Prepared Patient: Can Hospital Report Cards Help You?

Main Category: Public Health
Article Date: 18 Oct 2008 - 0:00 PDT

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Consumers are awash in information they can use to find the best deals on everything from dishwashers to car insurance. But is it possible to comparison shop for a hospital?

Hospital report cards which can include information on everything from how clean the hallways are to how many patients die after a certain operation have been touted as a valuable source of information for savvy hospital shoppers. But these report cards may not be as useful to you as a Consumer Reports guide. The information in them can be out of date, hard to interpret, and aimed more at the hospitals themselves than at patients. And for many patients, "choosing" a hospital just isn't an option no matter what the report card says.

"Most of these reports did not have the patient or consumer as the primary audience in mind when they were designed," says Judy Hibbard, D.Ph., of the University of Oregon. She studies how consumers use health information.

Still, hospitals do differ in the quality of the care and the patient experiences they offer, and it's wise to know as much as you can before entering a hospital to deliver your child or have major heart surgery. Hospital report cards may not be perfect, but they can offer clues as to the kind of care you might receive at one institution compared to another.

For instance, you might discover how well a hospital provides "evidence-based" care, such as delivering the recommended dose of aspirin to heart attack patients upon arrival. And increasingly, the report cards contain feedback surveys from patients who can talk about the nitty-gritty of their stay: Did the nurses disappear? Were the rooms warm?

You can find these stats and more in the online hospital report cards published by the federal government at sites such as HospitalCompare.gov, for-profit companies such as HealthGrades, and yes, even catalogued at the Consumer Reports Web site.

How did you "choose" your last hospital?

"The last time I went to a hospital was for the birth of my second child," says Elizabeth Tran of Arlington, Va. "We went there based on where our doctor was affiliated; we didn't have a choice in where we went.

"To be honest, where we live in a major urban area, I might just look at the location of a hospital as a proxy for its quality," Tran says, noting that hospitals in some wealthier neighborhoods have a better "word of mouth" reputation.

The "buzz" negative or positive about a hospital also figures into Jennifer Thorson's perception of local hospitals. But her choice of hospital would be limited to where her doctor will work. "If he or she had privileges at more than one hospital, I might ask them if they had a preference," says Thorson, who lives in Tucson, Ariz.

Many patients just go to the facilities where their doctor practices and where their insurance will pick up the tab. "To the extent that more than one hospital is covered, you might have some freedom of choice," her sister Amy Thorson says. "But other than that…"

What's the best way to use a report card?

If you do consult a hospital report card, look for the measurements that suggest a hospital does what it's supposed to do for your condition, advises Maribeth Shannon, director of the California HealthCare Foundation's Market and Policy Monitor program, which publishes the CalHospitalCompare.org report card.

For instance, if you're going into the hospital to have a pacemaker implanted, you might want to know how often a certain hospital uses the recommended anesthesia during the procedure. These types of statistics, when available, can tell you whether a hospital's care is in line with what national medical organizations have recommended.

"What we've found in our research is that very few hospitals are very good at everything, and very few are not good at anything. It may be that it's a good hospital for cardiac care, but not orthopedic care, for instance," Shannon says.

Outcome data how well patients fared after a certain hospital procedure can also give you an idea of how well a hospital performs, but these data are rare, Shannon says. Some report cards list "specialty" hospitals or centers of excellence those renowned for their cancer care, for example.

More report cards are now answering the questions that patients seem to ask most often about hospitals: Were the nurses friendly? Were the rooms quiet? Was the check-in process chaotic? Shannon says these data are "core" to a hospital's care. "It's about important things like, 'Did you feel the doctors and nurses were listening to you?' or 'Did you understand your discharge instructions?'"

Although it can be difficult for a patient know whether aspirin or antibiotics were dispensed properly, it's easy for a patient to know whether they felt their needs were taken care of in a hospital. "I think of it as customer service," Tran says.

The report cards "serve a dual purpose," says Rick Wade, senior vice president for communications at the American Hospital Association. "They are there for the public, but they are also there as benchmarks for hospitals to do better." However, in some cases, the report cards have not significantly changed a hospital's standard of care, or driven patients away from poorly performing hospitals.

The report card is "one of the many tools that a patient and family should use to choose a hospital," Wade says. "But we think that these are the best measures to start a conversation [about hospitals] between a doctor and patient."

But aren't all hospitals the same?

After glancing through a few report cards comparing hospitals in her area, Tran notes that "a lot of the ones that would be an option for us rank comparably." It's a common complaint from both physicians and patients. The cards clearly single out the best from the worst, but are less useful at helping patients decide between hospitals where overall quality is about the same.

Looking over a report card for her city, Jennifer Thorson says she might be interested in the measurements showing how often a hospital performs a certain procedure.

For some, familiarity will always be most important than low performance scores. "I'd prefer to go to a hospital I feel comfortable with, compared to a hospital I don't know even if it has an outstanding record," says Greg Reid, the husband of Amy Thorson.

Wade says navigation is the missing piece of hospital report cards, and he hopes to see more efforts to help patients figure out how to read the cards, get the information they need, "and understand what this all means."

Although Hibbard feels that there is much work to be done to improve hospital report cards, "I would look at the information" she admits, "because it's better than nothing."

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