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Be A Smart Shopper For Hospital Care

We’re savvy consumers when it comes to finding high-quality computers or cars or office equipment. When we’re buying health care? Not so much. And until recently, we had no way to make a fully informed decision when deciding where to have surgery.

All that’s changed with the launch of the HospitalCompare Web site.

The site was created through the collaboration of the government’s Centers for Medicare & Medicaid Services and Department of Health and Human Services with members of the Hospital Quality Alliance. Alliance members include medical associations, nonprofit organizations and businesses that have a stake in improving the quality of American health care.

The result is a site that was lauded by USA Today in 2008 for revealing hospitals’ mortality rates to the public for the first time.

Now informed consumers can see that the quality of hospital care varies significantly. Facilities within driving distance of your home may have quite different rates of patient satisfaction and, what’s much more important, differing scores when it comes to providing the best possible medical treatment. When your health is at stake, why take chances?

Although the site is invaluable in helping consumers choose the best hospital for their needs, finding the information you want can be tricky. It helps to have a road map to guide you around the site. And that’s just what you’ll find here.

To begin exploring, point your web browser to www.hospitalcompare.hhs.gov. But before you go, print out this report to take with you.

Information You’ll Find On The Site
The statistics on HospitalCompare reflect 12 months of data from each facility and are updated on a rolling basis. The information comes primarily from acute-care hospitals—those that provide inpatient medical care and other related services for surgery, acute medical conditions and injuries.

On the site you can compare facilities to see how well they care for patients with specific medical conditions or who undergo certain surgeries. You’ll also see detailed information on recommended treatments—and how frequently they are administered.

For example, one of seven recommended measures related to preventing infections in surgery patients is giving an antibiotic within one hour before the operation. When you do a “surgical procedure search,” you’ll be able to see how often this is done in various hospitals.

The site’s rankings include information on these medical conditions:

• Heart attack
• Heart failure
• Chronic lung disease
• Pneumonia
• Pneumonia
• Chest pain

A long list of surgical procedures is featured, including operations involving:

• Heart and blood vessels
• Abdomen
• Neck and back
• Arms and legs
• Bladder and kidney
• Prostate
• Female reproductive organs

Understanding The Comparisons
To fully understand the comparison data offered on HospitalCompare, you need to be clear about certain definitions and terms.

The site’s glossary defines dozens of words and terms frequently used on the HospitalCompare site.

Here are three you need to grasp to make the most of the comparison data:

• Hospital “process of care” measures: This data shows how often hospitals give “recommended treatments known to get the best results for people with certain common conditions.” Example: Percentage of heart attack patients who are given aspirin when they arrive at the hospital.

• Hospital “outcome of care” measures: This rather sobering statistic indicates whether those admitted to a specific hospital have a risk-adjusted 30-day death rate that is better than, worse than or about the same as the U.S. mortality rate as a whole. Example: Mortality rate of those admitted for, say, pneumonia, as compared with the U.S. national death rate.

• Survey of patients’ hospital experiences: A national, standardized survey that asks patients to rate aspects of their care during a recent inpatient hospital stay. Example: Percentage of patients who say their pain was always well-controlled.

Using The Search Tool
The heart of HospitalCompare is the ability to display detailed information on specific facilities. Follow these guidelines to make the most of the search tool.

Begin by clicking the “Find and compare hospitals” button on the site’s home page. On the first screen—step 1—you will specify whether you are searching for a facility by name or for all facilities within a certain distance of a ZIP code or city or within a state or county.

Click “continue.”

On the next screen, in step 2, you will choose whether to do a general search or one based on a medical condition (e.g., heart attack or chronic lung disease) or a surgical procedure related to a body part (e.g., female reproductive or neck, back and extremities). Selecting a body part will allow you to pick from a list of related surgeries.

Click “continue.”

Step 3, “choose hospitals to compare,” indicates the number of hospitals within the geographic area you chose. You can compare up to three hospitals at a time. If you want data on more than three, perform additional searches and print the results.

The results screen also allows you to view the facilities on a map, get driving directions, modify your search or start a new search.

Getting Detailed Information
At the bottom of the screen that displays your results, you’ll see a dark blue header in which each hospital is listed.

You can get details on as many as three hospitals at a time. Check the box to the left of a facility’s name, then click the “compare” button.

If you performed a general search and did not specify a health condition or surgery, you will see your selected hospitals listed, left to right, and details for each facility. The information is presented in four categories:

1. Hospital process of care measures
2. Hospital outcome of care
3. Survey of patients’ hospital experiences
4. Medicare payment and volume

If in step 2 you chose “medical condition search” or “surgical procedure search,” your results will be tailored to that choice, and hospitals will be listed top to bottom.

Once you have selected up to three hospitals to compare, you’ll see “hospital process of care measures” for that medical condition or surgical procedure. These indicate the percentage of time each hospital gave recommended care—“the treatment known to give the best results for most patients.” The closer the number is to 100, the better.

A low number may mean that the number of cases is too small to determine how well the hospital is actually doing. In that case, a footnote will indicate so.

You can learn much more about each measure by selecting the checkbox to the left of its description and clicking the “view graphs” button. A pop-up window shows a graph of rates for not only the hospitals you’ve selected but also all reporting hospitals in the U.S. and in your state.

Below the graph you’ll see an explanation of why that process of care measure is important.

For example, from the pop-up window for “percentage of heart failure patients given discharge instructions,” you’ll learn that when a patient checks out, the hospital staff should provide details on diet, watching his or her weight, medications, what activities he or she should and shouldn’t perform, a follow-up appointment, and what to do if symptoms get worse.

Selecting the checkbox next to the measure and clicking the “view table” button generates a pop-up window showing the rates for selected hospitals, the U.S. and your state.

Learning More About The Death Rate
When you do a medical condition search, you’ll find “hospital outcome of care measures.” This indicates whether the mortality rate for those treated in a particular hospital differed significantly from the national rate for the U.S. Note that mortality rates are not provided when you perform a surgical procedure search.

If you select the checkbox to the left of an outcome of care measure, then click “view graphs,” you’ll see a chart that gives, for example, the “national 30-day death rate from heart attack” (16.1 percent) among Medicare patients, compared with the percentages from each of your selected hospitals.

Clicking the “view table” button will show you a pop-up window that further indicates how many hospitals in the U.S. and in your state have mortality rates better or worse than that for the country as a whole.

The Patient’s Perspective
The last major category of results presents information about patients’ experiences, based on a national, standardized survey of those who have had a recent inpatient hospital visit.

Patients were asked whether their nurses always communicated well, whether staff always explained about medicines before giving them, whether patients would definitely recommend the hospital, and so on. Obviously, higher percentages are better.

Clicking the “view graphs” button for any of the survey items yields a bar graph that shows how the selected hospitals stacked up against each other, all hospitals in your state, and all U.S. hospitals.

The “view table” button also indicates how many surveys were completed and gives further data on how patients answered the question.

For example, you might learn that 68 percent of patients “would definitely recommend” a certain hospital, 26 percent “would probably recommend” it, and 6 percent “would not recommend” it.

Troubleshooting
A bug in Internet Explorer causes some site visitors to see a blank screen when trying to view search results.

If this happens, HospitalCompare recommends using an alternate browser. Firefox, Safari and Opera do not have this bug.

For More Information
Get more help in evaluating hospitals by visiting these Web sites.

U.S. News & World Report
A guide to America’s best hospitals, with related articles
health.usnews.com

U.S. Department of Health & Human Services
Agency for Healthcare Research and Quality
Detailed checklist to help consumers choose the best hospital care
www.ahrq.gov