2008 Health Accountability Health Care Report

So here's why I haven't been posting too much lately...

I've been working on two major projects and this is one of them. I finally got the Health Accountability Report Card out today, it covers all hospitals and HMOs in NY, NJ, CT, VT and RI.

It's huge, but my other project - due in December - is even more exciting, stay tuned.

The report card started off as a printed HMO report in 1999, I first put it online in 2002 I think.

I've been slowly adding more and more to it, three years ago I added hospitals and last year I included NJ. Here's a brief, OK, not brief summary of what's in it.

The team that puts this together is large, all in all about 25 people contributed their expertise to the report. The short story is that it's a public data gumbo, it collects up about 20 data sources from which we extract roughly 250 measures. For each measure, if we can find a standard comparator we run a variance analysis to find out if the HMO or hospital deviates significantly from the state average. We then simply paste a red, yellow or green circle onto the data to give you a really quick idea of just how well the HMO or hospital you're looking at is doing.

On the HMO side you can review quality of care data from NCQA HEDIS scores. This covers stuff like getting the correct medicines, asthma and diabetes care, vaccinations and that sort of thing. Also for HMOs we have a customer satisfaction survey results from CAHPS surveys. We then scoop up retail premium rates for standardised plans.

Unfortunately states differ slightly in how they measure HMOs, so we can't make a national comparison across the board, so in this report you're seeing either a comparison to a state average or a regional average.

On the hospital side it gets way more complicated. HHS puts out the Hospital Compare data for download, so we grab that and crunch some additional measures to derive composite topical scores from the appropriateness of care measures. This year we also got to add patient satisfaction score and Medicare reimbursement rates.

The real fun part was requesting discharge data from five states. I actually requested data from every state that borders New York, plus Canada, and I went with the four I got back. That data is a full set of every single hospital discharge in each state, deidentified. In it you can see primary diagnoses, age, gender, enough to make some serious measurements. So, we have the AHRQ Inpatient Quality Indicators as well as new this year some Patient Safety Indicators, recently endorsed by the National Quality Forum. These include mortality rates and adverse events.

I did have to lose Caesarean section rates, but I'll keep hunting for an NQF endorsed measure for this.

In addition, we calculate number of cases, average length of stay and average hospital charges. Besides that there's the now-recurring Leapfrog patient safety measures. Cardiac surgery mortality came out this year for the most part, but it'll be back next year.

Here's a full list of all the measures.

Go check out the report and please, please, please send me your feedback.

Now I'm going to sleep.‎