{"id":13670,"date":"2012-11-28T15:46:48","date_gmt":"2012-11-28T20:46:48","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=13670"},"modified":"2017-03-25T11:14:25","modified_gmt":"2017-03-25T15:14:25","slug":"new-hospital-safety-score-data-a-key-enabler-for-informed-choice","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2012\/11\/new-hospital-safety-score-data-a-key-enabler-for-informed-choice.html","title":{"rendered":"New Hospital Safety Score data: a key enabler for informed choice"},"content":{"rendered":"<div id=\"attachment_13675\" style=\"width: 366px\" class=\"wp-caption alignright\"><a href=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2012\/11\/HSS-comparison-weighted.pdf\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-13675\" class=\"size-full wp-image-13675 \" style=\"margin-left: 20px; border: 1px solid black;\" title=\"Hospital Safety Score 5 Hospital Comparison Nov 2012\" src=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2012\/11\/HospitalSafetyScore5hospitalComparisonNov20121.png\" alt=\"Comparison of five hospitals' data (click to open PDF)\" width=\"356\" height=\"291\" srcset=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2012\/11\/HospitalSafetyScore5hospitalComparisonNov20121.png 990w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2012\/11\/HospitalSafetyScore5hospitalComparisonNov20121-300x244.png 300w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2012\/11\/HospitalSafetyScore5hospitalComparisonNov20121-800x653.png 800w\" sizes=\"auto, (max-width: 356px) 100vw, 356px\" \/><\/a><p id=\"caption-attachment-13675\" class=\"wp-caption-text\">\u00a0\u00a0My comparison of five hospitals&#8217; data from this report (click to open PDF)<\/p><\/div>\n<p><em>The PDF at right is a summary of sample data from this new dataset.<br \/>\n<\/em><br \/>\n<a href=\"http:\/\/leapfroggroup.org\" target=\"_blank\">The Leapfrog Group<\/a> is a highly respected patient safety organization. They&#8217;ve\u00a0earned a reputation for carefully and thoughtfully assessing providers&#8217; actual performance in quality and safety. Their <a href=\"http:\/\/www.leapfroggroup.org\/about_leapfrog\" target=\"_blank\">mission statement<\/a>:<\/p>\n<blockquote><p>To trigger giant leaps forward in the safety, quality and affordability of health care by:<\/p>\n<ul>\n<li>Supporting informed healthcare decisions<br \/>\nby those who use and pay for\u00a0health care; and,<\/li>\n<li>Promoting high-value health\u00a0care through incentives and rewards.<\/li>\n<\/ul>\n<\/blockquote>\n<p>Today, Leapfrog&#8217;s affiliated organization <a href=\"http:\/\/hospitalsafetyscore.org\" target=\"_blank\">Hospital Safety Scores<\/a> announced a <strong>major update of its A-through-F grades<\/strong> of thousands of US hospitals, and new smartphone apps to access the data on the fly.<\/p>\n<p>Predictably, the hospitals who got an F &#8211; based on their own data! &#8211; are saying it&#8217;s &#8220;<a href=\"http:\/\/www.latimes.com\/business\/la-fi-ucla-hospital-grade-20121128,0,397898.story\" target=\"_blank\">not a fair scoring system<\/a>.&#8221; Happily, Leapfrog follows the best practices of open science: they fully disclose all their data, the methodology they used, and who designed the system. This means all buyers of care &#8211; e-patients, families, employers &#8211; can examine the data and assess claims of fairness for ourselves.<\/p>\n<p>The full press release is <a href=\"http:\/\/www.hospitalsafetyscore.org\/2012\/11\/errors-and-infections-still-a-serious-problem-in-american-hospitals\" target=\"_blank\">here<\/a>. I won&#8217;t take time to go into it; many others are doing so &#8211; \u00a0here&#8217;s a current\u00a0<a href=\"https:\/\/www.google.com\/webhp?&amp;ie=UTF-8#q=%22hospital+safety+score%22+leapfrog&amp;tbm=nws\" target=\"_blank\">Google News search<\/a>\u00a0and <a href=\"https:\/\/www.google.com\/webhp?