Name:                             Kristy KratzStudent Number:                   0188626Term paper for Health Economics, Ec...
1.0 IntroductionBeginning in 2002, through extensive analyses, consumer testing, and numerous field tests,CMS partnered wi...
that we have been given the tools to measure the quality of care for our hospitals in threedifferent ways, let’s see if th...
paper, I used only two measures each from three categories: one from heart attack care,heart failure and pneumonia care. A...
“Heart failure is the weakening of the heart’s pumping power. With heart failure, yourbody doesn’t get enough oxygen and n...
3.0 AssessmentUsing the hospital compare website, I pulled process of care data on the three hospitals anddeveloped a grap...
the average National averages in ALL areas surveyed. Overall, patients are most likely torecommend Good Samaritan Hospital...
Goodsam-md.org. Good Samaritan Hospital, Baltimore, MD. Retrieved May 2, 2009.      http://www.goodsam-md.org/body.cfm?id=...
AppendixTable 1                                                                                     Johns Hopkins         ...
Table 3                                     Franklin                                      Square       Good       Johns Ho...
Figure 1                      120                      100                       80                       60              ...
Figure 3Figure 4           87           82           77           72           67           62           57           52  ...
Upcoming SlideShare
Loading in …5
×

Does Providing Recommended Treatments Equal Low Mortality Rates

373 views

Published on

Final research paper completed in 2009 for Economics

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
373
On SlideShare
0
From Embeds
0
Number of Embeds
6
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Does Providing Recommended Treatments Equal Low Mortality Rates

