Statement from Richard Schirmer, vice president for health care policy analysis, Texas Hospital Association
As priorities in health care shift toward quality and patient safety, Texas hospitals are focused on improving patient outcomes. We have only begun to see the effects their embrace of new efforts will have on patients.
Because Texas did not begin collecting “present on admission” data until January 2011, the Dallas Morning News analysis does not identify conditions that could have been pre-existing complications. The Dallas Morning News acknowledged that the software tool they utilized when compiling the report “… imputes, or infers, whether the condition was probably present.” The absence of POA indicators may
produce inaccurate rates and reveals only part of a patient’s care history.
Had the Dallas Morning News used more recent data, it would have shown significant advancements in patient quality as hospitals embrace processes to address a number of quality based payment reforms, such as Hospital Value-Based Purchasing, readmissions reduction programs, and projects to prevent Hospital-Acquired Conditions. For example, over the last two years, the Texas Center for Quality and
Patient Safety worked with more than 60 hospitals and experienced a 33 percent reduction in central line-associated bloodstream infections through collaborative programs that focus on reducing all-cause harm.
There is also concern for aspects of the composite scoring that could be confusing to patients, which included categories for hospitals that fared “Better,” “Average,” or “Worse” in comparison to other statewide hospitals. For hospitals that received a “Worse” designation, this does not necessarily mean they performed “Worse” on all indicators. In fact, some hospitals received that designation and only scored “Worse” on 1-2 indicators.
THA welcomes the Dallas Morning News’ attempt to provide information on hospitals’ efforts to increase patients’ quality of care. Every year, more national organizations emerge with their own performance rankings through publicly available patient information. Consumers should continue to evaluate these rankings with their physician when discussing which hospital can provide the best service
to meet the patient’s health care needs. THA is committed to supporting initiatives that improve patient experience and care in the hospital setting.
It is misleading to patients for public assessments of quality and safety to be based on anything other than a comprehensive approach. Hospitals have an obligation to be constantly monitoring, analyzing, and improving the quality and safety of the care they deliver. UT Southwestern, like other hospitals, reviews data from multiple sources and takes into account established measures of patient safety, including mortality and complexity of illness. To use a single measure does not lead to greater clarity. UT Southwestern is proud of our commitment to ongoing quality to improvement – and to our record of delivering safe, high-quality, compassionate care to our patients.
Emailed statement by Dr. Mark Lester, clinical leader, Texas Health Resources Southeast Zone
Texas Health Resources fully supports transparency in quality and patient safety reporting. We welcome the opportunity to view our performance from many different perspectives. We use all of these viewpoints in our unceasing work to improve our care.
Patient Safety Indicators have found wide use as hospitals work to improve their quality and patient safety. CMS recognizes the limits inherent in these indicators, and therefore continues to refine the ways in which it views them. Despite their limits, patient safety indicators provide another recognized way to look at the complex activities within a hospital.
These reported indicators provide additional information to our community, along with many other sources of data. These indicator data are retrospective. More current data show us that we continue improvement in these measures. Nevertheless, much work lies ahead.
Patient Safety Indicators, together with other data, inform our work together in Texas Health Resources and with colleagues locally and nationally. We work with Dallas Fort Worth Hospital Council and its members, and share practices among our hospitals. We have implemented a Safe Surgery Checklist in our wholly owned hospitals, and are members of the Joint Commission’s Center for Transforming Healthcare. We are members of a Healthcare Engagement Network, Premier’s Partnership for Patients.
In all of these ways, we continue the hard work of continually improving our care and performance. We welcome data and feedback which assist us in this work, and in improving the health of the people in the communities we serve.
I wanted to update you on a story that the Dallas Morning Newsis preparing to run in one of its weekend editions. This story essentially uses patient safety indicator codes (PSIs) to attribute safety ratings to local hospitals. I wanted to make sure you understood that, regardless of the Morning News’s take on the data, there is some good news out of this report.
Patient safety indicators are a set of indicators providing information on potential in-hospital complications and adverse events following surgeries, procedures and childbirth. As they are administrative codes and miss vital information, many local health care experts outside of Parkland or UTSW feel it is inappropriate to use them in indicating safety rankings that compare various hospitals. There are also a couple of serious flaws in the way the Morning News calculated the PSI-based rankings.
First, the data is from 2010, which does not include the most recent available data and reflects a time period prior to putting our corrective action plan in place. So any suggestion that this story, using data that is two years old, will be reflective of where Parkland is today is simply inaccurate. In addition, PSIs were not intended to support comparative rankings for hospitals in the media. So, as purely administrative codes, they record many ailments a patient brings with them to the hospital as if they were caused atParkland. In short, the data fails to take into account what we call POAs (present on admission). While that is a disadvantage for every hospital, it is more so for Parkland as we have a unique patient population that suffers from numerous co-morbidities and often lacks access to primary care. So theMorning News is essentially doing hospital comparisons as if our patient population looked the same as any of the private hospitals in the region, and that is simply not the case.
But let’s look past the negative and accentuate the positive. This is the second year the Morning News has done hospital rankings based on its own analysis of PSIs. And, while these indicators are not adequate for use in a comparison between hospitals, they do give some insight into safety at our facility. With that in mind, it is encouraging that Parklandis steadily improving its PSI scores. When looking at PSIs, the lower the score the better. The first year the study was done, the Morning News reported we had a composite score of 1.07786. This weekend, the Morning News will report that for the 2010 data, we had a composite score of 0.76868. And, since the coming article got us wondering, we asked Jackie Sullivan, VP for Performance Improvement, to run the numbers for the most recent data we had internally. Running data January through March 2012, Jackie came up with a composite score of 0.68. That is great progress and even it does not reflect much of the accomplishments our dedicated staff has achieved under the corrective action plan.
In short, don’t worry about the comparisons and the media coverage that is really intended to sell newspaper advertising more than to reflect what is going on here. Rather, let’s focus on the great work that is being done to improve Parklandand make it a safe environment where all patients receive quality care. We still have a lot of work to do, but our system is clearly on the right path.