Hospital quality measures need work: Mass General experts weigh in

Measuring the quality of hospitals is an imperfect, messy science some have likened to "sausage making" — meaning there is definitely room for improvement.

In a recent post for U.S. News & World Report, ahead of the publication's Healthcare of Tomorrow conference, two executives from Boston-based Massachusetts General Hospital — Elizabeth Mort, MD, senior vice president of quality and safety, and Peter Slavin, MD, president — laid out some ways hospital quality measurement can improve.

A recap of their points is below. See the full article for more.

1. Incorporate structural measures. Several hospital ratings agencies exclude things like the availability of technologies, services offered and designations like Magnet for nursing excellence. "Many report cards…rely heavily on measures of process and outcomes and fail to include structural features as part of the scoring system," the authors wrote, calling this a "missed opportunity."

2. Get rid of patient safety indicators. PSIs are derived from administrative billing codes and have several limitations. "We should work hard to identify reasonable replacements and plan for their obsolescence," according to the article.

3. Use caution on clinical metrics. Hospitals collect their clinical data on things like hospital-acquired infections in different ways, meaning the data accuracy can vary from hospital to hospital. Drs. Mort and Slavin said "surveillance bias can influence the results when these measures are used for public reporting" and urged ratings agencies to avoid using clinical data.

4. Stop dividing scores into meaningless categories. "We believe that partitioning performance should only be done if there are meaningful clinical differences between categories," the authors wrote. Partitioning data into categories should only be done with "sound statistical testing."

5. Improve the readmission metric. Recent studies have called the usefulness of using 30-day readmissions in quality measurement into question, and Drs. Mort and Slavin also cast doubt on the metric. "We urge measure designers to refine and improve the metric which, arguably, is an important, albeit crude, measure of quality," they wrote.

6. Boost transparency and the use of clinical registries. Even though the authors note the public may not yet value this type of information, "we believe that over time, consumers will seek this information and push providers to share more of it."

7. Look at research and clinical trials. Patients are increasingly valuing physicians' participation in clinical trials, according to the authors. "We believe excluding research has been a lost opportunity, and would encourage U.S. News and others to revisit this," they wrote.

8. Examine equality of care. Drs. Mort and Slavin believe hospitals can measure care gaps between races, genders, ethnicities, locations and socioeconomic statuses, and would "encourage these measures to be refined and adopted for broader use."

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