Wednesday 01 Oct 2014

Information and opinions presented here do not always represent the views of the American Heart Association.

Hospital evaluations increase, but not created equally

Published: 12:14 pm CDT, July 28, 2014

The rate of available public information about healthcare and hospitals has gone from a trickle to a steady stream in the last decade. Now, patients and other consumers have a world of evaluations, ratings and rankings they can use to help them take charge of their healthcare.

But not all evaluations and rankings are the same. And while ratings make for good marketing material, experts say consumers need to look deeper.

“There are lots of ratings and rankings that exist for hospitals, but from variable sources,” said Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center and co-chief of the UCLA Division of Cardiology. He also is the chair of the steering committee for the American Heart Association’s Hospital Accreditation Science Committee. “In some cases rating criteria have evolved just from expert opinion, and they may not be well-vetted or open to disclosure.”

Many rating and ranking organizations use a variety of different measures to judge “quality of care” in hospitals.  But instead of rankings, the AHA has focused on creating a set of scientific procedures, resources and recommendations. It launched its Get With The Guidelines quality improvement program in 2000 to help hospital teams meet the latest research-based clinical guidelines for heart and stroke care. The program doesn’t rate hospitals but provides different levels of awards on how well they adhere to the scientific guidelines.

Studies show consistent application of the guidelines can lead patients to better recoveries and lower risks of ending up back in the hospital. In the last few years, the AHA created a Quality Map to help consumers find award-winning and certified hospitals that follow Get With The Guidelines or have met rigorous standards allowing them to be accredited cardiovascular or stroke centers.

“Ratings that are objective, meaningful, and are interpretable are critically important,” Fonarow said. “I think it’s really important when people are looking up quality of care and outcome information on hospitals where they will choose to receive care, that it not just be self-proclaimed or from advertising, but from a trusted organization founded on evidence and science, such as the American Heart Association or the American College of Cardiology.”

Carrie Teegardin, a reporter for the Atlanta Journal Constitution, has seen a sea change in what the public gets to see and how organizations and the media crunch the numbers and interpret the data.

“The internet has made it possible for anyone to gain access to all sorts of data. But the big shift has been the collection of data. That just didn’t happen in the past,” said Teegardin, who has been writing about health care issues for 20 years. “Now, everyone from the American Heart Association to Consumer Reports to the Joint Commission to the Atlanta Journal-Constitution is offering consumers a look at some aspect of quality for hospitals.”

Reporters used to have very little access to what was happening inside hospitals.

“Today, that has changed significantly,” she said. “Now we can look at reliable statistics for everything from patient satisfaction and ER wait times to infection rates and death rates at almost every hospital in the country. That gives us the chance to really examine how our local hospitals are performing.”

Fonarow believes science-based guidelines like the AHA’s and more access to information and hospital outcome reports will help improve the quality of care for everyone.

“Those hospitals that have the best experiences with quality and outcomes are going to be very much able to prevent heart attacks and strokes in the first place, and where you want to seek your treatment after an acute illness.”

For Teegardin, her watchdog role in healthcare has been bolstered by the expansion of the quality reports in the Centers for Medicare & Medicaid Services. Her latest reports looked at infection rates in hospitals and joint replacements.

The hospitals know the numbers are out there and their payments from Medicare are starting to be tied to how well they do on some of these measurements,” she said. “So they are more focused than ever before on quality.”

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