Quality report cards
Steve Pearlstein, business columnist for the Washington Post, writes today about hospital quality report cards. He discusses at length some of the pros and cons of HealthGrades, which compiles risk-adjusted data on health outcomes. Unfortunately, HealthGrades reports are based on coded administrative data, which have been shown to correlate poorly with actual quality of care received.
Pearlstein largely dismisses the process measures reported at HospitalCompare.gov in favor of outcomes measures. Process measures describe processes of care that are linked closely to outcomes, and those on the HospitalCompare site have been carefully vetted and validated to ensure that they represent quality of care. Outcome measures (such as hospital infection rates), while potentially of greater interest to consumers, require substantial standardization and risk adjustment in order to provide data that comparable between hospitals. And despite Paul Levy's assertions, patients want to be able to compare hospitals directly, not just track a given hospital's progress over time. State governments are moving toward mandatory reporting of hospital infection data; those already reporting such data are Missouri and Pennsylvania, and Missouri's data are the only ones thus far to be risk-adjusted (and thus comparable).
More reliable measures of quality than HealthGrades' can be found, for free, at http://QualityCheck.org, which is produced by the Joint Commission, the organization that accredits medical facilities. These measures are exhaustively tested and vetted, like the HospitalCompare measures (with which they overlap).