108 of the Health and Safety Code; rules that apply to the Texas Health Care Information Collection are found in Chapter 421 of Title 25, Part 1 of the Texas Administrative Code.)
  • Data are reported by the state to consumers as a proxy for the quality of care provided at a health care facility.
  • Information contained on the site reflects factors associated with safe care and the facilities that provide a service with the greatest volume.

Usefulness 

  • The THCIC is a part of the Texas Department of State Health Services.
  • The data are readily accessible to the public and can be used in guiding health care choices or for an organization in making quality improvement decisions.
  • There is value in using these data, however they are best used to broadly indicate a direction for further exploration.
  • Data are reported by the state to consumers as an indicator of the quality of care they should expect at a health care facility.

Limitations

  • There are concerns with the accuracy of this data set as it is derived from a combination of administrative, billing and abstracted data. Administrative data are demographic and billing information collected before or during the patient's visit to the facility. Abstracted data are clinical information collected from individual patient records.
  • The data set is subjected to limited checks on format, and the content is not validated, meaning that the THCIC's main product, the Public Use Data File (PUDF), may contain clinically inaccurate data.
  • The process for submitting the data may be prone to human error because it relies on hospital clerks translating financial billing data into clinically coded information that may have been interpreted incorrectly.
  • Due to the limitations associated with using financial data, the value in using this data set to make clinical decisions should be limited to broadly indicating a direction for further exploration.

Link
www.dshs.state.tx.us/thcic/

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Dallas/Fort Worth Business Group on Health (DFWBGH)

Sponsor
Dallas/Fort Worth Business Group on Health

Sponsor Type
Non-profit

Cost
There is no cost to access the reports on this website.

Information Reported

  • The DFWBGH site is operated by a regional, employer-sponsored health care coalition.
  • It contains information focused on employers in the Dallas/Fort Worth Metroplex area.
  • DFWBGH proclaims a commitment to promoting and maintaining a market-based health care system that provides quality, accountability and affordability.
  • Data displayed on this site are voluntarily provided by organizations participating in the coalition and is part of the Public Use Data File compiled by the Texas Health Care Information Council. (See the THCIC section of this report for additional information.)
  • Additionally, the DFWBGH site provides links to other sites containing public use data and voluntarily submitted data such as the National Quality Forum (NQF) survey on the Leapfrog site.

Usefulness

  • These data may be used by consumers to guide health care choices, in particular for picking a facility that has multiple safety checks and/or experience in performing a procedure or type of care.
  • These data may be of value in identifying facilities that promote safe, quality care.

Limitations

  • There are some concerns with the data as they are a combination of administrative and abstracted data. Administrative data are demographic and billing information collected before or during the patient's visit to the facility. Abstracted data are clinical information gleaned from individual patient records.
  • Abstracted data is prone to human error, and administrative data is based on coded information that may be subjectively determined by a collector who may have limited clinical knowledge. Both abstracted data and administrative data are subject to variability between facilities.
  • There are also concerns with survey data. The NQF survey is subjective and lack clarification of definitions of response. Additionally, the methodology used to calculate scoring is not well specified, and the scoring cut-off points are not provided. The quartile scoring may lead to the placement of two hospitals in two different quartiles on the basis of no significant differences.

Link
www.dfwbgh.org/txhospcheck.htm

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The Joint Commission (TJC)

Sponsor
The Joint Commission (TJC)

Sponsor Type
Non-profit agency

Cost
There is no cost to access the reports on this website.

Information Reported

  • The Joint Commission (TJC) is a regulatory agency that provides information on standards of care.
  • Data are obtained through voluntary submission of information for a defined set of elements focusing on patient care in selected patient populations.
  • Currently, indicators include community-acquired pneumonia, heart failure, acute myocardial infarction (heart attack), pregnancy and selected surgical procedures (with additional indicators added at undetermined intervals).

Usefulness

  • Hospitals are measured on quality indicators based upon the use of operational definitions and measurement criteria established by the TJC from evidence- based research.
  • The data are used as a proxy for the quality of care provided by a hospital related to these clinical conditions.
  • The data are valuable to individuals who want to choose a hospital that most successfully meets the standards of care as defined by The Joint Commission.

Limitations

  • Although there is value in using this source, there are some concerns with the reliability of the data as they are a combination of administrative and abstracted data. Administrative data are demographic and billing information collected before or during the patient's visit to the facility. Abstracted data are clinical information collected from individual patient records.
  • Abstracted data are prone to human error, and administrative data are based on coded information that may be determined by a collector who may have limited clinical knowledge. Both abstracted data and administrative data are subject to variability between facilities.
  • Additionally, vendor errors can result in incorrect data submissions, causing inaccurate information.

Link
www.jointcommission.org

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Leapfrog Group

Sponsor
The Leapfrog Group for Patient Safety

Sponsor Type
Nonprofit

Cost
There is no cost to access the reports on this website.

Information Reported

  • The Leapfrog Group Web site is designed to provide information on patient safety and quality.
  • The organization represents a set of Fortune 500 companies working to initiate breakthrough improvements in the safety, quality and affordability of health care for Americans.
  • It is a voluntary program aimed at mobilizing employer purchasing power to alert America's health industry that big "leaps" in health care safety, quality and customer value will be recognized and rewarded.
  • The site provides data on the status of a hospital's progress in meeting goals established through the National Quality Forum's (NQF) Safe Practices.

