What to look for in health care quality

You’re hungry, and you don’t want to cook. You look up restaurants near you. The first result looks delicious!

Then you see the restaurant has a terrible rating. The service is awful, the food tastes bad and there are several health code violations.

Does that food still look so delicious?

Quality matters.

The same is true for health care. Nobody wants to receive subpar care. That is where quality metrics come in handy. Tammy Crebo, vice president of clinical data for Quality & Safety at OSF HealthCare, gave the scoop on how to find quality measurements in health care and just how important quality health care is.

Why are health care quality metrics important?

Quality measures give people confidence that hospitals are staying up to date on best practices.

Having the same terms and definitions across the board makes it easier for patients to compare multiple hospitals and make sure they are finding the best care to fit their needs.

“These measurements serve as a ‘checks and balances’ system for hospitals. Hospitals know their performance is being monitored and reported,” Tammy said.

It’s not just patients that benefit from high quality performance. Payors incentivize hospitals to provide higher quality care and pay more or less based on performance.

What kinds of services measure health care quality?

There are several agencies and organizations that measure health care quality. Here are just a few.

Tammy says the Centers for Medicare and Medicaid Services (CMS) Five-Star Quality Rating System and the Leapfrog Hospital Safety Grade offer particularly consumer-friendly ratings.

“Both allow a patient to type in a city, state and ZIP code to more easily compare ratings across various hospitals.”

The Leapfrog Hospital Safety Grade measures patient safety. According to its website, “These national performance measures indicate how well hospitals protect patients from preventable errors, injuries and infections. Grades are assigned to U.S. general hospitals twice annually, using a scoring algorithm to determine each hospital’s score as an A, B, C, D, or F letter grade.”

CMS uses stars to rate hospitals and other health services “based on how well a hospital performs across different areas of quality, such as treating heart attacks and pneumonia, readmission rates and safety of care.”

What is assessed?

“Many rating systems measure both outcome and process information,” Tammy said.

Patient outcomes include mortalities after or during hospital care, readmission rates after discharge, emergency department wait times, patient experience survey feedback and other patient-centered outcomes.

Process information assessments include hand hygiene policies, strength of nursing leadership and engagement, safe medication administration and other processes in place to ensure safety and prevent medical error.

And it’s not just hospital services that are measured, either.

The American College of Surgeons measures the quality of surgeons by looking at five different care stages: preoperative, perioperative, intraoperative, postoperative and post-discharge.

Agency for Healthcare Research and Quality measures the quality of physicians by looking at patient safety, effectiveness, patient-centeredness, timeliness, efficiency and equity.

Home health care is measured by CMS based on five standards:

  • Care of patients
  • Communications between providers and patients
  • Specific care issues
  • Overall rating of care
  • Patient willingness to recommend Home Health Agency (HHA) to family and friends

While it’s helpful to see how hospitals and other health care facilities are rated, Tammy recommends carefully considering the definitions of the metrics and the timeframe of the data.

“Metrics included within the CMS star ratings include performance information that is over a year old, with many encompassing data from a span of 2-3 years.”

Why should you care about hospital quality?

“Patients need to understand the difference in various rating systems to determine what is appropriate for their specific need,” Tammy said.

OSF HealthCare Quality and Safety News.

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These ratings make it easy for a non-clinical person to understand important data. Ratings are explained in easy-to-understand terms and explain why these measurements are important.

“It is important for patients to ‘dig into’ the rating. For example, if they are seeking surgical care, the measures related to specific surgeries, complications, infections, postsurgical readmissions and postsurgical mortalities would be of more interest than measures related to specific conditions or Emergency Department wait times.”

The more knowledge you have about hospital and health care quality, the better you can advocate for yourself and your specific needs.

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About Author: Katie Faley

Katie Faley is a Writing Coordinator for OSF HealthCare. She graduated from Illinois State University with a degree in English Studies. Before joining OSF HealthCare in 2021, she worked in magazine editing, digital marketing and freelance writing.
Katie is often found listening to ‘60s folk music, deciding on a new skill to learn, losing track of time in a library or spending time with her family and friends.

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