Performance Metrics - Statistics show Patients should take care using Hospital Report Cards

Medicare Hospital Compare Quality of Care

Measuring Hospital Quality | GE Data Visualization

Performance Metrics are key to applying systems engineering to health care. Rating Hospital Performance is Typically too complex for one number. GE Data Visualization tool is one of the best. The ideal would be quantitative, specific, and objective measures, while the published ratings are usually too generic, subjective and qualitative.

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These days, hospitals — like students — have to worry about getting a bad report card. Employer groups, health insurers, government agencies, and even newspapers are amassing mountains of data about them, crunching the numbers, and assigning scores and rankings. Several private companies have turned the collecting and assembling of hospital data for public consumption into a nice little business. Patients and their families are increasingly expected to act like savvy shoppers, making smart choices based on all this computerized wisdom.

That’s the idea, anyway. Reality isn’t quite so simple. There’s no easy way to summarize quality. You get at it indirectly through what can be measured; but the individual measurements have problems. Mortality rates must be adjusted to take into account how sick patients were to begin with, and adjustment formulas vary. Patient volume is often used to judge quality because it’s easy to calculate. Studies have shown an association between volume and better outcomes, but it’s not a perfect correlation by any means. Any overall grade is based on assumptions about the relative importance of individual measurements — assumptions that are open to question.

How credible are the report cards and rating systems? They each fall short in some way. And they’re certainly not the only thing to go by when you’re picking a hospital — or, by extension, a doctor. Think of them as pieces in the puzzle. And we’d still ask around to see if people think it’s a good hospital.

1. U.S. News & World Report www.usnews.com
2. Leapfrog Group www.leapfroggroup.org
3. Consumer Checkbook www.checkbook.org
4. Health Grades, Inc. www.healthgrades.com
5. National Voluntary Hospital Reporting Initiative www.medicare.gov/hospital/home.asp
6. Select Quality Care www.selectqualitycare.com

Better-Than-Average and Worse-Than-Average Hospitals May Not Significantly Differ from Average Hospitals: An Analysis of Medicare Hospital Compare Ratings | RAND


Better-than-average and worse-than-average hospitals may not significantly differ from average hospitals: an analysis of Medicare Hospital Compare ratings -- Paddock et al. -- BMJ Quality and Safety

1. Susan M Paddock1,
2. John L Adams2,
3. Fernando Hoces de la Guardia1

+ Author Affiliations

1. ¹RAND Corporation, Santa Monica, California, USA
2. ²Kaiser Permanente Research, Pasadena, California, USA

1. Correspondence to Dr Susan M Paddock, RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90470-2138, USA; paddock@rand.org

Abstract

Background Public report card designers aim to provide comprehensible provider performance information to consumers. Report cards often display classifications of providers into performance tiers that reflect whether performance is statistically significantly above or below average or not statistically significantly different from average. To further enhance the salience of public reporting to consumers, report card websites often allow a user to compare a subset of selected providers on tiered performance rather than direct statistical comparisons of the providers in a consumer's personal choice set.

Objective We illustrate the differences in conclusions drawn about relative provider performance using tiers versus conducing statistical tests to assess performance differences.

Methods Using publicly available cross-sectional data from Medicare Hospital Compare on three mortality and three readmission outcome measures, we compared each provider in the top or bottom performance tier with those in the middle tier and assessed the proportion of such comparisons that exhibited no statistically significant differences.

Results Across the six outcomes, 1.3–6.1% of hospitals were classified in the top tier. Each top-tier hospital did not statistically significantly differ in performance from at least one mid-tier hospital. The percentages of mid-tier hospitals that were not statistically significantly different from a given top-tier hospital were 74.3–81.1%. The percentages of hospitals classified as bottom tier were 0.6–4.0%. Each bottom-tier hospital showed no statistically significant difference from at least one mid-tier hospital. The percentage of mid-tier hospitals that were not significantly different from a bottom-tier hospital ranged from 60.4% to 74.8%.

Conclusions Our analyses illustrate the need for further innovations in the design of public report cards to enhance their salience for consumers.