Usefulness 

  • Participating hospitals and health care organizations complete a self administered safe practice survey and submit information about a variety of topics relevant to safe, quality care.
  • The topics include measures associated with:
    • Intensive Care Unit (ICU) care
    • Implementation of computerized physician order entry process
    • High-risk treatments
    • A quality index based on the 27 safe practices outlined by the National Quality Forum (NQF)
  • The survey results are posted on the site using quartiles displayed in a clock-like symbol showing the degree of implementation in each category.
  • These data may be used by consumers to guide health care choices, in particular for selecting a facility that has multiple safety checks and experience in performing a procedure or type of care.

Limitations

  • Although the data may be of value in identifying health care facilities that promote safe, quality care, there are concerns with reliability of the data. The NQF survey responses are provided by each hospital and may not be subjected to independent validation.
  • Data are subject to variability between hospitals due to differences in reporting and lack of precise practice definitions.
  • The methodology used to calculate the scoring is not fully available to hospitals, and the scoring cut-off points are not provided.
  • The quartile scoring may lead to the placement of two hospitals in two different quartiles on the basis of no significant differences.

Link
www.leapfroggroup.org

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HealthGrades

Sponsor
HealthGrades Inc.

Sponsor Type

A private, for profit company that is not authorized on a regulatory or statutory basis.

Cost

HealthGrades provides a general (free) and comprehensive (fee charged) report on hospitals across the country.

Information Reported

  • The site offers evaluations and comparisons of hospital performance based on measurements of patient safety and quality indicators.
  • The data provided contain information that may be used by the consumer as a proxy for the quality of care delivered to the selected patient populations.

Usefulness

  • The data may be of value when choosing a facility that has more experience and better outcomes for certain procedures, diagnosis, or safety of care provided.
  • Analysis of patient results is based on hospital data from the Centers for Medicare & Medicaid Services and represents a subset of elderly (age >65) and/or poor individuals (patients).

Limitations

  • There are concerns with using data from an administrative (billing) database. Administrative data are based on coded information that is determined by a collector who may have limited clinical knowledge. Because of the data collection method, administrative data are subject to variability between facilities.
  • These databases do not reflect pre-existing health problems that can affect outcomes.
  • Inappropriate coding of patient data may lead to inaccurate results.
  • The methods used by HealthGrades account for risk factors coded into the billing data.
  • The methodology used to analyze the data is proprietary. The limitations preclude other parties (including the rated hospitals) from validating the results provided.

Link
www.healthgrades.com

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Revolution Health

Sponsor
Revolution Health

Sponsor Type
Private, for-profit company
The site is currently under development.

Cost

  • Free until 2008, at which time a fee will be charged.
  • The free membership requires users to enter the site quarterly and engage in one of the tools or to write a review of a physician or hospital.

Information Reported

  • Revolution Health is a patient-oriented resource that utilizes publicly reported data from Medpar, Leapfrog reports and consumer reviews.
  • The site offers a tool that allows visitors to compare a hospital's performance to other local hospitals, the state Medicare average and the national Medicare average.
  • The site has nine tabs directing users to specific information. Most tabs are focused on the individual, their health and tools designed to encourage management of health issues.

Usefulness

  • The site offers reference information about hospitals and physicians.
  • The site allows consumers to rate and write reviews on physicians and hospitals based on personal experience.
  • The site offers individuals the opportunity to store profile information, personal health information and general health profiles.

Limitations

  • The information that is offered (or soon to be offered) is not identified by source or time period covered. There is some mention of source in support documents but these are not easily accessed and most users would not be able to locate such information or even know that it was important.
  • The hospital ratings site does not adequately explain at a lay level the association between co-morbidities, age, severity of illness and mortality rates.
  • The patient review section has the potential to be highly subjective and could focus on extreme opinions.

Link
www.revolutionhealth.com

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Subimo

Sponsor
Subimo LLC

Sponsor Type

A private, for profit company that is not authorized on a regulatory or statutory basis.

Cost

Reports on this Web site are available for purchase.

Information Reported

  • Subimo represents itself as providing information and tools for consumers to use in making informed health care decisions.
  • It licenses the tools to employers, health plans and benefit management firms that have an interest in ensuring users make informed, cost effective health care decisions.

Usefulness

  • Consumers may use the information to make health care choices, and in selecting organizations that are attentive to quality and patient safety while providing selected care or procedures.

Limitations

  • There are concerns about the accuracy of data utilized by Subimo as they are derived from a combination of aggregated administrative and abstracted data.
  • Abstracted data are prone to human error, and administrative data are based on coded information that may be determined by a collector who may have limited clinical knowledge.
  • The methodology used to analyze the data is proprietary. The limitations preclude other parties (including the rated hospitals) from validating the results provided.
  • Subimo offers data to the public "as is" with disclaimers shielding it from any and all liability as to the level of accuracy or clinically appropriate content.

Link
www.subimo.com

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