New database provides information on ‘hospital-acquired conditions’

According to controversial new data released by the federal government, foreign objects were left in Medicare patients after surgery four times at one Connecticut hospital from October 2008 through June 2010.

From the data, you could learn that Medicare patients at 10 Connecticut hospitals got severe bed sores during that time, and all but one hospital had at least one Medicare patient get a “hospital acquired condition.”

But you might have a harder time figuring out what to do with the information.

The data on hospital-acquired conditions is the latest in a growing list of health care quality measures being reported publicly. Later this month, it will be added to the U.S. Department of Health and Human Services’ Hospital Compare website, which already offers information about mortality and readmission rates, how often hospitals follow recommended care measures, and the results of patient surveys.

The federal government also runs a site to compare nursing homes, and is developing a Physician Compare website that will draw from a voluntary program that pays bonuses to doctors who provide data about the care they provide.

“There’s a dizzying array of information that’s now available to the public,” said Dr. Jamie Roche, senior vice president for patient safety and quality at Hartford Hospital. “It becomes harder and harder for them to put it in perspective.”

Consumer groups say that public reporting can motivate hospitals to put more focus on preventing problems. Because hospitals must report data in standardized ways, it makes information on problems available to researchers who can analyze problems and develop strategies to address them, they say.

“Reporting alone can improve behavior,” said Ellen Andrews, executive director of the Connecticut Health Policy Project.

Having data reported can make hospitals or other providers aware of how their performance compares with others, and can lead to sharing of best practices, she said.

For now, it’s mostly “really motivated” consumers who make decisions based on publicly reported data, Andrews said, but she predicted that that could change over time as patients are better educated about what to look for and data reporting improves.

“I think it’s an evolution,” she said. “People are going to have to learn how to do that. The fact that most consumers don’t right now doesn’t mean that we won’t.”

The focus on reporting quality data has grown since the Institute of Medicine’s 1999 report “To Err is Human,” which suggested that as many as 98,000 people die in hospitals every year from medical errors that could have been prevented. Among the report’s recommendations was the development of a national public mandatory reporting system that would ensure that health care providers and institutions have incentives to make improvements that could reduce errors and respond to the public’s right to know about safety.

Public data reporting has at times met with grumbling from health care providers. The American Hospital Association opposed the release of the hospital acquired conditions data, arguing that it has not been reviewed by “consensus-based” outside groups, and that it represents rare events.

“These data portray an inaccurate and unreliable picture of quality,” the association said in an advisory released last month. “Since these are rare patient safety events, we believe that they are more appropriate for analysis by Patient Safety Organizations, rather than rate-based reporting.”

The Connecticut Hospital Association also has concerns about the usefulness of the data, which is drawn from medical claims that might not precisely distinguish conditions, said Patty Charvat, the association’s interim director of communications.

But hospitals recognize that public reporting is “here to stay,” she said.

The hospital association reports quality measures for heart attacks, heart failure, pneumonia and surgery on its website. Some hospitals have also started reporting data on their own websites. Griffin Hospital, for example, publishes data on hospital-acquired infection rates and “core measures” of care for patients with heart attacks, heart failure and pneumonia, and surgical patients. Hartford Hospital posts data on catheter-related bloodstream infections, falls, handwashing, and bed sores.

Charvat said patients could use the hospital acquired conditions data to begin conversations with their health care providers if it raises concerns.

“It’s another piece of the whole puzzle,” she said. “If I was going to go into a hospital for a procedure and I had some concerns after looking at that data, I would ask about it. I would use that as the launching point to say, ‘I saw this, what does it mean, how do you prevent it, how will you keep me safe?'”

In Connecticut, hospital acquired conditions occurred in less than one in 1,000 Medicare discharges in nearly all cases, although on some measures, some Connecticut hospitals had higher rates than the nation as a whole. Only one, Masonic Home and Hospital in Wallingford, had no hospital acquired conditions.

The most common hospital-acquired conditions among Connecticut Medicare patients were falls and trauma, which occurred at 27 different hospitals a total of 126 times.

Infections occurred nearly as many times. Urinary tract infections associated with catheters occurred 106 times at 24 hospitals, and vascular catheter-associated infections occurred 111 times at 16 hospitals.

One hospital–Yale-New Haven–was responsible for half of the eight cases in which objects were left in Medicare patients following surgery; no other hospital had more than one. (Yale-New Haven did not return a call for comment.)

Statewide, there were 17 cases of manifestations of poor glycemic control–the category includes hypoglycemic coma and diabetic ketoacidosis–and 23 cases of stage III or IV pressure ulcers, or bed sores.

Two conditions–blood incompatibility and air embolisms, which occur when air enters the circulatory system–did not occur in Medicare patients at any Connecticut hospitals.

Andrews said that if she is having a particular problem, she will look at data on how hospitals handle that problem. But she also looks at other indicators to see how hospitals are doing generally. Infection rates can be a good indicator because patients can get infections regardless of what they are being treated for, she said, and hospitals that do well at preventing infections are likely to be doing well at other things. She also recommended looking at trends over time.

Roche said patients looking at data should look for sustained improvement and ask what providers are doing to decrease the frequency of problems. The information reported is often outdated and might not be directly relevant to a particular patient’s experience, he said.

“When they look at it, they should be asking themselves how recent is this data, what is the definition that’s being applied, how much does it change from reporting period to reporting period, because there’s tremendous variability,” he said.

But there are other reasons for reporting quality measures. It is expected to be increasingly tied to how health care providers are paid. Already, Medicare does not pay for hospital acquired conditions like the ones reported in the recently released data, and many private insurers no longer pay for so-called “never events”–errors that are never supposed to occur, such as surgery being performed on the wrong patient or an object being left in a patient after surgery.

Regulators and employers and other payers of health care costs have put increased pressure on institutions to report on quality measures, increasing the competition and transparency, Roche said.

Public reporting can also show that there is significant variation in patient care, even between hospitals in the same city, which can be useful in trying to bring everyone to a care standard.

“It’s gone from in the 1990s, only a few people being aware of these issues and quality improvement was kind of an activity that people engaged in, or a regulatory requirement…it now has become how people work,” Roche said.