:: How to Use : A Consumer Guide to Hospital Quality ::

Why was the Consumer Guide to Ohio
Hospital Quality Created?
• Consumers are taking a more active role in managing their own healthcare.
• In order to make informed decisions, such as where to get a high quality and cost effective care, consumers need access to accurate, timely information and tools.
• The guide that follows is one such tool that a consumer could turn to when making an important healthcare decision.
• This guide should not be used in emergency situations.
• This guide should not be used for pediatric care.

How are the Hospitals Ranked?
• Hospitals are ranked based upon their performance as compared to the average performance of all hospitals in the State of Ohio.
• Three quality indicators contribute equally to a hospital's ranking:
- Mortality- Deaths that occur in the hospital
- Major complications- the occurrence of problems such as blood clots and infections
- Failure to Rescue- deaths that occur in the hospital after a condition or procedure-specific complication
• Many hospitals treat very sick patients that other hospitals cannot treat. To be fair, all of the data in this guide are risk – adjusted to account for the age and gender of the patient and severity of the case.
• The volume of patients treated has been shown to have an impact on outcomes for certain conditions and/or procedures. Research suggests that the greater the volume, the better the outcome. For the four procedures/conditions where it is relevant, (AAA, Angioplasty, Carotid Artery Surgery, CABG) hospitals marked with an (H) are considered to be high volume hospitals when applying the criteria used by the Agency for Healthcare Research and Quality (AHRQ).

What is the Source of the Data?
• WebMD Quality Services builds databases that hospitals use for internal analysis and quality improvement. WebMD Quality Services provided the data on which this guide is based.
• Hospitals are required to submit billing data of their Medicare patients to the Center for Medicare and Medicaid Services (CMS). This guide is based on the most current data available, specifically the Medicare patients treated during the 2005 federal fiscal year. While Medicare patients do differ from patients under age 65, the correlation between outcomes based on Medicare patients and patients of all ages has been shown to be highly positive.

Why are the Rankings Different from
Others that I have Seen?
There are many reasons why the rankings in this guide are different than those distributed by other organizations.
• The source of the data may differ from Medicare billing data.
• The timeframe of the report may be longer or shorter than one year, and may be a year(s) other than 2005.
• The measures used to create the rankings may be different than the mortality, major complications, and failure to rescue, used in this guide.
• The ranking may include satisfaction surveys and opinion polls, which are not included in this guide.

The rankings used for this Consumer Guide to Ohio Hospital Quality are based on outcomes measures - the actual results of how a hospital delivers care. However, it is also important to recognize and understand the different steps that a hospital takes to improve its performance. For example, patients are likely to have a better outcome if a hospital does a good job of complying with nationally recognized clinical treatment guidelines. These guidelines are called process of care measures.

The Centers for Medicare and Medicaid Services (CMS) has partnered with public and private entities to form the Hospital Quality Alliance (HQA). Industry groups worked together worked to develop a standard set of metrics to measure and report on process of care. The rankings on the next pages tell you whether a hospital is better than, equal to, or worse than other hospitals when it comes to implementing best-practices for a particular condition.

To learn more about the HQA, or how these measures were developed, please visit: http://www.hospitalcompare.hhs.gov

Factors Considered for Heart Failure Care
• Does each qualifying patient leave the hospital with a prescription for an ACE Inhibitor drug?
• Does each patient get specific discharge instructions when leaving the hospital?
• Has the hospital done an in-depth examination of the heart’s pumping capacity (left ventricle function)?
• Does each patient receive advice and counseling on how to quit smoking?

Factors Considered for Pneumonia Care
• Did the hospital do an appropriate blood test before beginning medication therapy?
• Did the hospital administer antibiotics within four hours of the patient’s arrival?
• Did the hospital administer the correct medication for the special needs of patients in both regular nursing and intensive care units?
• Did the hospital effectively measure the amount of oxygen in the patient’s bloodstream?
• Does the hospital provide influenza and pneumococcal vaccines to patients?
• Does each patient receive advice and counseling on how to quit smoking?

What Conditions are Analyzed?

Cardiac Care
• Abdominal Aortic Aneurysm repair (AAA)
• Angioplasty
• Cardiac Catheterization
• Carotid (Neck) Artery Surgery
• Congestive Heart Failure (CHF)*
• Coronary Artery Bypass Graft (CABG)

Orthopedic Surgery
• Hip Replacement
• Knee Replacement

Pulmonary Disease
• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia*

General Surgery
• Colon Surgery

If you cannot find a particular hospital in the report for a certain condition or procedure, it means that the hospital doesn't perform that procedure or treat that condition. Or, it may mean that a hospital does so few procedures or treatments that it would be inaccurate to report its results.

*In addition, process of care measures for heart failure and pneumonia are included in this guide. The source of data for these measures is the Joint Commission on Accreditation of Healthcare Organizations. You can find more information at:

http://www.qualitycheck.org/consumer/searchQCR.aspx

How can Consumers Use this Guide?
• If you need hospital care, use this guide along with advise from your doctor and other sources to choose a facility that is right for you.
• Talk to a doctor about the results in this guide. If you are concerned about the rankings, ask your doctor what you can do to make sure you get high quality care. Call your hospital to find out what is being done to improve performance.
• Share this report with family, friends, and other people you care about.
• Do not use this guide in emergency situations.
• Do not use this guide for pediatric care.

Understanding the Symbols
These symbols reflect a comparison of a hospital versus
all hospitals in Ohio.

Limits of this Guide
• This guide is as accurate as possible, but hospitals collect and report information in different ways. There is also no uniform way to adjust for patient differences. This guide reflects the care for patients overall, but your individual experience may be different.
• Consider this guide a tool to help you manage your health. Do not use it to generalize about the overall quality of a hospital. Instead, use it to examine hospital performance in specific categories.