Kentucky gets left out!
A few weeks after the Leapfrog Group released their Hospital Safety Scores, Consumer Reports (CR), the well-respected consumer protection organization, released their own version of a safety score based entirely on publicly available information, including Leapfrog’s data. Both organizations have also prepared more extensive hospital surveys focussing on quality of care. Leapfrog augments its own survey and safety score with information collected directly (and voluntarily) from the hospitals themselves. Otherwise both safety scores are based largely on the same information collected by Medicare with some interesting but minor differences. Consumer Reports’ Safety Scores include elements such as surgical-site infections, readmissions within 30 days for some diagnoses, avoiding unnecessary radiation from certain duplicate CAT scans, and good communication to patients about drug information at discharge. [I must confess though, I am still not altogether clear on what the distinction is between quality and safety measures. Perhaps someone can educate us in the comments.]
Unfortunately the Consumer Reports scores were not released to the general public for free– one must pay to subscribe to their commercial website. (Charging for their evaluation is how they stay independent!) In contrast, Leapfrog’s Safety Scores and Hospital Survey are both free to all. Nevertheless, I thought it would be instructive to compare the CR safety scores with those of Leapfrog, so for $6.95 per month, I signed up.
Alas, I was disappointed. No comparison of the two Safety Scores for Kentucky Hospitals was possible. In fact, only about 18% of all U.S. hospitals received a CR Safety Score, and only two of those were in Kentucky. I did not know that Kentucky would come up a blank slate until after I had ponied up my money! I obviously cannot recommend the CR Safety Scores to my Kentucky readers. [Norton Hospital and Manchester Memorial Hospital were the only two hospitals in Kentucky that were committed enough to stick their necks out. They get big credit from me for that.]
Since I paid my money that also gave me access to CR’s more detailed Hospital Ratings, I started to take a deeper look. I will try to tabulate the available information for my “comparison hospitals.” The data has to be extracted manually. It is not easy to compare individual hospitals in any of these surveys. I suspect that is one of the reasons to try to come up with a simpler rating score! In the meantime, I offer the following observations based on the Consumer Reports “Hospital Ratings Preview” pages for Kentucky.
Kentucky not in the red!
CR uses their well known “fractional-blob” system to rate the individual components of their evaluation. A “blob,” or circle that is half- or entirely filed in red is good, and circles filled partially or completely with black are not so good. For CR, being “in the red” is a good thing! For the purposes of this discussion, and in the absence of a statistical treatment, I am calling the open, uncolored circle in the middle between black and red– average.
As a state we do not come out looking very good. As already mentioned, only 2 of the 105 Kentucky hospitals rated received a safety score at all. Only Manchester Hospital and some of the Norton Hospitals were rated for bloodstream infections and they were all average or better. In terms of avoiding readmissions, 13 of the 105 hospitals were average, and all the rest worse than average. In terms of providing patients accurate information about their drugs, only two hospitals were above average, 10 were average, and all the rest worse than average or unrated. In the final category of the Preview, use of electronic patient records, we did better as a state with 31 hospitals better than average, 10 average, and the remainder worse than average or unrated. I guess somebody has to be average. Might as well be us! How sad. Why does it have to be that way?
A preliminary look at our Louisville hospitals does not yet reveal any big surprises. Unlike Leapfrog and Hospital Compare, the Norton Hospitals are broken out individually. There is no listing for Sts. Mary & Elizabeth Hospital, but Jewish Hospital, Frazier Hospital, and Our Lady of Peace are listed separately. It is apparent that the CR Survey includes a broader range of types of hospitals than Hospital Compare or Leapfrog. Our two premier state teaching hospitals come out not looking so good again.
The CR Hospital Ratings include some of the “touchy-feely” things taken from patient questionnaires including if the room and bathrooms were clean, the wards quiet, staff interactions satisfactory, and the like. All of the Kentucky hospitals did much better in this regard than their technical performance or quality measures. I am not surprised. We are after all, patients and professionals alike, compassionate human beings who have become trapped in a healthcare system where flash is valued over substance, marketing substitutes for performance, second class care is tolerated, vestiges of segregation persist, and making money counts more than excellence in teaching or clinical competence. Harsh words? Perhaps. Prove me wrong! Help make it different! Demand better!
Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL