Continuing the thread of the previous post about the new MyHospitals website, Croakey’s Washington correspondent, Dr Lesley Russell, suggests that we should be learning from similar initiatives in the US.
Lesley Russell writes:
It’s fascinating to watch the AMA fighting against improvements to patient health and safety at every turn, including the initial attempts at the MyHospitals website, when doctors should be taking the lead in improving the quality and safety of the health care system.
There are so many obvious and easy ways to save lives and save money – arguably this is an area where the low-hanging fruit are yet to be picked.
I don’t find it all that easy to be an advocate for the US health care system (after all, I’m spending most of my time here helping to reform it and to push back on efforts to repeal the new law), but when it comes to putting information on hospitals into the public domain, the US has much to offer.
There are some problems in that (1) there is yet to be a national system for comparisons of individual hospital performances (although that is coming courtesy of health care reform) and (2) there are many unofficial websites that also offer rankings, information and commentary on both hospitals and doctors.
It is amazingly easy to find out how many law suits you doctor has faced, what patients think about him/her and the office staff, where they were educated and are licenced and affiliated. Does that get you the best doctor in town for your needs? Not necessarily, but it can help.
For starters on hospital data, try the website of the Maryland Health Care Commission.
This website has information for patients, practitioners and hospital managers. It enables access to data that enables comparison of hospital performances for a range of specific conditions, including cardiac, respiratory, surgeries, maternity and newborn care.
Under heart conditions you can find:
- A list of cardiac procedures, with the number done by each hospital, and the average length of stay. For example, the Johns Hopkins Hospital in Baltimore did 520 cardiovascular catheterizations in 2009, and the average length of stay was 1.7 days.
- Under quality of care you can see that 100% of Johns Hopkins heart attack patients got aspirin on arrival and 99% got aspirin prescribed on discharge, 98% got an ACE inhibitor for LVSD, 100% got smoking advice cessation and 99% got a beta blocker prescribed at discharge. 86% of patients got discharge instructions.
- If cardiac patients have surgery, you can see what the likelihood is of patients having a post-operative infection, controlled post-operative blood glucose, and treatment to prevent blood clots.
- Under the Practitioner Guide, (open to everyone, but with more medical language) you can see how patients rate their hospital experiences, the rate of central-line associated blood stream infections for each surgical specialty in both the adult and pediatric units and how this compares with the national average,(John Hopkins is right on the national average), and the rate of active testing for MRSA in ICUs.
- You can also find the 30-day mortality rate for acute myocardial infarction (the Johns Hopkins number is 15.3% compared with the state average of 16%).
- And there is a detailed pricing guide with the hospital costs given for every procedure – and the reasons why there are outliers are also provided. Under ‘Cardiac arrhythmias and conduction disorders’ – the sort of heart issue that leads to a pacemaker – you can see that the average charge in Maryland hospitals for this is $6173 and the charge at Johns Hopkins is $7907. The higher charge is due to sicker, more complicated patients choosing their care at this well known and highly respected teaching hospital.
It’s pretty clear from the data provided that there are some hospitals where you would not want to go, and that costs don’t necessarily reflect better health outcomes. But it’s not clear how useful this information is to patients and their families.
There is certainly evidence that regular reporting and public publication of results forces remedial action on the part of Maryland state health regulators and hospital administrations.
• Dr Lesley Russell is a Senior Fellow at the Center for American Progress in Washington DC. She is a Research Associate at both the Menzies Centre for Health Policy and the US Studies Centre at the University of Sydney.