Data sets are collected on hospitals across the country, which serve to gauge a facility’s capacity to provide care for its patients. Scientific evidence is the basis for these measures that are intended to reflect practice parameters, guidelines, and standards of care. Medical information that is gathered from patient records is converted into a measurable unit that permits facilities to conduct performance assessments. For the purpose of this paper, three hospitals in the greater Southern California region are being compared. The primary hospital being reviewed is Huntington Memorial Hospital in Pasadena, CA. Subsequent measures for the purpose of comparison are drawn from San Gabriel Valley Medical Center in San Gabriel, CA., and Glendale Adventist Medical Center in Glendale, CA.
The following date reflect Process of Care measures for Huntington Memorial Hospital:
- Cataract surgery outcome: The California Average on this indicator is 100%, while the National Average is 87%. For the available reporting period, results were not available for the three hospitals being compared.
- Colonoscopy follow-up: Two measures are reflected: 1) Percentage of patients receiving appropriate recommendations, and 2) percentage of patients with polyps receiving follow-up colonoscopy. The California Average is 76% and 80% respectively; the National Average is 80% and 87% respectively. Huntington Memorial is 91% and 99% respectively; San Gabriel is 86% on measure #1 and on measure #2 information was not available; Glendale Adventist is 93% and 68% respectively.
- Heart attack care: Four measures are reflected: 1) Average number of minutes before outpatients with chest pain or potential heart attack requiring specialized care were transferred to another hospital: California Average is 71 minutes; National Average is 58 minutes; no results available for Huntington Memorial or Glendale Adventist; San Gabriel had too few cases to report.
2) Average number of minutes before outpatients with chest pain got an ECG: California Average is 9 minutes; National Average is 7 minutes; Huntington Memorial is 10 minutes; San Gabriel is 13 minutes; Glendale Adventist is 7 minutes.
3) Outpatients with chest pain/potential heart attack who got drugs to break up blood clots within 30 minutes of arrival: California Average is 63%; National Average is 59%. No available data for Huntington Memorial and Glendale Adventist; San Gabriel had no cases that met the criteria.
4) Outpatient who received aspirin within 24 hours of arrival or before transfer from the ER:
California Average is 95%; National Average is 96%; Huntington Memorial is 92%; San Gabriel is 100%; Glendale Adventist is 92%.
Emergency department care: 3 measures are reflected:
1) Average time patients in ER with broken bones had to wait before pain medication was administered: California Average is 58 minutes; National Average is 52 minutes; Huntington Memorial is 92 minutes; San Gabriel is 50 minutes; Glendale Adventist is 46 minutes.
2) Percentage of patients who left emergency department before being seen: California Average is 3%; National Average is 2%; Huntington Memorial is 4%; San Gabriel is 0%; Glendale Adventist is 3%.
3) Percentage of patients with stroke symptoms receiving brain scan results within 45 minutes of arriving at ER: California Average is 71%; National Average is 69%. No cases met the criteria for Huntington Memorial and Glendale Adventist; San Gabriel had too few cases to report.
Preventive care: 2 measures are reflected: 1) Patients assessed and given influenza vaccination:
California Average is 94%; National Average is 94%; Huntington Memorial is 81% (based on a sample of patients); San Gabriel is 96% (based on a sample of patients); Glendale Adventist is 99% (based on a sample of patients).
2) Healthcare workers given influenza vaccination: California Average is 82%; National Average is 86%; Huntington Memorial is 71%; San Gabriel is 84%; Glendale Adventist is 76%.
Stroke care: Ischemic stroke patients who got clot breaking medicine within 3 hours after onset of symptoms: California Average is 92%; National Average is 87%; Huntington Memorial is 73%; San Gabriel is 100%; Glendale Adventist is 100%.
Blood clot prevention & treatment: 2 measures are reflected: 1) Prevention ‘ patients who developed a clot while in hospital and did not get preventive treatment that could have prevented clot: California Average is 2%; National Average is 2%; Huntington Memorial is 19.2% (based on patient sample); San Gabriel had too few cases to report; Glendale Adventist is 0%.
2) Treatment ‘ Patients with blood clots that were discharged on a blood thinner medicine and received written instructions about that medicine: California Average is 95%; National Average is 93%; Huntington Memorial is 69% (based on sample of cases); San Gabriel is 100% (based on sample of cases); Glendale Adventist is 96% (based on sample of cases).
Pregnancy & delivery care: Percent of mothers whose deliveries were scheduled too early (1-2 weeks early), when a scheduled delivery was not medically necessary: California Average is 2%; National Average is 2%; Huntington Memorial is 5% (based on sample of cases); San Gabriel is 1% (based on sample of cases); Glendale Adventist is 2%.
Public reporting of data of this nature has a number of pros and cons associated with it.
Although hospitals understand the need for collecting information on process of care, they have traditionally used not only their own data but, more importantly, their own methods by which improvement, or lack thereof, is measured. Arguably, it is not sufficient to stop there, and hospitals find it necessary to ultimately compare their own performance measures with the performance of their peers and competitors. Hospitals have indeed engaged in a variety of programs that shared data among themselves, outside the context of public reporting. On the other hand, public reporting is largely supported and encouraged by employers, payers, regulators, and consumer advocate groups. The intention behind public reporting is to enhance facility accountability and, by doing so, performance will also be enhanced. Those in favor of public reporting argue that it is necessary for information of that nature is required to help people make informed decisions about how and where they seek medical treatment.
This is not to say that hospitals are not focused on gathering meaningful quality measurements that accurately reflect the care that facilities provide. Those representing providers suggest that even with a high-rating report card, facilities and providers have concerns about the unintended consequences that collecting such data for public reporting might ultimately have. Add to that an additional concern that the time and cost involved in developing and providing data needed for public reporting might potentially fail to be related to consumer value. Finally, it is not out of the question for proprietary organizations to use public reporting for their own gains. According to the Hanys Quality Institute (2007), ‘Public reporting can become an entrepreneurial opportunity for proprietary organizations, which have begin to profit from the release of these report cards and their supplemental services’ (p. 12).