Which Metrics on Hospital Quality Should Patients Pay Attention To?

I live in a community that has one of the worst hospitals yet their public relations apparatus maintains that it is one of the highest rated in the region and the state. They routinely tell ER patients who walk in with severe chest pains that they have indigestion. Many walk out and have a heart attack in the parking lot while some make it home and have a heart attack three days later. One day I was on line at the bank . The woman in front of me had a tattoo of her husband on her arm. She said if it wasn't for the local hospital he would still be alive. When the radio commercial comes on touted the hospital everyone within ear shot laughs and / or swears.
It is important to know the facts behind so called ratings. Just one more sad commentary on health care in America

There was a time when we trusted our medical care professionals. Perhaps it's not a greater gamble to do just that at this time.
Most doctors and nurses don't make the choice to care for the sick without a generous dose of empathy.

Mortality is a deceptive metric, unfortunately. When I worked in Oncology at one of NYC's premiere hospitals, patients at death's door were sent to hospice. Some even died en route. Thus, the hospital could claim they hadn't died on their premises

Even the "best" hospitals make mistakes. Low-level employees do most of the real work nowadays, while doctors and nurses just drop in to sign the medical records, you need to look at the quality of the workers, not just the reputation of the famous doctor you delusionally think will be at your bedside like Dr. Marcus Welby or those other TV docs. My late mom died as the result of an error in performing a routine kidney biopsy. The PA who did the procedure accidentally cut a vein, causing internal bleeding, and the hospital did not catch his mistake until hours later, after mom started feeling bad. The bleeding caused kidney failure and brain and heart damage. Mom suffered for 6 months before passing away, unable to walk or eat without assistance. Congress better do something to control overpayments to doctors, hospitals, Big Pharma, medical supply and equipment companies, rehab programs, mental health professionals, etc. We are not getting our money's worth in health care and are being ripped off every day. Most people don't notice or care because the taxpayers are footing the bill. I support universal health care, at least for catastrophic illnesses like AIDS, cancer, heart disease, etc, for ALL citizens of the USA.

The focus on patient satisfaction scores- one of the few metrics that healthcare administrators can understand without a medical background- has been posited (by both medical professionals, and representatives of the NYS attorney general's office) as a major factor behind the overprescribing of opioids during the period from roughly 2004-2012. It's fine to evaluate hospitals based on patient satisfaction, but the aspects of the hospital stay that are evaluated need to be the same types of factors that one might evaluate in the food service and hospitality industries. Medicine is the only field where a "business" has the option of satisfying their customer by legally providing them with controlled (ie otherwise illegal) drugs.

The fact that "some hospitals may attract disproportionately sicker patients" is because some hospitals serve more working class Americans who cannot afford the costs of health insurance and thus need to resist getting prompt medical intervention until the issue requires hospitalization. The wealthy ruling class is now striving to throw all working class citizens under a bus and reserve quality medical care for the wealthy by using their lobbyist-dependent lackeys in Washington to play keepaway on affordable single payer health care from American citizens. The ethics of this are shameful, and the political corruption that supports it is a profound embarrassment. We look like a third world country in medical care, and those responsible for it should be in jail, not just out of political office.

Why is it such a surprise that if the patient is happier then the long term health result is better? Because the for profit medical industry in this country sees patients as a collection of symptoms and not as human beings. Maybe this study will wake some people up.

The first rating I heard of in a hospital was a really handy 1-to-5 rating called the Buzzard Index. Without a word exchanged, users of the B.I. could ask and receive that forecast on whether the patient before them was catching a ride home soon or was going to leave feet-first in a station wagon.

In the late 80's and early 90's, a number of investigations - some that were part of the Rand Corporation's Medical Outcomes Study - identified specific factors related to patients' satisfaction with care. Perhaps the most salient of these was subsequent adherence to treatment recommendations. One would expect that following through on a treatment plan would have a positive effect on mortality rates as well as readmissions. That would make patient satisfaction a very logical metric to include when considering the quality of health care institutions and organizations.

There’s supposed to be some crusty old New Yorker, who always turns up for the purpose of being a crusty old New Yorker, who’ll swear that the ambulance companies are controlled by the mafia.

The best indicator would be the hospitals selected by most physicians for nonemergency surgery.

There are some questions in medicine that are answered by many well-designed studies with consistent results, and we can be confident of those answers.

There are other questions for which the evidence is weak or flawed, and the different approaches give inconsistent results.

Metrics on hospital quality are the second kind. If you compare different hospital ranking schemes, they are widely inconsistent. Some hospitals at the top of the UN News and Word Report rankings can be at the bottom of the Centers for Medicare and Medicaid Services rankings.

There were articles about this by Jia in JAMA (sorry, don't have time to look them up, try PubMed).

One of the paradoxical results is that highly-regarded academic teaching hospitals get bad metrics. One of the obvious reasons is that if a patient doesn't get proper procedures, such as warfarin, the big academic hospitals are more likely to catch the error and report it than the smaller hospitals.

Another problem is that patients with higher socioeconomic status do better than patients with lower socioeconomic status. Patients with lower SES can't pay for medication, followup visits, or even transportation back to the hospital. The hospital has no control over that. And there is no good way to determine a patient's SES from the data available from US hospitals.

I will be looking forward to Aaron Carroll's take on this.

Why not focus on comparisons between American and European or Japanese hospitals? And why not focus on whether or not the hospital sends the patient a bill for services.

In Britain, no one ever receives a bill for a hospital or other medical services. All paid by taxes to the government. And Britain spends barely half of what America does on its healthcare system. Or Japan? Or Canada?

Why not focus on how many people are bankrupted by hospital bills? America is the only nation in the wealthy, or even industrializing world, in which a person can go bankrupt due to hospital bills.

How about The Times starts publishing progressive writers who have the courage to point out these facts, instead of this right-wing lineup?

How 'bout it?

Professional nursing metrics are buried in patient satisfaction, but they need to be independently studied in relation to patient outcomes. How many registered nurses hold the BSN or higher? How many perform direct patient care? What is the staffing ratio of these RN's to patients in every clinical unit delivering direct care? How often do they assess patients, educate patients, perform direct case management for continuity of care and receive promotions based on this care? How are registered nurses accountable and autonomous in providing nursing care? How are they accountable for nursing quality and patient safety?

Patients are more satisfied with better care, who knew?

When I was working in healthcare, we put a lot of effort into patient satisfaction. It's encouraging to see the directional correlation between satisfaction and outcomes!