|
|
HOME ► National Performance Rankings ► National Rankings for Hospitals ► Data Limitations and Analytic Considerations
Data Limitations and Analytic Considerations
Data source: We computed hospital rankings using publicly reported data downloaded from the CMS Hospital Compare web site (www.hospitalcompare.hhs.gov - last accessed 3/31/081). This data set contains hospital-specific performance on 24 quality measures for over 4,200 hospitals nationwide2. The data presented on Hospital Compare comes from hospitals that volunteered to submit their data for public reporting. Approximately 98% of eligible hospitals nationwide are participating. Those not participating have no data posted on the website and are not included in the rankings.
1 This currently includes data from the 7/1/06 to
6/30/07. To obtain a copy of the database, go to http://www.hospitalcompare.hhs.gov/Hospital/Static/Resources-
Links.asp?dest=NAV|Home|Resources|RelatedWebsites#TabTop
click on “Download Database”.
| 2 These measures are: |
- Heart Attack (Acute Myocardial Infarction or AMI)
- Aspirin at arrival
- Aspirin at discharge
- ACE Inhibitor for Left Ventricular Systolic Dysfunction
- Beta Blocker at arrival
- Beta Blocker at discharge
- Fibrinolytic medication within 30 minutes of arrival
- PCI within 90 minutes of arrival
- Smoking cessation advice/counseling
- Heart Failure
- Assessment of Left Ventricular Function
- ACE Inhibitor for Left Ventricular Systolic Dysfunction
- Discharge instructions
- Smoking cessation advice/counseling
- Pneumonia
- Oxygenation Assessment
- Initial Antibiotic Timing
- Appropriate Initial Antibiotic
- Pneumococcal Vaccination
- Influenza vaccination
- Blood culture prior to first dose of antibiotics
- Smoking cessation advice/counseling
- Surgical Infection Prevention
- Preventative antibiotics one hour before incision
- Preventative antibiotics stopped within 24 hours after surgery
- Appropriate preventative antibiotics
- Treatment to prevent blood clots within 24 hours before or after selected surgeries
- Doctors ordered treatments to prevent blood clots (venous thromboembolism) for certain types of surgeries
|
| Click here for a description of the quality measures for hospitals. |
Hospital Compare displays data provided by acute care (prospective payment hospitals – PPS) and critical access hospitals (CAHs). Long-term acute and acute rehabilitation hospitals are not eligible to report data.
CAHs that have also agreed to participate in the HQA, do not receive any financial incentive to report their data. These hospitals can elect to submit data for any or all of the measures, and can elect to withhold the data from display on Hospital Compare.
| Data limitations: |
- While a great deal of time and study has been devoted developing a clinically valid and reliable public hospital performance reporting system, the system is still relatively new. The CMS rollout of the Hospital Compare web site was in April 2005. Other national public reporting efforts – within and beyond health care – have experienced a period of instability wherein opportunities for improving data quality were recognized and acted upon.
- The measures used to compute rankings were drawn from four clinical topic areas – heart attack, heart failure, pneumonia, and surgical infection prevention – even within these areas, they reflect only a portion of the patient care experience. Patient satisfaction and quality of care for other conditions are not reported and are not incorporated into the rankings.
- Data submission to Hospital Compare is subject to auditing procedures and edit checks, which assess whether data submitted is consistent with defined parameters for sample size, outliers, and missing data. The data are subject to validation to verify that the data abstracted and reported by the hospitals is consistent and reproducible. The limitations of this process are such that for each quarter of data submitted, a random sample of five medical records across all topics are selected for each hospital, regardless of the number of cases submitted.
- Hospital Compare displays data from discharges that occurred between 9 and 18 months ago. More recent changes in the reliability of hospital performance are not reflected in the rankings.
- Because of differences in hospital size, the types of patients they care for, and sampling strategies, the numbers of patients used to compute reported performance rates varies by hospital, clinical topic, and measure. This impacts the precision with which performance can be ranked.
|
| |
| Analytic considerations: |
- Hospital performance measures reflect processes of care supported by clinical science rather than patient outcomes. For these types of measures, risk adjustment is not considered necessary. 100% performance is thought to be achievable for all measures used in the rankings.
- Our ranking approach attempts to emphasize and anticipate a hospital's ability to improve performance across their system rather than only within focused areas.
- The extent to which each indicator contributes to a hospital’s overall ranking is proportional to the number of cases reported for that measure.
- While percentile scores, by definition, always range from 0-100, reported performance on a given indicator may cluster very tightly.
- A single composite performance score or ranking can mask either strong or weak performance in specific indicators.
|
|
