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    Friday, July 24, 2009

    How to Find a Good Hospital

    The reality is, says S.Balauf of US News, that not all hospitals—or doctors or nurses, for that matter—deliver high-quality care. The United States has a "very inconsistent, uneven quality of healthcare," says Anne Weiss, who leads the quality/equality healthcare team at the Robert Wood Johnson Foundation, a healthcare philanthropy based in Princeton, N.J. Even the type of treatment that similar patients get can vary from hospital to hospital and region to region. In some parts of the country, for example, heart patients are more likely to receive angioplasty than coronary bypass surgery, while in many places the opposite is true. (U.S. NEWS wrote about this phenomenon and the fact that some heart patients may get the less appropriate procedure because they may not be fully informed about their options.)

    The time to find a good hospital is long before you need one. By tapping a few readily available resources, however, patients can make informed decisions about a good local hospital for the treatment they need. According to the National Committee for Quality Assurance, a healthcare nonprofit based in Washington, D.C., patients who make informed choices and get engaged in their care early ultimately reap better health outcomes.

    Your primary-care physician. Consult this trusted source if a specialist ever tells you that surgery or treatment is necessary, and ask your primary-care doc where he recommends you have it done. Primary-care physicians have a good working knowledge of the hospitals in their area, including each institution's overall reputation and how it stacks up against its local peers for specific procedures and treatments. Ideally, their reasoning will be based on other patients' outcomes

    Your insurance company. Inquire about the quality data they've collected on each facility where they would cover your treatment. That info can typically be found on the plan's website or by phone. The data might be limited to the pool of patients your plan covers and the doctors and hospitals in the plan's network, but it's nevertheless a source of details that can inform your choice.

    That friend of a friend who is a nurse. Your extended social network may include more hospital employees than you realize. "Most people know someone in the local healthcare system. But realize they provide a narrow view, seeing perhaps only one slice of all the variables that make up a hospital's level of care.

    A trusted family member or friend. Bringing someone you trust to an important appointment, or simply going through the hospital-selection process with another person, can be quite powerful. "Never go alone" and "Never stay alone."If nothing else, your companion is likely to be more clear-headed than you are when you're faced with daunting new information about your health. He or she need not be a medical professional.

    • I would not trust highway billboards touting a hospital's latest award. They're hard to miss—and plentiful in many regions of the country. But beware the source. The prize may or may not have any real bearing on the real quality of care a patient could expect at that hospital. As an example Hospital Compare, hosted by the federal Centers for Medicare and Medicaid Services, focuses on how often hospitals give heart attack patients aspirin within 30 minutes of their arrival at the ED, give surgery patients the correct antibiotic at the right time prior to the procedure, and otherwise do the right thing in 23 "process measures." Some-I believe most of these criteria-- are relative lightweights. Most hospitals show great success, for example, at giving smoking-cessation advice to heart patients who smoke. (Nurse: "I see you're a smoker, Mr. Smith. You know it doesn't help your heart condition, don't you?" Mr. Smith: "Yes, I do." Nurse marks box on discharge form.)

    • Hospital Compare also indicates whether a hospital's death rates in heart attack, heart failure, and pneumonia patients is better, no different, or worse than the U.S. average. That might seem useful, but the average is so broadly defined that only about 2 percent of hospitals are "better" or "worse." Clicking on the graph or table view of the page will reveal the actual death rates, as well as average state and national rates. Last year, the site began offering patient satisfaction data gleaned from surveys, such as the percentages of patients who reported their nurses always communicated well and of those who said they would definitely recommend the hospital. Look, but take with a grain of salt. Studies show that individuals whose medical care was successful tend to be more satisfied with a hospital in other ways.

    • Some websites [www.hookman.com] have links to other sites that also rank or rate good hospitals across the country, and such sites have potential value to people who are seeking a good hospital in their area.

    Is there a correlation between hospitals’ “quality”scores?

    Unfortunately no! A study reported in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION found no correlation between how well hospitals scored on a 13-item set of Leapfrog quality and safety measures and death rates, adjusted for severity, of patients admitted to the hospitals. The study didn't look at rates of complications.The Leapfrog Group is a nonprofit business coalition that allows consumers to compare hospital safety and quality ratings based on results of a voluntary survey. Hospitals are rated on their ability to satisfy two sets of safety standards. One set, such as appropriate ICU staffing and a program to reduce bedsores, applies to the entire hospital. The other set reflects quality of care and cost for 10 specific procedures and conditions, including repairing an abdominal aortic aneurism and treating pneumonia. Hospitals can be compared directly. You may not be able to find yours, however. Roughly 1,300 hospitals out of more than 5,000 in the nation—two out of 16 in Baltimore, for example—responded to the most recent Leapfrog survey.

    COMMENT:
    In the end after you do all your research it then really comes down to luck and faith. Faith that you have a fine doctors who will make good decisions for you. Trust—but verify.
    African medical facilities always have relatives in with patients. That’s a good thing.
    Always have someone with you in the hospital—a friend or loved one who will stay with you and watch out for you.




    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for WHAT DIET IS EFFECTIVE IN REDUCING PROSTATE CANCER RISK?.

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