&amp;ie=UTF-8#q=%22hospital+safety+score%22+leapfrog&amp;tbm=blg\">blog search<\/a>. Here, I want to focus on two aspects that are core to participatory medicine: <strong>understanding the data<\/strong>, and <strong>why this matters<\/strong>.<\/p>\n<p><!--more-->In the table above I&#8217;ve summarized (somewhat laboriously) half the data for one sample hospital at each grade level. Why only half the data? Because it was a lot of work, and my purpose is only to illustrate how their analysis works. This post is about the method, not about individual hospitals.<\/p>\n<p><strong>Anyone who wants to challenge the Hospital Safety Score conclusion must identify specifically they say is wrong with the data or the method.<\/strong>\u00a0And, just as important, anyone who wants to <strong>use<\/strong>\u00a0the data should understand how it works. That includes patients, families and employers who want to be engaged in improving healthcare &#8211; or selecting a hospital for their own use.<\/p>\n<p>In this discussion I won&#8217;t name hospitals, because my purpose here is to discuss method.<\/p>\n<h2><strong>Designed by a truly blue-ribbon panel.<\/strong><\/h2>\n<p>Leapfrog wisely convened a blue-ribbon panel to design the methodology:<\/p>\n<ul>\n<li>Lucian Leape MD, revered safety figure for whom the Lucian Leape Institute is named.<\/li>\n<li>Arnold Milstein, M.D., M.P.H., Stanford University<\/li>\n<li>John Birkmeyer, M.D., University of Michigan<\/li>\n<li>Ashish Jha, M.D., M.P.H., Harvard University<\/li>\n<li>Peter Pronovost, M.D., Ph.D., F.C.C.M, Johns Hopkins School of Medicine<\/li>\n<li>Patrick Romano, M.D., M.P.H., University of California, Davis<\/li>\n<li>Sara Singer, Ph.D., Harvard University<\/li>\n<li>Tim Vogus, Vanderbilt University<\/li>\n<li>Robert Wachter, M.D., University of California, San Francisco<\/li>\n<\/ul>\n<p><strong>Anyone who wants to criticize the method has to discredit the thinking of these figures.<\/strong><\/p>\n<p>I&#8217;ve personally met and engaged with Lucian Leape, and you gotta be pretty crazy to say he doesn&#8217;t know what he&#8217;s talking about. Same for Bob Wachter. I haven&#8217;t met the others, but they have similar reputations.<\/p>\n<p>In particular, Peter Pronovost is internationally known, and in April was <a href=\"http:\/\/www.abms.org\/News_and_Events\/Media_Newsroom\/Releases\/release_PronovostAwardedHCQPSA_04252012.aspx\" target=\"_blank\">awarded<\/a> the first American Board of Medical Specialties quality and safety award. So, in a sense, anyone criticizing Pronovost&#8217;s approach is saying this board of specialties doesn&#8217;t know what it&#8217;s doing.<\/p>\n<p>Pronovost has a special place in my heart (close to it, anyway), because of this item, from the award&#8217;s press release:<\/p>\n<blockquote><p>Dr. Pronovost is credited with developing an acclaimed five-step checklist protocol for doctors and nurses designed to prevent deadly bloodstream infections associated with central line catheters&#8230;<\/p><\/blockquote>\n<p>During my cancer treatment I had central lines inserted four times &#8230; four months after he <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa061115\" target=\"_blank\">published his checklist<\/a> in NEJM. Safety matters to me, at a gut level.<\/p>\n<p>The letter grades are based on a combination (as described on their site) of data the hospitals sent CMS (Medicare and Medicaid) and Leapfrog&#8217;s own data. Unfortunately, many hospitals decline to participate in Leapfrog, usually saying that they already have to report to CMS and it&#8217;s redundant. I can only assume, then, that they feel the CMS data is good enough for people to draw conclusions. (A year ago <a href=\"http:\/\/news.consumerreports.org\/health\/2011\/10\/three-big-name-hospitals-stop-publicly-reporting-some-infection-data.html\" target=\"_blank\">Consumer Reports told<\/a> of three big systems that dropped out.)