Tuesday, September 18, 2007

Judging the quality of hospital surgical services

A study by Leonardi et al. published in this month's Archives of Surgery looks at the various sources of general surgery data for comparing hospital performance in the US.

The highlights:

- The authors identified 6 websites containing this kind of data, including 1 government site (CMS's Hospital Compare), 2 nonprofit sites (JCAHO's Quality Check, the Leapfrog Group's Hospital Quality and Safety Survey Results), and 3 proprietary sites (names withheld)

- Sites were rated on accessibility (cost, sign-up required/not required, visibility in terms of where the site appeared in their Google search results); data transparency (data source, statistical/analytical methods, risk adjustment methods); and appropriateness (variety of quality measures employed)

- Government and non-profit sites fared better on accessibility and were also the most transparent in terms of their data sources, statistical methods, and risk adjustmen descriptions.

- The proprietary sites were rated as more "complete" regarding the appropriateness measure, ie. the variety and types of measures used to evaluate quality.

- None of the sources provided real-time data; all data was at least one year old.

- The study also looked at consistency, i.e. whether they got the same results from the different sites, for several procedures. For laparoscopic cholecystectomy, the sites were consistent; hernia repair data varied more widely due to lack of data; and the different evaluation sites provided conflicting results on colectomy.

- Limitations of included sites: lack of working definitions for quality-related terms (e.g. complications); inadequate procedure-level information; concerns about timeliness of data; fragmented and inconsistent data sources supporting the sites

The authors' overall conclusions: Current hospital quality data sources may provide inconsistent results and utilize "suboptimal" measures of quality in some instances. Given the apparent trend toward patient consultation of such indicator sites, surgeon involvement in data gathering and resource refinement may be key ways to improve the utility of these resources.

Reference: Leonardi MJ, McGory ML, Ko CY. Publicly Available Hospital Comparison Web Sites: Determination of Useful, Valid, and Appropriate Information for Comparing Surgical Quality. Arch Surg 2007;142 863-869. Abstract (full-text requires subscription)

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