USA Today has a piece today on HealthGrades, one of the sites that provide information on medical outcomes and safety. The data show that quality varies widely. Experienced e-patients know this, and will learn what they can about their local treatment options.

e-Patients, the time to learn about this is before you have a crisis. As we reported last year, Jesse Gruman’s patient engagement framework lists ten categories of engagement behaviors, and #1 on the list is:

  1. Find Safe, Decent Care

There are no easy answers here – no hospital is great at everything. Medical care is complicated, with many variables: it’s not like an auto production line where you figure out all the variables and “just do everything right” – many many tasks get done, by a wide range of people under highly varying circumstances. So if you choose to be proactive in selecting a provider, find out about the hospital’s overall record, but also look into the specific procedure.

Example: above is a sample of ratings at one hospital in the Boston area. Note that the patient outcomes vary widely even within a specialty.  (Some providers always argue with ratings, but the article quotes George Halvorson, widely respected chairman of Kaiser Foundation Hospitals: “You can’t make progress without ratings.” So if you want to be responsible for your care, learn what you can, even while you realize that the data’s not perfect.)

Reputation is no sure predictor of outcomes. While writing this I browsed a number of hospitals, local to me and big-name hospitals nationwide, and man is there variation. Word of mouth can be useful, but it doesn’t correlate with the data, so you should know what you want and choose with your eyes open.

In one famous place, quality data was all over the map – 12 one-star ratings and only 2 five-stars. But that can be affected by patient mix and other factors: a top-name place draws more complicated cases, and, as the USA Today piece says,

“People come to [hospitals] far sicker if they’re from a low-income area,” Foster says. “They might have multiple complications [that have not been adequately treated]. They might struggle to find healthy food. They might find it hard to find a safe place to exercise. All are important components of good health outcomes.”

Still, that can be an excuse for shoddy work. Years ago a relative was hospitalized in an economically depressed area, which was a factor in his condition, but the hospital was severely lacking in basic competence: their ICU methods were years out of date, and he’d ended up in the ICU partly because staff had stopped feeding him, presuming he was dying. (I’m not making this up.) (The family helicoptered him out of there and he outlived his physician by a decade.)

Meanwhile, at that big-name hospital, 9 out of 10 patients would definitely recommend it to others, although every aspect of patient experience was completely average or worse! Less likely to get help when they needed it, less likely to say their room was quiet at night, etc. I guess that shows the therapeutic(?) value of having confidence in a place: people apparently felt cared for, even though objectively these numbers say it wasn’t happening better than anywhere else.

Bottom line, it’s complicated, so if you want to optimize your chances, get the information you can, don’t expect it to be perfect, and stay engaged in the case during the stay.

And run from anyone who argues that you shouldn’t. They’re either unaware of the facts (which is never good in medicine) or in denial (ditto). Participatory medicine welcomes informed, engaged conversations.


Other sources of ratings:

If you know others, let me know in a comment and I’ll add them here.

I’m explicitly excluding the highly commercialized U.S. News and World Report ratings, because they won’t publish the facts on which they base their ratings. Ignore them.