<\/p>\n<p>In the PDF you can see how a range of hospitals compare in today&#8217;s new ratings &#8211; their letter grade and the underlying data for each. Here are my takeaways and why it&#8217;s important.<\/p>\n<h2><strong>There is a range of quality. Consumers need to know.<\/strong><\/h2>\n<p>As we <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2012\/01\/that-means-there-is-hope-atul-gawande-at-cisummit.html\" target=\"_blank\">reported in January<\/a>, famed surgeon Atul Gawande said there is &#8220;a wide gap&#8221; between the best and the worst. Lesson: it&#8217;s a mistake for a consumer to think it doesn&#8217;t matter where they go &#8211; or where they send their grandmother.<\/p>\n<h2><strong>Doctors need to know, too.<\/strong><\/h2>\n<p>Don&#8217;t assume that just because your family doctor recommended a place, it must be good. Doctors can&#8217;t function, either, without this data.<\/p>\n<p>I personally know a famous doctor blogger who was unaware that a hospital he uses, in his own town, is horrific about hand-washing when he&#8217;s not around. (He learned about it because a vigilant family member told him.)<\/p>\n<h2><a id=\"morethanhalf\"><strong>More than half of hospitals got an A or B.<\/strong><\/a><\/h2>\n<p><strong>Good hospitals deserve to be recognized!\u00a0<\/strong>To improve healthcare, consumers need to know who&#8217;s doing a great job and who&#8217;s doing a good job. Give us the data.<\/p>\n<p>Note that the curve isn&#8217;t arbitrarily negative: 30% got an A and 26% got a B, totalling\u00a0<strong>56% B or better.<\/strong> That means any hospital with <strong>a C or below is in the lower 44%<\/strong> of performers. In particular, a D or F was given to only 6% of hospitals; 17 out of 18 had better numbers. Look at the data.<\/p>\n<h2><strong>Brand is no guarantee of quality.<\/strong><\/h2>\n<p>In the table above, the four hospitals who got A through D are <strong>all part of the same system.\u00a0<\/strong>And it&#8217;s a big-time world-class brand. This means informed, engaged buyers need to look at the individual &#8220;shop,&#8221; not just the brand.<\/p>\n<h2><strong>The specifics can help guide family vigilance.<\/strong><\/h2>\n<p>My doctor, SPM co-founder Dr. Danny Sands, often quotes English philosopher\/scientist Sir Francis Bacon: <strong>&#8220;Knowledge is power.&#8221;<\/strong>\u00a0Without it, we&#8217;re disempowered; with it, we can contribute.<\/p>\n<p>Here&#8217;s an example: I know most families won&#8217;t travel a great distance, even if it would take them to a much safer hospital. But the data can still help: if your local hospital is pretty good but ranks poorly on bedsores (pressure ulcers), you can be aware, and help the staff keep an eye on it.<\/p>\n<p style=\"text-align: center;\">* \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 *\u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 *<\/p>\n<p>To wrap it up, I&#8217;ll return to Gawande, in his talk last January, then touch on TEDMED 2012 and 2013.<\/p>\n<h2><strong>To be an informed consumer, you need data on price and quality.<\/strong><\/h2>\n<div>\n<p>In that moment I cited above, the fuller version of Gawande&#8217;s quote was:<\/p>\n<blockquote><p>There is a bell curve for quality \u2013 a wide gap between the best care and the worst.<\/p>\n<p>There is another bell curve for costs \u2013 again, a wide gap.<\/p>\n<p>Surprisingly, the two curves do not match.<\/p>\n<p>And that means there is hope.<\/p>\n<p>Because if the two curves did match \u2013 if the best care were the most expensive \u2013 then we\u00a0<em>would\u00a0<\/em>be talking about rationing.