First it was ratings, then rankings, and now it’s stars. It’s enough to confuse even the savviest health care consumer. All of these rating systems share the goal of making it easier for the public to understand whether their community’s hospital provides quality patient care – a goal the American Hospital Association enthusiastically shares.
Unfortunately, there is wide variation among the numerous kinds of reports and rankings of hospital performance, and that causes confusion for both patients and health care professionals. To address these concerns, the AHA has started a conversation about a more deliberate and focused approach to quality measurement, with the goal of improving public reporting and pay-for-performance programs. Our members are overwhelmed by the deluge and variability of quality measures they are asked to report to public and private entities, and we believe a more focused approach will lead to even more substantial improvements in care – improvements that mean better outcomes for patients.
We have already demonstrated the success of using a standardized approach to measures in our work leading the nation’s largest Hospital Engagement Network in a program that focused on improvement in targeted areas. This program prevented some 92,000 instances of harm and saved the health care field nearly $1 billion.
Through conversations with our Board of Trustees and representative groups of our membership, we developed a set of principles for choosing quality metrics and a list of 11 prioritized areas on which hospital measurement should be focused. These focus areas sync up with the Department of Health and Human Services’ National Quality Strategy. They include: rates of harm resulting from errors in care; risk adjusted mortality; effective patient transitions; infection rates; rates of honoring end-of-life preferences; cost per case or episode of care; readmission rates; adherence to guidelines for commonly overused procedures; rates of medication errors; effectiveness of diabetes control; and the incidence of obesity in the community.
This is just a starting point. We want to urge others interested in quality improvement to review this list and offer their ideas so that we can get to a consensus on a standardized, high priority list of issues to measure and improve. This list will provide a foundation for collaborative work among physicians, nurses and other health care practitioners, hospitals, public health officials, insurers, employers, and others who wish to work in partnership with patients to make care better.
Patients should have useful information to make decisions about their care – something some of the existing report cards don’t provide. Having agreement on what is important to measure, how report cards should work, and what each party in the health care system can do to generate better patient outcomes will move care forward.
Hospitals are leaders in quality and patient safety. They have been reporting quality data publicly for more than a decade and strive to be transparent with quality and safety information. Other care providers have also embarked on the journey to collect and report quality data. We are now ready to take the necessary steps to use quality measurement to promote better coordination and outcomes across the care delivery system.
The data will help patients and providers determine the best means to meet each patient’s unique health care needs. And that’s where quality care begins.