1. How do Consumer Reports' hospital Ratings differ from information available elsewhere?
Our Ratings come from scientifically based data on patient experience and outcomes gathered from public sources. Some of that information is available elsewhere. For example, you can see the federal government's version of patient experience and readmissions data on its Hospital Compare website. Similarly, a number of states report data on hospital-acquired infections. But ConsumerReports.org collects all the information and summarizes it in an easy-to-interpret format, using our familiar ratings symbols.
2. How can the hospital Ratings help me get better care?
They can help you compare hospitals in your area so you can choose the one that's best for you. Even if you don't have a choice of hospitals, our Ratings can alert you to particular concerns so you can take steps to prevent problems no matter which hospital you go to. For example, if a hospital scores low in communicating with patients about what to do when they're discharged, you should ask about discharge planning at the hospital you chose and make sure you know what to do when you leave.
3. How can you compare hospitals if patients in some are sicker than those in others?
When possible, our Ratings have been statistically adjusted to minimize differences among hospitals due to the types of patients they serve. For example, scores for bloodstream infections and surgical-site infections were adjusted based on where the patients were treated (which intensive-care unit, for example) and type of surgery. Scores related to the chance of readmissions, patient experience, and avoiding adverse events in surgery patients were adjusted based on the health status of patients.
4. Why can't I find my hospital in your Ratings?
Our Ratings have information on over 4,000 hospitals. If a hospital you're looking for isn't listed, it could be for several reasons. Some report data under a parent company, so they might not show up as individual facilities. Others may have changed names during the reporting period. And some hospitals, mostly smaller ones, might not have sufficient data for any of our Ratings categories.
5. Why doesn't my hospital have a safety score?
For a hospital to have a safety score, it must have valid data for all measures that we include in calculating the score: patient experience, readmissions, scanning, infections, and mortality. The data we use come from the Center for Medicare and Medicaid Services. If CMS does not report data for one or more of those measures, it is because the hospital either did not have sufficient data or because there were discrepancies in data collection.
6. What about patient privacy?
Our Ratings are comprised of data available to the public from several sources. But none of the information can be used to identify specific individuals.
7. What are some of the limitations of the data used in the Ratings?
Unlike most other Consumer Reports Ratings, we don't collect the data in our hospital Ratings ourselves, so there may be issues with quality we can't control. In some cases the information comes from billing and other administrative data submitted by hospitals to Medicare, and isn't designed to measure patient outcomes. However, we review the methods of data collection, validation, and analysis used by each data provider, and use only the most relevant and best data that's available.
8. What information is included in the Ratings?
Our Ratings include information on the following.
A. Safety score. This is a summary of five categories that relate to hospital safety: avoiding infections, avoiding readmissions, communicating about medications and discharge, appropriate use of chest and abdominal scanning, and avoiding mortality (medical and surgical). The score is expressed on 100-point scale. A hospital would score a 100 if it earned the highest possible score in all measures and would score 1 if it earned the lowest scores in all measures. Each of the five domains (infections, readmissions, mortality, communication, scanning) are weighted equally. Each are worth 20 points out 100.
- Hospital acquired infections. About 650,000 patients each year develop a hospital acquired infection. So, on any given day, about one of every 25 hospitalized patients are infected while in the hospital. The most common types of infections that patients get in the hospital are pneumonia and surgical site infections. About 12 percent of patients die in the hospital from the infections that they get while hospitalized.
- Unnecessary readmissions. Theseare tied to patient safety in several important ways. First, any hospital admission has inherent risks, so a second admission exposes the patient to additional risk. Second, readmissions can be caused by something that went wrong during the initial discharge. Finally, readmissions can reflect errors in the initial admission.
- Mortality. Some 440,000 hospital patients a year die at least in part because of t preventable medical errors. Our Safety Score contains two measures of mortality: –mortality in patients with heart failure, heart attack, or pneumonia; and surgery patients.
- Communication about new medication. This is included because lack of communication about drugs can lead to their misuse and other errors. And lack of communication about discharge instructions can lead to errors in post-discharge care.
- Appropriate use of scanning. This is included because double scans of the chest and abdomen are rarely necessary and unnecessarily expose patients to additional radiation.