<\/p><\/blockquote>\n<p>Get that? If we know who&#8217;s doing well and we know the costs, we can improve healthcare.<\/p>\n<p><strong>But we can&#8217;t reward great performers if we don&#8217;t have the data.<\/strong>\u00a0Knowledge is power.<\/p>\n<h2><strong>This will help patients behave like consumers.<\/strong><\/h2>\n<p>Last April, at TEDMED 2012, Quest Diagnostics Chief Medical Officer Jon Cohen MD gave a talk asking &#8220;<a href=\"Why don\u2019t patients behave like consumers\" target=\"_blank\">Why don\u2019t patients behave like consumers?<\/a>&#8221; \u00a0Well, Dr. Cohen, really &#8211; let&#8217;s try giving consumers the same information <em>you<\/em> get when you shop for a TV or a car.<\/p>\n<p>Dr. Cohen, were you aware that when I called\u00a0<em><strong>one of your labs<\/strong><\/em>\u00a0this year to inquire about costs,\u00a0<a href=\"http:\/\/epatientdave.com\/2012\/03\/25\/let-patients-help-cost-cutting-edition-part-3-shopping-for-my-next-ct-scan#quest\" target=\"_blank\">their answer to me<\/a>\u00a0was &#8220;We don&#8217;t know&#8221;? \u00a0Can you help your company answer that question, for the next consumer who calls?<\/p>\n<h2><strong>The Role of the Patient depends on information.<\/strong><\/h2>\n<p>As <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2012\/04\/tedmed-and-rwjf-accept-the-role-of-the-patient-as-a-great-challenge.html\" target=\"_blank\">we&#8217;ve noted before<\/a>, for TEDMED 2013 there&#8217;s a Great Challenges program led by TEDMED and the Robert Wood Johnson Foundation. And one of the Great Challenges facing medicine is The Role of the Patient.<\/p>\n<p>Too often in my travels I hear people saying &#8220;Patients can&#8217;t understand this stuff,&#8221; or remarks like Quest&#8217;s last April. So I&#8217;ve taken to saying, in some speeches: <strong>&#8220;It&#8217;s a particular perversion to keep people in the dark and then mock their knowledge.&#8221;<\/strong><\/p>\n<p>Give us our damn data, then let&#8217;s see if we behave like consumers. Good, reliable data, with an openly published methodology.<\/p>\n<p>Thank you to Leapfrog, thank you to the blue ribbon panel, and <em>especially <\/em>thanks\u00a0to all the hospitals who do participate voluntarily in Leapfrog. We <em>know <\/em>you&#8217;re committed to improving quality &#8211; and that builds my confidence.<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The PDF at right is a summary of sample data from this new dataset. The Leapfrog Group is a highly respected patient safety organization. They&#8217;ve\u00a0earned a reputation for carefully and [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"give_campaign_id":0,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[21,1,59,7,62,2],"tags":[1144,38,128,7606,133,55,153,2644],"coauthors":[],"class_list":["post-13670","post","type-post","status-publish","format-standard","hentry","category-e-ptsresources","category-general","category-policy-issues","category-positive-patterns","category-reforming-healthcare","category-trendsprinciples","tag-consumers","tag-data","tag-healthcare","tag-hospital-safety-scores","tag-hospitals","tag-patients","tag-quality","tag-tedmed"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>New Hospital Safety Score data: a key enabler for informed choice - SPM Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/participatorymedicine.org\/epatients\/2012\/11\/new-hospital-safety-score-data-a-key-enabler-for-informed-choice.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"New Hospital Safety Score data: a key enabler for informed choice - SPM Blog\" \/>\n<meta property=\"og:description\" content=\"The PDF at right is a summary of sample data from this new dataset. The Leapfrog Group is a highly respected patient safety organization. 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