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What is the source of the data used to calculate these quality indicators?

The data collected by the CBGH comes from information that hospitals record primarily for billing purposes. This type of record, referred to as "administrative data,"* consists of diagnoses and procedures along with information about the patient's age, gender, accompanying medical conditions and discharge status. While administrative data cannot be used as a conclusive source of information on health care quality, it can provide important insights into the quality of care being delivered by hospitals. The CBGH data reflect only the care provided to patients who were admitted to the hospital in calendar year 20012. Patient and physician names are removed to preserve confidentiality. However, when only five or fewer patients in a facility had a specific procedure, no data are included in the report as a further step to protect confidential patient information. If a hospital had fewer than 30 patients with a specific diagnosis or procedure, no statistical analyses were performed because the results would have been less reliable.

Hospital comments regarding their performance on these indicators are included in the report and are available on the CBGH's Web site.
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What do the hospital-specific comparative reports mean?

For many years, the federal government has supported research into what factors affect quality of health care services, including care delivered in hospitals. The federal Agency for Healthcare Research and Quality (AHRQ, http://www.ahrq.gov) has conducted extensive research; in July 2002, AHRQ released software that analyzes administrative data and assesses performance on certain indicators that studies have shown are related to quality. AHRQ has identified four categories of quality indicators which appear to have relationships to the outcomes of care provided within hospitals: mortality for specific procedures, mortality for specific conditions, procedure utilization and procedure volume.

Research has confirmed that the rate of patient deaths for certain procedures and conditions may be associated with quality of care. While research can predict an expected range of patient deaths for a given procedure or condition, mortality rates above or below the expected range may have quality implications. For some procedures, research has shown that overuse, under use and misuse (utilization) may affect patient outcomes. For certain procedures, the number of times (volume) the procedure is performed in a hospital has been linked to the patient's outcome.

AHRQ developed the AHRQ Quality Indicators (QIs) with the intention that they would be used for researching national, state-wide, regional and hospital-specific performance. They were not developed with the intention that they be used for publicly released hospital quality reports. However, experts and scholars across the nation have determined that the AHRQ Quality Indicators (QIs) represent the current state-of-the-art in assessing quality of care using administrative data. As noted by the Centers for Medicare and Medicaid services, these indicators must be used "cautiously" for public reporting.

This report is based on administrative data. Recording administrative data - or coding - varies among hospitals. Individual judgment often is required. Codes do not provide specific details about a patient's condition at the time of admission, nor capture everything that occurs during the hospital stay. Especially when reviewing mortality rates, remember that medicine is not an exact science and death may occur even when all standards of care are followed. These reports provide some information about hospital performance, but consider the limitations of the data in your decision-making process. The Alliance for Quality Health Care (AQHC) recommends that consumers discuss these data with their physician.
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Are the comparisons between hospitals appropriate?

Because of their expertise, some hospitals treat more high-risk patients. And, some patients arrive at hospitals sicker than others. That makes comparing hospital mortality and utilization rates for patients with the same condition but different health status difficult. To compensate for this fact, the AQHC has "risk adjusted" each hospital's data to reflect the score the hospital would have had if it had provided services to the average mix of sick, complicated patients. The risk and severity adjustments allow researchers and statisticians to separate the effects the patient and his degree of illness have from the hospital stay.
AQHC used a risk adjustment methodology developed by 3M Corporation (http://www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml) and AHRQ (http://www.qualityindicators.ahrq.gov/data/hcup/qinext.htm). Detailed information about the process used to organize and adjust the data for study purposes can be obtained on the AHRQ website.
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What is the best way to use these reports?

1. Familiarize yourself with the 25 indicators provided in this report.
2. Decide which quality indicator is most relevant to you, and review that chart. Look to see if the hospital you are interested in is listed. If not, it means that the hospital did not have any cases for that indicator. You might wish to look at another quality indicator for that hospital's performance.
3. Hospitals are arranged alphabetically by region. You may wish to compare the performance of hospitals in your area or those that are covered by your health insurance plan. Each chart provides the results for specific hospitals as well as a statewide average. Note that each chart provides guidance on how to interpret the findings.
4. View the hospital's comments, if the facility provided them. It is especially important to view the hospital's comments if performance is lower than expected. Click on the hospital's bar in the chart to access specific comments. Go to the Table With Detailed Information for additional information on a hospital's performance.
5. A table of hospital characteristics provides the number of licensed beds for each hospital. If the hospital is a teaching facility, it is noted. It is sometimes appropriate to compare the performance of similar sizes and types of hospitals.
6. Do not try to compare the results of these reports with other reports you may find on the World Wide Web or elsewhere. The results are sure to be different, unless the exact same methodology is used. It is more appropriate to track hospital performance over several years using the same data source.
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Definitions of terms used in the tables of data

• Confidence Interval - A range that depicts the likelihood that a hospital's performance could be influenced by random chance. The larger the range is, the greater the possibility that the hospital's performance may be influenced by random chance. The range will vary for each hospital depending upon the number of cases or deaths for that condition or for that procedure, and the standard error rate for that year.
  
• Expected Rate - The hospital's observed rate divided by the hospital's risk-adjusted rate (ratio), then multiplied by the state average risk-adjusted rate. This adjustment is done to reflect an expectation of hospital performance if that hospital had performed at the level of the state average.
  
• Observed Rate (Mortality Indicators) - The number of patient deaths for a specific condition or procedure divided by the total number of patients admitted for the condition being treated. Consumers can consider observed rates as crude measures of performance. When compared to the risk-adjusted rates, consumers can see the impact of patient case mix on that hospital's performance.
  
• Observed Rate (Utilization Indicators) - The number of patient cases for a specific procedure divided by the total number of patients admitted for the condition being treated. Consumers can consider observed rates as a crude measure of performance. When compared to the risk-adjusted rates, consumers can see the impact of patient case mix on that hospital's performance.
  
• Risk-adjusted rate - Adjustments made to the AQHC data based on national patient demographics such as age, gender and medical codes (diagnostic groups) for a specific condition or procedure. The risk-adjusted rate is the best estimate of what the hospital's rates would have been if the hospital had a mix of patients identical to a national-average patient mix for that year.
  
  Hospitals with significantly lower risk-adjusted rates than observed rates may have a more complex patient case mix. Hospitals with significantly higher risk-adjusted rates than observed rates may have a less complex patient case mix.
  
  Risk Adjustment software developed by 3M. (http://www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml)
  
  * Data Source: Statewide Planning and Research Cooperative System
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