Tuesday, December 1, 2009

So much for consumer-driven health care!

Today, I was curious about how a hospital in New York performs compared to the national average, so I went to Center for Medicare and Medicaid Services (CMS) website, which hosts resources on hospital quality initiatives and, of my interest, Hospital Compare. According to the description on the website...

"Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide recommended care to their patients. On this site, the consumer can see the recommended care that an adult should get if being treated for a heart attack, heart failure, or pneumonia or having surgery...The HQA effort is intended to make it easier for the consumer to make informed healthcare decisions, and to support efforts to improve quality in U.S. hospitals. The major vehicle for achieving this goal is the Hospital Compare website."

Reading this paragraph starts to turn me off a little bit, mostly because the part omitted (in the ...) contains terms like "30-Day Risk Adjusted Death and Readmission measures." What does that even mean? Adjusted how and for what? How would a layperson fully understand what that means?

But OK, sounds like a good initiative. Let's give the Hospital Compare website a try.

Well, as of 12/1/09, the website cannot be found! The only other somewhat acceptable alternative is to download data for past quarters to view on your computer. I went ahead and downloaded the zip file for the latest preceding quarter. The file consisted of a complicated PDF file giving legends to possibly the many abbreviations in the database which requires Microsoft Access to view. I do not have Microsoft Access but to give you a glimpse of how complicated this dataset may be, let's take a look at part of the legends listed in the PDF file...

"There are fourteen tables in the Hospital Compare database.
1) dbo_vwHQI_FTNT
2) dbo_vwHQI_HOSP
12) dbo_vwHQI_HOSP_MPV_MSR

To be fair, at the beginning of this PDF legend file, the disclaimer reads...

"This functionality is primarily used by health policy researchers and the media... For information about hospitals in a particular geographical area, you should use the Hospital Compare tool instead of downloading the data."

I think it's fair to say that it is out of the question that the underserved patient population will be able to navigate this set of data, considering the fact that they probably don't even have a computer. But consider a college-educated, middle-income family - they will probably have a computer, and access to the internet, and maybe acrobat reader, but will they have Microsoft Access? I don't use it enough to own it, even as an economics major in college. But don't even mind that, how can we expect a college-educated, middle-income person to navigate this monstrosity of a dataset? I'm hoping the Hospital Compare tool/website is easier to navigate and more readily available.

I think this goes to show that free flow of information in health care has a long way to go before the market can become somewhat efficient and patients can make truly informed decisions, because even an effort, like this one, made specifically to help inform consumers, so far isn't informing me anything, because I don't get to see the data. All it's doing is confusing me with abbreviations and Greek terms that are poorly-defined.

The website is set to for maintenance on December 17 - will check back at that time, but until then, I'm disappointed.

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