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Sunshine Week: Some hospital quality measures online but more could be done Date: 03/15/09

Sunshine Week 2009: March 15-21 Sunshine Week is a national initiative to open a dialogue about the importance of open government and freedom of information. Participants include print, broadcast and online news media, civic groups, libraries, nonprofits, schools and others interested in the public's right to know.

By Felice Freyer

The Internet offers vast new opportunities to answer every patient’s most pressing question: Am I entrusting my health to people who will take good care of me?

In recent years, state and federal agencies have begun yanking data out of filing cabinets and opening their folders to the daylight of cyberspace. In addition to informing consumers, such Web sites prod everyone in health care to do a better job.

The federal government’s Nursing Home Compare Web site  provides a detailed guidebook to anyone looking for a nursing home, or checking up on one. You can find out how a nursing home performed in state inspections, staffing levels and certain critical aspects of medical care, compared with other nursing homes in your state and in the nation as a whole. Recently, Nursing Home Compare has added a star rating system that gives consumers a quick way to narrow their search.

Medicare’s Hospital Compare provides several ways of comparing hospital quality, focusing on care and outcomes for a few common conditions. Especially useful are the results of patient satisfaction surveys and the death rates for heart attack, heart failure and pneumonia. But hospital care is complex, and patients who have conditions that are not measured may find these comparisons unhelpful.

Some states have also thrown open the shutters in remarkable ways.

The Indiana Department of Health provides a “consumer report” on each hospital that links to complaint and inspection reports, so the viewer can find out how often a hospital has had problems – and exactly what those problems were.

Minnesota’s Department of Health reports any of 28 serious, preventable medical errors at hospitals. These “never events” include such catastrophes as a patient dying from a fall, a baby discharged to the wrong mother, surgery performed on the wrong body part and a foreign object left in the body after surgery. Patients can read an annual report on such incidents statewide, and they can check to see whether any particular hospital has had a “never event.” 

Rhode Island surveys nursing home residents and their families about their experiences – focusing not just on care but what it’s like to sleep, eat and live in such a place. Comparative ratings are posted online and updated each year.

But much more can and should be done to give the public easier access to what the regulators know. For example, California lists how many complaints, incidents, enforcement actions, and survey deficiencies each facility had. But it doesn’t provide links to the reports that would detail what those problems were, even though those reports are public documents.

Information about individual professionals can be difficult to get. Most states list basic licensing information about physicians, including whether the doctor has ever been disciplined. But only some post the documents spelling out each doctor’s transgression. Information on other licensed professionals, such as nurses, is even harder to find.

More than two decades ago, Medicare sparked an uproar among hospitals when it publicized the mortality rates at every hospital. To consumers, the list seemed to address the burning question: Am I going to die if I go there? To hospitals, though, the list unfairly tarred those that took more complicated cases; the data didn’t take into account how old or sick patients were when they arrived. Medicare abandoned that effort.

Last year, with no discernible uproar, Medicare once again released hospital mortality data. These statistics were narrower and more nuanced: they listed death rates only for three common conditions, and adjusted for patient mix. The findings, buried amid other information about how well hospitals follow guidelines for common conditions, offer critical insight into quality of care. 

Such advances reflect a growing emphasis on exposing how well or how poorly providers take care of us. Much has been accomplished, but much vital information still lies in dusty manila folders. It’s time to pry open all the file drawers. The Internet allows the display of information with an ease and clarity never before possible – and patients need to know.

Felice J. Freyer is a medical writer at The Providence (R.I.) Journal and a member of AHCJ's Right to Know Committee.