1. How do Consumer Reports' hospital Ratings differ from information available elsewhere?
Our Ratings come from scientifically based data on patient experience and outcomes as well as certain hospital practices 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. And several states report data on cesarean sections (C-sections). 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 are based on data that have been statistically adjusted to minimize differences among hospitals due to the types of patients they serve. For example, data for bloodstream infections and catheter-associated urinary tract infection (CAUTI) were adjusted based on where the patients were treated (which intensive-care unit, for example). 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 organization, 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 is weighted equally. Each is worth 20 points out of 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 is 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. These are 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 preventable medical errors. Our safety score contains two measures of mortality: mortality in patients with heart failure, heart attack, stroke, pneumonia, or COPD; and mortality in surgery patients.
- Communication about new medication and discharge instructions. 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 several 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). Our data come from CMS through Hospital Compare.
- 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 the surgical procedure. All of the states in the U.S. report data on surgical-site infections that occur after one or both of the following procedures: colon surgery and abdominal hysterectomy.
- Catheter-associated urinary tract infections (CAUTIs). These are urinary tract infections that are associated with the patient having an indwelling urinary catheter (tube inside the body inserted in the bladder) and are diagnosed based on the patients' symptoms, as well as urinary tract infections without symptoms that have caused a bloodstream infection, within 48 hours of insertion of the catheter.
- Methicillin-resistant Staphylococcus aureus (MRSA) infections. MRSA is a type of staph bacteria that is resistant to many antibiotics. In a healthcare setting, such as a hospital or nursing home, MRSA can cause severe problems such as bloodstream infections, pneumonia, and surgical site infections. Hospitals must report all MRSA bloodstream infections that start in the hospital and that are identified by lab tests.
- Clostridium difficile (C. diff) infections. C. difficile is a common cause of antibiotic-associated diarrhea and, in rare cases, can causes sepsis and death. Antibiotic overprescribing, improper room and equipment cleaning, and poor hand washing in hospitals are the leading causes of infection. Hospitals must report all C. difficile infections that start in the hospital, with the exception of hospital locations with mainly infants.
- 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, stroke, pneumonia, or chronic obstructive pulmonary disease (COPD).
- Avoiding mortality – surgical. This Rating is based on data measuring 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: C-sections and the appropriate of use of scanning.
- 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.
- Avoiding C-sections. This information comes from state-based billing data that calculates the percent of low-risk deliveries—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned—that occur by cesarean section. The Ratings include all mothers, not just first-time mothers. The data the Ratings are based on do not include information on factors that may increase the risk for a C-section, such as heart problems in the mother or fetus, pregnancy-related high blood pressure, diabetes, obesity, or any other chronic disease. C-section rates in the United States are considered too high; recently two major health organizations—the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM)—teamed to publish groundbreaking new practice guidelines aimed at preventing unnecessary cesarean births.
E. Heart Surgery. We rate hospitals for heart surgery based on two common procedures: heart bypass surgery and aortic heart valve replacement.
- Heart Bypass Surgery. A hospital’s rating in this measure reflects its performance in isolated heart bypass operations, meaning that the patient is having only that surgery, not a combination procedure. A hospital’s overall score is a composite of four separate measures. Survival: Percentage of patients who are discharged alive and survive at least 30 days after having the surgery. Complications: Percentage of patients who avoid all of the most serious complications, including needing a second operation, developing an infection deep in the chest, suffering a stroke, requiring prolonged ventilation, and experiencing kidney failure. Best surgical technique: Percentage of patients who receive at least one bypass from an internal mammary artery, located under the breastbone, a technique that improves long-term survival. Right drugs: Percentage of patients who receive these medications: beta-blockers before and after surgery to control blood pressure and prevent abnormal heart rhythm; aspirin, to prevent blood clots; and a drug after surgery to lower LDL (bad) cholesterol.
- Aortic Heart Valve Replacement. A hospital’s score in this measure reflects its performance in surgical aortic valve replacement. A hospital’s overall score is a composite of two separate measures. Survival: Percentage of patients who are discharged alive and survive at least 30 days after having the surgery. Complications: Percentage of patients who avoid all of the most serious complications of the operation, which are the same as for bypass surgery. For both procedures, the data were adjusted based on the health of patients, to avoid penalizing hospitals that treat sicker patients.
For more details, download our Hospital Ratings Technical Report.