AHRQ: What Do Patients Want? Hospital Compare Asks Their Opinions
November / December 2008
AHRQ
What Do Patients Want?
Hospital Compare Asks Their Opinions
While not spread evenly, our national investment into improving the quality of care has begun to pay dividends. So far, the payback has been modest: Quality inched upward by 2.3% between 1994 and 2005, according to a 2007 national report from the Agency for Healthcare Research and Quality (AHRQ).
This national picture also includes significant improvements in how health providers treat individual diseases and conditions, which reflect the use of evidence-based guidelines and a team-based approach to follow-up care. For example, AHRQ’s National Healthcare Quality Report found that more than 93% of heart attack patients received the recommended hospital care in 2005, up from about 77% 5 years earlier. And the percentage of heart attack patients who were counseled to quit smoking increased from about 43% to 91% over that same time period.
The report provides a useful road map on how well our country is performing on more than 200 measurements of quality. Like its companion study on healthcare disparities, the annual quality report was mandated by Congress and is used by policymakers, health insurers, public health advocates, and consumers.
Both of these reports offer perspectives from patients on their experience of care. For example, patients give their views on how often their provider listened carefully to them, explained things clearly, respected what they had to say, and spent enough time with them.
While this national data provides a useful quality benchmark, it cannot answer the question many patients ask: How will I be cared for by doctors and nurses at my local hospital?
To address this critical question, information about patients’ experience of their care in their local hospital is now publicly available on the Hospital Compare web site. Patients answer questions on 10 topics, ranging from communicating with nurses and doctors and getting information about post-hospital care to whether they would recommend the hospital to friends and family. In short, these are exactly the types of questions that consumers would ask each other when selecting a hospital.
Patients’ responses, collected as part of AHRQ’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS®) survey, were first posted on the Hospital Compare web site on March 28, 2008. As of August 2008, 2,565 hospitals reported this data; updated responses will appear quarterly. Data are reported nationally and by average score for participating hospitals in each state.
Creating a Big Picture of Quality
Adding data about patients’ hospital experience to Hospital Compare provides a more multidimensional, consumer-friendly picture of hospital quality. Hospital Compare was created by the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and members of the Hospital Quality Alliance.
The patient-focused data complements existing information on 26 quality measures, which include process of care and outcomes measures. Process-of-care measures report how well a hospital provides care on selected clinical conditions, such as treatment of heart attacks, heart failure, and pneumonia. Outcomes measures reflect the results of care that Medicare patients received while in the hospital.
While process and outcomes measures are familiar metrics to quality experts, data about patients’ experiences in the hospital reveal some significant areas for improvement (Centers for Medicare & Medicaid Services). National data reported in August 2008 found that:
- 58% of patients said that hospital staff told them what new medicines were for and explained side effects in a way they could understand.
- 60% said they received help quickly from hospital staff, such as a fast response when they pressed the call button.
- 67% said they thought their pain was well controlled and hospital staff did all they could to help manage patients’ pain.
Informing patients about a new medication and its potential side effects can serve more than one purpose. In addition to helping the patient understand his treatment plan, describing a new medicine, its purpose, and its side effects also may reduce the likelihood of a medication error.
Preventing adverse drug events (ADEs) protects patients and saves increasingly scarce healthcare dollars. One study cited by the Institute of Medicine (2006) found that each preventable ADE that occurred in a hospital added about $8,750 to the cost of the hospital stay. Assuming that 400,000 such events occur each year — a figure that many consider to be conservative — the total annual cost of preventable ADEs would be $3.5 billion.
Communicating with Doctors and Nurses
Responses from patients about their care offered some encouraging news, such as:
- 79% of patients said they were given information, such as what symptoms or health problems to look out for, once they left the hospital. Patients also said hospital staff talked to them about whether they would have the help they needed at home.
- 73% said nurses listened to them carefully, treated them with respect, and provided explanations they could understand.
- 79% said the same about their doctors.
As inpatient hospital care shifts toward patients with complex medical needs, organizations will need to continue to focus on clear, comprehensible discharge instructions. This is no small challenge in light of the low health literacy levels of many patients. Nearly 90 million Americans have only basic or below-basic health literacy skill, which affects people from all age, income, and educational levels (Institute of Medicine, 2004).
Research at Boston University Medical Center supported by AHRQ is examining how to “re-engineer” the hospital discharge process using personalized calendars, appointment books, and patient-friendly medication instructions. Preliminary results have found a significant reduction in hospital utilization by patients who are high users of hospital services (Jack, 2008).
Conclusion
With its publicly available data that measure process and outcomes of care, Hospital Compare offers a valuable tool to assess and improve quality. By including patients’ experience of care, the federal government and key stakeholders have enhanced this tool and created benchmarks that will, over time, spur meaningful quality improvements.
Carolyn Clancy is director of the Agency for Healthcare Research and Quality, Rockville, Maryland. she is a general internist and holds an academic appointment at George Washington University School of Medicine in Washington, DC. She may be contacted at carolyn.clancy@ahrq.hhs.gov.
References
Agency for Healthcare Research and Quality. (2008, February). 2007 National Healthcare Quality Report. AHRQ Publication No. 08-0040, Rockville, MD.
Agency for Healthcare Research and Quality. (2008, February). 2007 National Healthcare Disparities Report. AHRQ Publication No. 08-0041, Rockville, MD.
Centers for Medicare & Medicaid Services. HCAHPS® executive insight. http://www.hcahpsonline.org/executive_insight/default.aspx. Accessed September 18, 2008.
Institute of Medicine. (2004, April). A prescription to end confusion, report brief.
Institute of Medicine. (2006, July). Preventing medication errors, report brief.
Jack, B. (2008). Promoting quality, partnering for change. Paper presented at the AHRQ 2008 Conference, Bethesda, MD, September 710, 2008.
U.S. Department of Health and Human Services. Hospital compare A tool for adults, including people with Medicare. http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home. Accessed September 18, 2008.