B. Patient outcomes. Our Ratings of patient outcomes focus on five measures.
- Central-line associated blood stream infections (CLABSIs). Central lines are catheters, or tubes, used to deliver fluids, medication, and nutrition to patients. Bloodstream infections are caused by a mishandling of those central lines and are the most deadly kind of hospital-acquired infection. Our data are based on CLABSIs that affect patients while they're in a hospital's intensive-care unit (ICUs). Most of our data come from CMS through Hospital Compare, and most hospitals nationally report, but we supplement with state data for hospitals that are not included in CMS.
- Surgical-site infections (SSIs). These are surgery-related infections that occur on or close to the skin surface, deeper in the body, or in any part of the body that is opened and manipulated during surgery. They are counted in our Ratings if they occur within 30 days of most surgical procedures or, in the case of implants, within a year. About 25 percent of the states in the U.S. report data on surgical-site infections that occur after one or more of the following procedures: caesarean section, colon surgery, coronary bypass surgery, gallbladder surgery, hernia repair, hip or knee replacement, hysterectomy, and spinal fusion. The data come from states that require hospitals to report that data, and that report that information in a way that we can use.
- Readmissions. This shows the chance that a patient will have to be readmitted to a hospital within 30 days of his or her initial discharge. The information is collected by the Centers for Medicare and Medicaid Services (CMS). Patients can be readmitted to the same or different facility, and for the same or different condition.
- Avoiding mortality – medical. This Rating is based on mortality rates for Medicare patients who died within 30 days of admission for patients who had been hospitalized for heart failure, heart attack, or pneumonia.
- Avoiding mortality – surgical. This Ratings is based on data measure how often surgical patients died after developing a complication that should have been identified and quickly treated. Complications include pneumonia, a blood clot in a vein deep in the body (deep vein thrombosis) or sudden blockage in a lung artery (pulmonary embolus), potentially fatal bloodstream infection (sepsis), sudden kidney failure, shock/cardiac arrest, or gastrointestinal bleeding acute ulcer.
- Avoiding adverse events in surgical patients. This Rating is based on the percentage of patients undergoing scheduled surgery who died in the hospital or stayed longer than expected for their procedure. Research shows those measures are correlated with complications, and some hospitals themselves use this approach to monitor quality. To develop the Ratings, we worked with MPA, a health care consulting firm with expertise in analyzing billing claims and clinical records data and in helping hospitals use the information to improve patient safety. In addition to an overall surgery Rating summarizing results for 27 different kinds of surgeries, we also provide surgery Ratings for five specific types of surgeries: back surgery, hip and knee replacement, angioplasty, and carotid artery surgery. The Ratings are based on billing data submitted by hospitals to the Centers for Medicare and Medicaid Services.
C. Patient experience. This information comes from a survey of millions of patients regarding recent hospital stays. The survey, the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, was developed by AHRQ.
We rate overall patient experience based on the average responses to two survey questions: The percentage of respondents who said they would "definitely" recommend the hospital; and the percentage of respondents who gave the hospital an overall rating of 9 or 10 on a scale of 0 to 10.
In addition, we rate specific measures of patient experience based on answers to questions about:
- Communication about discharge and medications
- Doctor-patient and nurse-patient communication
- Pain control
- Receiving help when needed
- Keeping hospital rooms quiet at night and keeping rooms and bathroom clean.
D. Hospital practices. This includes two separate measures: the use of electronic health records, and the appropriate of use of scanning.
- Use of electronic health records. This information comes from a survey of hospitals conducted by the American Hospital Association. Our Ratings are based on the 28 items on the survey that describe the extent to which the hospital has a computerized system for a variety of uses by hospital staff, including documenting physicans' and nurses' notes, viewing lab reports and diagnostic test reports, viewing radiology images, entering prescriptions for drugs and tests, and important alerts and reminders.
- Appropriate use of scanning. This information comes from billing data submitted to CMS that calculates the percent of computed tomography (CT) scans of the abdomen and thorax that are performed twice [once with and once without a dye (contrast)]. It is well established that such double scans are rarely necessary; the evidence supports scanning with, or without contrast, but not both. Unnecessary double scans expose patients to excess radiation, and also to the potential adverse effects of the dye.
For more details, download our Hospital Ratings Technical Report.