  1. 1. Name: Kristy KratzStudent Number: 0188626Term paper for Health Economics, Econ 339Does Providing RecommendedTreatments Equal Low Mortality Rates?A Comparison of HCAHPS Data in ThreeBaltimore HospitalsAbstract: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, is a standardizedsurvey instrument for measuring patients’ perceptions of their hospital experience. In addition to the HCAHPSsurvey, the Hospital Compare website was created through the efforts of the Centers for Medicare & MedicaidServices (CMS). Hospital Compare shows the responses from the HCAHPS surveys and also displays rates forProcess of Care measures and Outcome of Care measures. I selected three similar facilities in the Baltimore areato compare the HCAHPS data: Franklin Square Hospital Center, Good Samaritan Hospital, and Johns HopkinsBayview Medical Center. Based on my review of the data, there is no way to tell if the providing recommendedtreatments equal low mortality rates. Data corresponded both negatively and positively with mortality rates indifferent hospitals.
  2. 2. 1.0 IntroductionBeginning in 2002, through extensive analyses, consumer testing, and numerous field tests,CMS partnered with the Agency for Healthcare Research and Quality (AHRQ), anotheragency in the federal Department of Health and Human Services, to develop and test theHCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, astandardized survey instrument for measuring patients’ perceptions of their hospitalexperience. HCAHPS has provided a national standard for collecting and publicallyreporting information, enabling consumers to have valid comparisons of hospitals locally,regionally and nationally. In addition to the HCAHPS survey, the Hospital Compare websitewas created through the efforts of the Centers for Medicare & Medicaid Services (CMS), anagency of the U.S. Department of Health and Human Services (DHHS), along with theHospital Quality Alliance (HQA). The information on the website can be accessed byanyone, including patients needing hospital care. Hospital Compare shows the responsesfrom the HCAHPS surveys and also displays rates for Process of Care measures andOutcome of Care measures. The Process of Care measures show whether or not hospitalsprovide recommended treatments for patients being treated for serious conditions, such asheart attack, heart failure, and pneumonia. The Outcome of Care measures consist of 30-day risk-adjusted death rates, which are compared to the National Averages. Hospitalsvoluntarily submit data from medical records about the treatments their patients receivefor these conditions. According to the Hospital Compare website, measuring thepercentages of times certain recommended treatments are given, mortality rates, andpatient experiences are all ways to measure the quality of care a hospital provides. Now 2|Page
  3. 3. that we have been given the tools to measure the quality of care for our hospitals in threedifferent ways, let’s see if they are consistent.2.0 Survey BackgroundThe HCAHPS survey is administered to random samples of adult patients across varyingmedical conditions between 48 hours and six weeks following discharge. The survey askspatients 18 questions about their hospital stay, and publically reports results on 10measures (communication with nurses and doctors, the responsiveness of hospital staff,the cleanliness and quietness of the hospital environment, pain management,communication about medicines, discharge information, overall rating of hospital, andwould they recommend the hospital). The patient survey portion of the HCAHPS data isadjusted based on the type of survey completed (phone, paper, etc.) because phone surveysfor example usually yield higher return rates and higher scores. The survey is not yetfederally mandated, but hospitals that fail to report on the required quality measures mayreceive an annual payment update that is reduced by 2.0 percentage points, so there is asubstantially large incentive for hospitals to participate. Although CMS instituted thesurvey in October of 2006, the first public reporting of HCAHPS results occurred in March2008, so the survey is not yet widely known.2.1 Process of Care MeasuresThe hospital process of care measures include seven measures related to heart attack care,four related to heart failure, seven related to pneumonia care, seven related to surgical careimprovement, and two related to asthma care for children only. For the purposes of this 3|Page
  4. 4. paper, I used only two measures each from three categories: one from heart attack care,heart failure and pneumonia care. All data was taken from information reported from July2007 through June 2008. The reason I chose these three are because every year around 5million people suffer from either a heart attack, pneumonia or heart failure and they areamong the leading causes of hospital admissions for Medicare beneficiaries, age 65 andolder. Also, as you will see later, the outcome of care measures only includes mortalityrates for these three illnesses.“A heart attack happens when the arteries leading to the heart become blocked and theblood supply is slowed or stopped.“ (hospitalcompare.hhs.gov). Relating to heart attackcare, the two measures I compared were percent of patients given aspirin at arrival andthose given it at discharge. These two measures are important because aspirin can helphelping dissolve blood clots that may have formed and helps get oxygen through bloodvessels easier. If given upon admission, this could reduce the severity of the heart attackand given upon discharge, can help prevent blood clots from forming.“Pneumonia is a serious lung infection that causes difficulty breathing, fever, cough andfatigue.” (hopsitalcompare.hhs.gov). With respect to pneumonia patients, the twomeasures I chose to compare were the percent of patients given oxygenation assessmentand the percent of patients given pneumococcal vaccination. Pneumonia can lower theoxygen in the blood stream because the air spaces in the lungs fill with mucus. Measuringthe amount of oxygen in the blood within 24 hours of arriving to the hospital is importantto know if oxygen therapy is needed. The pneumococcal vaccine has been known to helplower the risks of pneumonia caused by bacteria. 4|Page
  5. 5. “Heart failure is the weakening of the heart’s pumping power. With heart failure, yourbody doesn’t get enough oxygen and nutrients to meet its needs. “(hospitalcompare.hhs.gov). In the category of heart failure, I compare the percent of heartfailure patients given discharge instructions and the percent of heart failure patients givenan evaluation of the Left Ventricular Systolic (LVS) function. Because heart failure is achronic condition, giving discharge instructions is important to help reduce the risk ofrecurring illness. The evaluation of the LVs test is important to determine how the heart ispumping and can help determine what area of the heart is affected.2.2 Outcomes of Care MeasuresThe hospital outcome of care measures consist of the 30-day risk-adjusted death rates forheart attack, heart failure and pneumonia at different hospitals. Comparing the mortalityrates with the U.S. National rates and the state rates can help understand whether ahospital is doing a good job or not. Having the rates risk-adjusted indicates they areadjusted based on how sick the patient was when they were admitted to the hospital.2.3 HospitalsThe Hospital Compare website has information from over 45 hospitals in Maryland and4500 in the United States available for comparison. I attempted to choose three similarfacilities in the Baltimore area to compare: Franklin Square Hospital Center, GoodSamaritan Hospital, and Johns Hopkins Bayview Medical Center. For basic statistics, seeTable 1. 5|Page
