Healthcare providers are jumping on the outcomes data bandwagon in New York, Cleveland and Indianapolis. But many questions remain about the value of the data that are being reported.
Data from Cleveland and New York are being used to acclaim drops in mortality rates, and Cleveland also is touting favorable comparisons with national averages.
But how can patients or payers realistically distinguish between individual providers when the New York State Health Department data show that only one of 31 hospitals had a death rate that was significantly higher than the state average, while only one had rates significantly below the state average? In Cleveland, Health Quality Choice data show only three of 30 Cleveland hospitals had poorer-than-predicted mortality rates, and two did better than expected.
In Indianapolis, Methodist Hospital of Indiana ballyhooed the release of the first data comparing individual hospital quality of care with "national" statistics in 22 clinical and performance areas. But lacking any true national data, researchers at Methodist were forced to compare the hospital's 1992 performance data with results of various studies published in the past few years. Add this to the fact that results weren't adjusted for severity of illness, and comparisons stray close to becoming meaningless.
Many purchasers and patients are wondering what to make of these numbers, in light of the fact that there are no true benchmarks to ensure that providers compare apples with apples. The National Committee for Quality Assurance is attempting to develop standards for managed-care plans, but a uniform method of comparing data does not yet exist.
The clamor from government and payers for quality measures of cost-effective, quality care is growing louder. As a result, substantial progress is being made in developing quality measurements.
Providers should avoid getting caught up in a numbers game. The value of outcomes data is that it gives executives the ability to look within their institutions to initiate internal quality improvements. Outcomes-based feedback can help executives understand what really works in clinical practice, assess treatments, counsel patients on expected treatment results and make better choices when they allocate resources.
Such efforts will be invaluable in helping providers focus on continuous quality improvement efforts that enable them to win managed-care contracts and thrive in a new cost-efficient environment.