Evidence about poor hospital quality isn't enough to make change happen.

Even when there's substantial evidence that a particular hospital delivers an unacceptable level of care, that doesn't necessarily mean it will be improved or closed: Other forces often outweigh the medical evidence, including the jobs the hospital provides and the community it serves.

Is "buyer beware" enough? There are ways to dig up information about a hospital's performance, though I wonder how many people actually know about the available ratings services.

 

HealthGrades.com provides ratings based on Medicare data. Here's a snapshot of search results on Gastrointestinal Surgeries and Procedures in Syracuse, New York. Both Crouse and University Hospitals are rated 'Poor" for Inhospital Mortality. The site uses a statistical method to predict how many deaths would typically be expected, and compares that number to actual outcomes. (Though as you can see here, the evaluation is based on only 61 Medicare cases.)

The consumer recommendation site Angie's List has added reviews of physicians, hospitals, and other medical providers. But compiling detailed quality evaluations is really difficult: I wrote about one of the most impressive sites doing this, CalHospitalCompare.org, last year (see Comparing hospitals: Lots of evidence. But who is it helping?).

The United States doesn't have a federal agency providing hospital oversight, though I'm not convinced that would make much difference: States have various ways of compiling information already. None of this bodes well for evidence-based medicine: As explained in today's Evidence Gap column in the New York Times, University Hospital in Syracuse, New York "provides a stark example of how hard it can be — not just in New York, but around the nation — to close or shrink hospitals, even when there is evidence they are providing costly and below-average care.... In 2006, patients at University were three times as likely to develop infections stemming from hospitals as were patients at the average New York hospital. HealthGrades, a company that rates hospitals using data from Medicare, ranks University among the least safe hospitals in the United States — although the hospital’s executives strongly dispute that assertion.... [The United States] relies on a patchwork of state health departments and a nonprofit group called the Joint Commission that sets basic quality standards for the nation. Hospitals are rarely closed or hit with significant financial penalties for hurting patients. One of the reasons is that even troubled hospitals are major employers, and communities generally rally behind them when they face the threat of cuts, as Syracuse did for University."

Comments

[Lee Sherry]

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