A new tool to compare hospital performance
It used to be that you picked a hospital based on the recommendation of your doctor, perhaps your spouse or neighbor. Location was certainly a factor, particularly in an emergency.

It used to be that you picked a hospital based on the recommendation of your doctor, perhaps your spouse or neighbor. Location was certainly a factor, particularly in an emergency.
But increasingly, consumers have had access to hard data on how well hospitals actually heal the sick. This year, for example, the federal government publicized figures for eight serious, generally preventable conditions such as bedsores and certain infections.
Are consumers using this information to make health-care decisions? And should they?
So far, there is limited evidence that consumers consult a computer screen full of numbers before choosing where to get a hip replacement. Experts on health-care quality expect that to change as more information becomes available, but they urge caution.
"You're better off making a decision with some information rather than no information," said David J. Shulkin, president of Morristown Medical Center in northern New Jersey, who years ago founded one of the first companies to provide consumer health-care data. "But everybody has a little bit of hesitancy in relying too much or solely on numbers."
As part of its new health channel website, The Inquirer is publishing performance data from 48 hospitals in Southeastern Pennsylvania and southern New Jersey. For the first time, consumers can easily compare regional hospitals on such factors as how well doctors communicate and how likely patients are to survive a heart attack.
The first batch of numbers comes from Medicare's still-evolving "Hospital Compare" program, and experts warn that some of it can be misleading - especially the eight preventable conditions.
Take Thomas Jefferson University Hospital, a well-regarded hospital that nevertheless reported one of the region's highest rates of blood infections from large-vein catheters - tubes used to infuse medication: 0.98 cases per 1,000 discharges. But Jefferson handles a greater proportion of complex cases than most hospitals, and thus has more patients who need catheters to begin with.
A fairer method, perhaps, is to count the number of infections per days of catheter use, as the state Health Department does in a separate report, which also includes non-Medicare patients.
By that measure, Jefferson fares better than predicted, given its patient mix and type of care provided. The state report is broken down by different hospital units; for its critical-care units and wards, for example, Jefferson had one-fourth as many of these catheter-associated infections as expected.
In Camden, Our Lady of Lourdes Medical Center is another such example. From October 2008 to June 2010, the current period for Medicare's data, Lourdes had a higher-than-average rate of the blood infections from large-vein catheters. But a separate New Jersey state report finds its rate was lower than expected, given the kinds of care provided.
The Inquirer Web channel also includes two categories of data for heart attacks, heart failure, and pneumonia: how likely patients are to be readmitted within 30 days of being discharged after treatment for those conditions, and how likely they are to die within 30 days of admission.
These numbers are "risk-adjusted," meaning, in effect, that hospitals are graded on a curve. Thus, hospitals whose patients are sicker to begin with can be fairly compared with those whose patients are healthier.
Even so, the goal of publicizing the numbers is not to steer everyone to the best hospitals, said Harlan Krumholz, a Yale School of Medicine professor who helped develop these measures for the government. The top 10 percent of hospitals don't have room for 100 percent of the patients.
"Our goal is to stimulate all hospitals to improve," said Krumholz, director of Yale's Center for Outcomes Research and Evaluation.
And for heart conditions, the key is getting help quickly, he added.
"If someone is short of breath, I don't want them going to a computer," Krumholz said.
Most of the region's hospitals were no different from the national average on these six risk-adjusted measures. Doylestown Hospital and Lankenau Hospital were both better than the national average on two counts, including 30-day death rates from heart attack. Doylestown's rate - 10.9 percent - was among the nation's best.
Scott Levy, the hospital's chief medical officer, attributed this success to several factors, including a loyal group of physicians and nurses that has been working as a team for years.
But he raised a note of caution on another of Doylestown's data points: its rate of accidentally leaving sponges or other objects in the body after surgery - 0.13 times per 1,000 discharges. That figure was worse than the national average, but it was the result of just one such event in five years, Levy said. Had the data come from a different year, the rate would have been zero.
"Nobody wants to see episodes, but it just depends when that episode falls," Levy said.
Another pitfall: The data from some hospitals are likely incomplete, said Vinita Bahl, a health-care quality executive at the University of Michigan Health System, who cowrote a 2009 commentary in the American Journal of Medical Quality.
The eight conditions are drawn from billing data. But in 2008, Medicare stopped paying hospitals for treating most of the eight conditions, so there is little urgency to make sure everything is recorded, Bahl said. The fact that data are now publicized is also a disincentive, she said - citing the fact that 1,700 hospitals nationwide reported zero urinary-tract infections from catheters.
"That is ridiculous on its face," Bahl said.
As for the quality of patient experience, perhaps the purest indication comes from the patients themselves. The Hospital Compare database includes a survey of both Medicare and non-Medicare patients.
Most patients are not health-care experts, and thus not equipped to pass judgment on a hospital's overall quality. But among the questions are two on how well the doctors and nurses communicate. That's a key factor in getting patients to fill prescriptions and generally take care of themselves after discharge, said Morristown's Shulkin.
"There is an art and there is a science to medicine," Shulkin said. "Getting care that recognizes that patients do have to be involved in their care is really, really important."
at 215-854-2430 or tavril@phillynews.com.
To see how your hospital