  6. 6. 3.0 AssessmentUsing the hospital compare website, I pulled process of care data on the three hospitals anddeveloped a graph, see Table 2 and Figure 1. With the exception of “Percentage of HeartFailure Patients Given Discharge Instructions” all percentages were fairly high withcompliance of giving the recommended treatments. With respect to the percentage ofheart failure patients given discharge instructions, the numbers were low, ranging from62% to 74% compliance, but yielded lower mortality rates for heart failure than for heartattack or pneumonia, representing a negative correlation. For example, Good SamaritanHospital had the lowest percentage of compliance with giving discharge instructions, buthad the lowest mortality rate. However, John’s Hopkins Bayview Medical Center was theleast compliant with giving pneumonia patients oxygenation assessments and they had thehighest mortality rate associated with pneumonia, showing a positive correlation. Figure 3shows the gaps in mortality rates and the process of care data graphically together.According to the survey, none of the hospitals had mortality rates for heart attack, heartfailure or pneumonia that were “statistically different” than the U.S. National Rate.However, I think it’s important to note that all mortality rates were below the U.S. NationalRates for all three hospitals in each category with the exception of Good Samaritan hospitalwith heart attack mortality (Figure 2). With regard to the survey of patients’ hospitalexperiences, Table 3 and Figure 4, all three hospitals scored lower than both the Marylandaverage and National averages for room and bathroom cleanliness. In reviewing the twoareas that have higher scores for Good Samaritan Hospital, in both areas, it appears thatroom cleanliness is related to whether or not patients would recommend the hospital.What was most surprising to me to see was that the average for Maryland was lower than 6|Page
  7. 7. the average National averages in ALL areas surveyed. Overall, patients are most likely torecommend Good Samaritan Hospital over the other two.4.0 ConclusionBased on my review of the data, there is no way to tell if the providing recommendedtreatments equal low mortality rates. Data corresponded both negatively and positivelywith mortality rates in different hospitals. This could be because of case mix,demographics, location of the facility, etc. Although the surveys are risk-adjusted, thequestion remains of how to do you judge a hospital as efficient or good? Each of thesemeasures by themselves didn’t seem to be consistent, but maybe by combining thedifferent methods, the consumer can make a more informed decision. Although the effortis intended to “make important information about hospital performance accessible to thepublic and to inform and invigorate efforts to improve quality” (hopsitalcompare.hhs.gov),I think the ultimate goal is to move towards a pay for performance rating system. Theinformation is useful to have, but it doesn’t appear that organizations that follow theprocedures of care recommended are achieving the outcomes they should be. Anotherproblem with HCAHPS is that most professionals don’t know about the information. Itwould be difficult for patient’s to make more informed decisions about their healthcarebased on this unless it is made more publically aware.ReferencesFranklinsquare.org. Franklin Square Hospital Center, Baltimore, MD. Retrieved May 2, 2009. http://www.franklinsquare.org/documents/2008%20Annual%20Report.pdf 7|Page
  8. 8. Goodsam-md.org. Good Samaritan Hospital, Baltimore, MD. Retrieved May 2, 2009. http://www.goodsam-md.org/body.cfm?id=185Hcahpsonline.org. Centers for Medicare & Medicaid Services, Baltimore, MD. Retrieved April 30, 2009. http://www.hcahpsonline.orgHopkinsmedicine.org. Johns Hopkins Medicine, Baltimore, MD. Retrieved May 2, 2009. http://www.hopkinsmedicine.org/about/statistics/clinical.htmlHospitalcompare.hhs.gov. U.S. Department of Health and Human Services, Baltimore, MD. Retrieved April 30, 2009. http://www.hospitalcompare.hhs.gov 8|Page
  9. 9. AppendixTable 1 Johns Hopkins Franklin Square Good Samaritan Bayview Medical Basic Stats Hospital Center Hospital CenterLicensed beds 380 346 333Annual Net Operating Revenue $ 412,506,000.00 $ 247,000,000.00 unknownAnnual Patient Admissions 30,209 18,064 23,180Annual Inpatient Days 109,117 96,135 97,690Table 2 Johns Hopkins Franklin Square Good Samaritan Bayview MedicalProcess of Care Measures Hospital Center Hospital CenterPercentage of Heart AttackPatients Given Aspirin at Arrival 96 96 98Percentage of Heart AttackPatients Given Aspirin atDischarge 98 95 100Percentage of PneumoniaPatients Given OxygenationAssessment 100 98 100Percentage of PneumoniaPatients Given PneumococcalVaccination 90 95 80Percentage of Heart FailurePatients Given DischargeInstructions 74 62 71Percentage of Heart FailurePatients Given an Evaluation ofLVS Function 96 96 95 9|Page
  10. 10. Table 3 Franklin Square Good Johns Hopkins Average Average forSurvey of Patients Hospital Hospital Samaritan Bayview for UnitedExperiences Center Hospital Medical Center Maryland StatesPercent of patients whoreported:That their nurses ALWAYScommunicated well 74 74 71 71 74That their doctors ALWAYScommunicated well 77 79 78 77 80That they ALWAYS receivedhelp as soon as they wanted 57 53 53 55 62That their pain was ALWAYSwell controlled 68 66 63 66 68That staff ALWAYS explainedabout medicines before givingit to them 61 56 57 55 59Reported that their room andbathroom was ALWAYS clean 57 62 59 63 69That the area around theirroom was ALWAYS quiet atnight 47 55 47 52 56YES they were giveninformation about what to doduring their recovery at home 85 82 83 78 80YES they would definitelyrecommend the hospital 64 73 65 64 68Percent of patients who gavetheir hospital a rating of 9 or 10on a scale from 0 - 10 (10highest) 62 59 62 59 64Key:Better than Average for MDSame as Average for MDWorse than Average for MD 10 | P a g e
  11. 11. Figure 1 120 100 80 60 40 Franklin Square Hospital Center 20 Good Samaritan Hospital 0 Johns Hopkins Bayview Medical CenterFigure 2 18 17 16.1 15.4 16 14.1 14 11.4 11.1 12 10.3 Franklin Square Hospital 10 8.88.6 8.78.5 9 Center Good Samaritan Hospital 8 6 Johns Hopkins Bayview 4 Medical Center Average for United States 2 0 Heart Attack Pneumonia Heart Failure 30-Day 30-Day 30-Day Mortality Mortality Mortality 11 | P a g e
  12. 12. Figure 3Figure 4 87 82 77 72 67 62 57 52 47 12 | P a g e

×