What's Measured Matters
So, while the search is on for measures that matter, what is measured also matters. Research has identified the most common causes of patient safety problems for hospitalized patients: adverse drug events, hospital-acquired infections, blood clots, bedsores, falls, and surgical complications.
Pronovost notes, however, that nationally there is a validated approach to measuring quality for only one of them—hospital-acquired infections.
Dean Sittig, PhD, a biomedical informatics professor at The University of Texas Health Science Center at Houston agrees that more research is needed to validate measures. The problem is that payers and regulators can’t really admit that the measure needs to be refined if they are already using them.
"If you call for measures, you’ve got to act like the measures are perfect and we know exactly what to do with them,” he says. “If they say they are going to fund research in this area, they can’t really use the measure for a while.”
That would be fine with him.
Sittig echoes the very complaints that have been lobbed at CMS over the Hospital Compare data. “Most of the measure we have are not really for comparison across organizations, across facilities, [or] across physicians,” he says.
Look at readmissions. While not all readmissions are preventable, hospitals get penalized for them anyway. “So we have a measure that is very imprecise and when we start paying hospitals for that, they start dong all kind of crazy things to avoid readmissions,” he says.
The goal is not to get hospitals to optimize scores and ranking, but to get them to optimize quality and safety, he adds.
Health information technology could help and someday will. For example, rather than relying solely on billing data, researchers could more easily tap into richer clinical data. But challenges abound there too, including interoperability, inconsistent coding, and data validation. Currently, Siting says, many quality measure are still reported manually, not electronically.
Pronovost agrees that HIT systems are not yet up to the job of using data to improve safety. He would like to see better-integrated IT systems. “Healthcare is unique among industries in that it has spent heavily on technology and has very little to show for it,” he says.
CMS’s decision to hold off on hospital rankings might be a sign that it is willing to slow down and heed all this advice. But it seems unlikely that the practice of issuing rankings will go away. The newly empowered healthcare consumer wants to comparison shop.
Plenty of third parties–the Leapfrog Group, US News & World Report, Healthgrades, Consumer Reports–rank hospitals. The investigative reporters at ProPublica even turned CMS data into surgeon scorecards. The project drew both mostly jeers and some cheers from health policy types for taking data journalism to a new level. (Pronovost was critical. Jha called it a "step in the right direction.")
And then, there’s always Facebook and Yelp. Studies have shown that their rankings don’t fall far from the others. How’s that for validation?
Tinker Ready is a contributing writer at HealthLeaders Media.