California Health Care Quality Dips Slightly in HHS Report Card

The overall quality of health care in California dipped slightly last year, according to the federal government’s Agency for Healthcare Research and Quality.

The agency, part of HHS, released its fifth annual National Healthcare Quality Report last week that gives state-by-state comparisons as well as national trends. Using a complex system measuring preventive, acute and chronic care in hospitals, nursing homes and home health programs, the report’s State Snapshots section issues a numeric rating for overall care based on five clinical categories.

California’s score overall was 50 for 2007, a slight drop from 50.53 in 2006.

Compared to other states, California’s overall quality was judged “average,” the same as last year. Minnesota earned the highest ranking for overall care in 2007 with a score of 66.96. Louisiana was lowest with 18.97.

In the five clinical categories, California’s scores fell from last year in three areas — respiratory disease, heart disease and diabetes — and rose in two — cancer, and maternal and child health.

Nationally, the overall quality of health care improved a modest 1.5% over the past two years, according to the report. The average rate of annual improvement nationally between 1994 and 2005 was 2.3%.

Keep It in Context, Hospitals Say

Most health care providers welcome quality measurements and comparisons, but they urge patients and purchasers to use report cards in context.

“Comparisons and measurements are great tools,” said Debby Rogers, vice president of quality and emergency services for the California Hospital Association. “They can help both consumers and providers.”

“Having said that,” Rogers added, “There are a few things people should remember. There are so many report cards out there that you really need to make sure you understand what it is you’re looking at.”

“It’s my understanding that the data used for this report comes from 2003 to 2005, so it’s a little old. I think California hospitals have made changes over the past two or three years that may not be reflected in this report,” Rogers said.

Rogers, a registered nurse, also said most report cards and comparisons don’t take into account many of the subtleties involved in the delivery of health care.

“A lot of the care in hospitals is physician-driven,” Rogers said, “and that has to be part of the equation. For instance, the timing of antibiotics before surgery — they’re supposed to be given within an hour of cut time — can be used as a measure of quality. But that involves more than one variable — the physician has to give the order, the hospital staff has to carry it out and the timing of surgery has to be close enough to on time to make it all work right,” Rogers said.

Rogers mentioned two quality comparison efforts she endorses – and the Institute for Healthcare Improvement., a Web site designed and operated by three partners, includes ratings for clinical care, patient safety and patient experience for 216 hospitals in California. The partners are the California HealthCare Foundation, UC-San Francisco Institute for Health Policy Studies and California Hospitals Assessment and Reporting Taskforce (CHART).

About 150 California hospitals participate in the Massachusetts-based Institute of Healthcare Improvement’s quality improvement programs, according to Rogers.

Physicians Weigh In

The California Medical Association, representing the state’s physicians, issued a written statement giving its “broad view on quality measures.”

“Doctors are seeking ways to improve the practice of medicine and the quality of health care. Our concern is that many of the so-called quality measures we’ve seen, particularly those of the insurance industry, have been little more than cost-cutting efforts dressed up as quality metrics.”

“Cheap care should not be a substitute for quality care,” the statement concluded.

Room for Improvement

The AHRQ Snapshots distinguish care in four settings:

  • Home health care, where California’s rating improved slightly to “very strong”;
  • Ambulatory care, where California showed a small improvement to “average”;
  • Hospital care, for which the state’s rating fell from “strong” to “weak”; and
  • Nursing home care, with another fallen rating, this time from “average” to “weak.”

In clinical areas, California went from “strong” to “very strong” in cancer measures, and maternal and child health. Treatment of respiratory diseases fell from “strong” to “weak,” heart disease measures dropped from “average” to “weak” and diabetes measures dropped slightly from “strong” to “average.”

“I think overall, in the settings and the clinical sections, we came out about average in this report card,” Rogers said.

“But when you drill down into specific measures, there’s definitely room for improvement,” Rogers added.

More Report Cards Coming

A few years ago, the idea of quality comparisons in health care was relatively new. If a patient or insurer wanted to compare a physician or hospital to other physicians and hospitals, data were scarce, hard to come by and rarely presented in digestible, useful formats.

Now, roughly 15 years after the comparison campaign picked up steam, dozens of user friendly yardsticks are available … with more on the way.

This week, doctors and insurers unveiled plans for a standardized, national system to rate physicians. After years of resistance and contention, the agreement between large insurers, physician groups and employers is considered a major step in the campaign for quality comparison.

Two key physicians groups — the American Medical Association and the American College of Surgeons — are part of the agreement, along with America’s Health Insurance Plans, a national trade association representing almost 1,300 insurers providing coverage for some 200 million Americans. Several of the country’s largest insurers — including UnitedHealth, Aetna and Cigna — are also involved. Consumer and labor groups, including AARP and AFL-CIO, lined up to support the plan.

Another new quality measurement — an extra grade on an existing report card — was announced last week. Medicare added patient satisfaction measures to its “Hospital Compare” Web site, giving people the opportunity to see how patients rated their hospitals in a variety of areas such as how well doctors and nurses communicated with them, how well their pain was controlled and how quiet it was outside their rooms at night.

Although data are collected through Medicare patients by CMS, the hospital report card is designed to be useful for all adults all over the country.

CHCF publishes California Healthline.

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