Check out the differences in hospital quality across Massachusetts
December 3, 2012 in Quality of care
UPDATE: There were errors in the initial posting of our pneumonia quality numbers. We apologize for misrepresenting the quality of care for hospitals that looked worse than others in our original post.
Everyone seems to be talking about the “engaged” patient. Have you noticed? Fine, except there’s stunningly little information about health care with which I can engage.
Some of you are paying attention to how much your MRI or stitches or surgery costs. Tracking down the costs is hard. But try asking about the quality of that test or repair or the normal birth of a baby? Not only is the information hard to find, in many cases it doesn’t exist. It’s just amazing that I get a blank look when I ask, who does the best job with knee surgery or removing a gallbladder or a colonoscopy?
Hospitals say they are making great strides in gathering quality information. That’s great, but turning it into information we, consumers, can use still has a long way to go. And figuring out which doctors do a better job than their colleagues is nearly impossible to determine, expect by word of mouth.
We’re hoping to kick off a broad discussion about where to find the best care, starting with this snapshot of hospital quality in Massachusetts. The scores and ratings you see on the map and bar chart below are not new. This is all public data, collected by private, state or federal agents and posted online somewhere else. We’re pooling a range of quality measures here to offer you a glimpse of how much quality varies from one hospital to the next and to give you a place to ask your questions about what the health care system will and won’t tell you about quality and why.
If you don’t find what you’re looking for here, let us know. We are putting readers on notice: this the quality information that is available. We don’t think it’s good enough. Many hospitals agree. We all need to push for more. In the meantime, tell us what other quality information you’re looking for. We’ll see if we can help or let you know why we can’t.
Here’s a HUGE thanks to Dianne Finch who created the map and bar chart and to Ted Natoli who collected and packaged the data for this project.
Gary Riccio said on December 3, 2012
This site could be a stimulus for change if a lot of people use it and then comment that they have chosen one hospital over another based on the quality data. For this to be influential in a good way, hospitals would have to “graded” on the amount, relevance, and completeness of data they provide. Then hospitals might actually compete to be more transparent on quality.
Martha Bebinger said on December 3, 2012
Gary – if you make a choice based on quality – we’d love to hear your story. Feel free to write a post for Savvy at your convenience.
Rob said on December 9, 2012
I’m not sure I agree that this site could be helpful if a lot of people use it – “online reviews” are notoriously unreliable and it’s likely to be even worse for healthcare (than, say restaurants or hotels) – there is simply too much money and prestige tied up in the reputations of these institutions. And, I think we underestimate how difficult it is to define and measure quality/safety in healthcare.
That said, the science of measuring and monitoring quality in healthcare is in its infancy so we should keep trying…for now, the question is how and when to display the information, especially if its validity is a concern.
Liz Morgan said on December 3, 2012
Great map! I’ve looked this info up hospital by hospital; this is much better.
I’d like to know staff-to-patient ratios, especially at night. If an elderly patient needs to go to the bathroom at night, will a nurse answer the call button promptly, or is there just one nurse on duty for the whole floor? Also, how closely are the elderly monitored after admission, especially on weekends? If they become disoriented, lose touch with reality, or become incontinent, will anyone on the staff notice? What about coordination between the doctors and caseworkers–are they on the same page, or are they confused about whether the patient is staying or going, and if going, where and when? These are all issues I’ve had to deal with.
Martha Bebinger said on December 3, 2012
Liz – all critical issues. Do you know who collects data on the concerns you raise?
Measurement MD said on December 5, 2012
http://www.patientcarelink.org/
The MA Hospital Association reports staffing data on this site.
Michele said on December 5, 2012
This is a terrific project. Will there be more hospitals added? I was looking for Mt. Auburn info and didn’t see it.
Thanks.
Martha Bebinger said on December 5, 2012
Thanks Michele – Mount Auburn should be in there. It’s a little hard to drill into the cluster of hospitals around Boston. We’re trying to make that easier. You can see the specific measures for Mount Auburn on the bar charts. Does that help?
Anne DiNoto said on December 5, 2012
Great project! I have an HMO with BCBS, the “plan network is the same, what’s different is what you pay for care (your copays) will depend on the primary care pysician (PCP) you choose to coordinate your care. To pay the lower copays members need to choose a PCP affiliated with one hospital”. So, I’m looking for quality information on PCPs.
Martha Bebinger said on December 5, 2012
Hi Anne – great question. There is no quality information for individual primary care docs in Massachusetts that is made public, at least none that I know of. Mass Health Quality Partners looks at primary care group practices (not individuals), so you might start here: http://www.mhqp.org/quality/whatisquality.asp?nav=030000.
Here’s a warning though…the quote in your comment suggests that you’re in a limited network or tiered plan where Blue Cross has decided which doctors deliver higher or lower value care. I suggest you ask Blue Cross for a list of doctors who are high quality and the reasons for this determination.
Your comment makes me wonder, what measures would you use to decide which PCP delivers the best care. Here are some of the things I’d have on my list – what would be at the top of yours?
A great PCP….
1) doesn’t keep me waiting
2) asks me about my health goals, how I plan to reach them and what s/he can do to help
3) helps me set up all the supports I need to be in the best possible health and is my best advocate when I need one
4) gets to root of my health problems without over-testing or over-prescribing mes
5) nudges me when I fall off the path to my goals
5) calls me after a sick visit to find out how I’m doing
6) is available for phone, Skype or email consults
OK – a start.
Let me know how this works out for you!
Josh Archambault said on December 7, 2012
Great map Martha,
Now we just need someone to create a neutral third-party app the pools this data, updates it regularly, links it with your insurance plan design, provides cost estimates along with recommendations for where to go, and consumer reviews of each doc. That would be true consumer engagement.
Mike Ciaraldi said on December 8, 2012
Great story and comments. One caveat: Years ago, when I was living in Rochester, NY, I remember a similar survey was done on recovery rates at local hospitals. People were initially surprised that Strong Memorial Hospital, the world-renowned teaching hospital associated with the University of Rochester School of Medicine and Dentistry, had the worst statistics. Then someone pointed out that, good as the other hospitals were, Strong was where everyone went if they had the worst forms of cancer, needed a heart transplant, etc — In other words, on the average, Strong patients entered the hospital already in worse shape, and requiring riskier treatment, than those entering other hospitals.
We used to say that it didn’t help its reputation that Strong is across the street from Mount Hope, the largest cemetery in the city.
David C. Holzman said on December 8, 2012
This is indeed one of my main concerns about these sorts of lists: those who take the harder cases come out worse, and so outcomes are not strictly comparable from provider to provider or hospital to hospital.
Dianne Finch said on December 8, 2012
It looks like the statisticians who analyze hospital data already had these issues in mind. Take a look at the website below. Does this help? I also wonder how nurse-patient ratio, doc-patient ratio, profit versus non-profit structure, reporting laws, voluntary reporting (some hospitals don’t participate), etc.. affect this data.
Martha was hoping for a discussion. Would be great to see some of the professional statisticians comment!
http://www.hospitalcompare.hhs.gov/Data/RCD/Healthcare-Associated-Infections.aspx
Heather Ryan said on December 8, 2012
Great project idea – I applaud you for diving in and providing the data for people to use. One thing that I wonder about is whether these hospitals were dealing with patients who are in the same severity category? For example, if a doctor or community hospital always sends his or her/its sicker patients to a teaching hospital then have you adjusted for the type of cases the different hospitals are treating?