Numbers — the hard facts. People often consider numbers, or data, to be unimpeachable, or that they can speak for themselves. More often than not, however, numbers can be presented differently to show different things. As hospitals ramp up quality reporting efforts to meet CMS requirements and to boost transparency to consumers, hospitals need to consider how they report data to most accurately and clearly reflect their performance.
For example, an article in American Journal of Infection Control by Michael Klompas, MD, MPH, an assistant professor in the department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, showed how changing the boundaries for certain measures can dramatically affect an organization's rate of infection. For example, more rigorous definitions of clinical signs of ventilator-associated pneumonia could lead to fewer counts. "Stricter observers seeking unambiguous, sustained evidence that surveillance criteria are being met will inevitably assign fewer VAPs," he wrote.
Kenneth Sands, MD MPH, senior vice president of health care quality at Beth Israel Deaconess Medical Center in Boston, explains three ways reporting quality data can affect people's perception and understanding of a hospital.
1. Data storage. Where does a hospital report its quality data — in one place, or in many different places? In 2007, BIDMC set a long-term goal of eliminating preventable harm. To reach this goal, the hospital shared data quarterly with the board of directors, the quality and safety board committee and ultimately to all stakeholders in the organization. In the past, BIDMC had shared data for different types of harm, such as infections and falls, separately. To facilitate quarterly reporting, the hospital started displaying and analyzing data as part of a unified view of performance, which made understanding the data easier, according to Dr. Sands.
Similarly, presenting all quality data in one area on a website can help patients more easily access and understand a hospital's performance.
2. Data format. The format data is presented in can also influence people's responses to data. BIDMC presents its quarterly quality reports to the board in a table format to allow for easy comparisons across time and measures. On its website it provides quality data in a slightly different format to ensure clarity for patients. For example, on a page about infection prevention, BIDMC provides a table comparing BIDMC's current performance to its goal for different measures. By clicking on the measure, patients can view a graph and a more detailed explanation of the measurement.
Similarly, the website for Charlotte, N.C.-based Carolinas HealthCare System provides descriptions of steps the health system is taking to improve quality in areas where its score is below the state average.
HHS is also considering data format in terms of how to best present personal medical information to patients to balance transparency and clarity. In mid-September, HHS proposed changes to the Clinical Laboratory Improvement Amendments of 1988 and HIPAA privacy regulations to allow patients access to test results directly from labs. There have been concerns that direct access, however, may create confusion or unwarranted concern in patients. For instance, in a commentary in The Journal of the American Medical Association, Traber Davis Giardina, MA, MSW, and Hardeep Singh, MD, MPH, wrote that immediate and direct access without a physician's interpretation may create unnecessary anxiety for patients.
3. Data value. Dr. Sands says BIDMC reports harm data as counts as well as rates. "Saying four patients suffered ventilator pneumonia in the most recent quarter compared to three last quarter feels different than saying the ventilator rate was 0.7 per 1,000 ventilator days vs. 0.5," he says. "Somehow counts are more tangibly related to actual patients than rates, which create some degree of separation."
One disadvantage of using counts is that few other organizations report data in counts, which makes comparisons between facilities difficult. Therefore, BIDMC also reports harm data as rates to more effectively benchmark its performance against peer institutions.
The Leapfrog Group, a patient safety and healthcare quality advocacy group, has recently come under fire from the American Hospital Association and some high-profile hospitals for its new rating system, which gives hospitals one letter grade for their performance on various safety measures. While designed to be easy to understand to consumers, the letter-grade score does not convey differences for individual measures and does not show the thresholds for each grade. In addition, The Leapfrog Group's method for assigning scores has been criticized as being inaccurate and biased.
Quality Reporting Affects Reimbursement, Reputation
Quality data will play an increasingly large role in hospitals' success as new reimbursement models penalize low scores on certain measures and as consumers play a larger role in choosing their healthcare providers. Presenting accurate data will thus be crucial for hospitals' financial health as well as their reputation in the community. Hospitals should consider where they store data, in what format they present data and what value the data represent. Besides ensuring transparency, accurate and clear data presentation can improve a hospital's ability to meet their patient safety and quality goals.
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