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Quality at Rush
Making Informed Decisions

Francis Fullam, Senior director, patient relations and marketing research at Rush University Medical Center in Chicago, Illinois.

By Francis Fullam
Senior director, patient relations and marketing research

There has never before been so much information available about the quality of different hospitals' patient care. Over the last few decades more and more information has been made public by hospitals, state and federal agencies responsible for health care, insurance companies, employers, magazines, Web sites and commercial firms specializing in providing health information.

Not all hospitals provide the same level of care or have the same amount of experience with a particular condition or disease, so it is important for you to find the right match for your needs. The wealth of public information available today can help you make that decision, but it is important to know where the information is from, what it means and how you can use it.

Here are a few guiding principles to help you make informed decisions about your own health care or the care of loved ones.

1. Do not rely on just one source of information.

We are in a period of rapid change and development of thinking among health care researchers about what quality means and how to measure it, so not everyone agrees at this point on the best single way to provide information to consumers and what that information should be. That is why using multiple sources will be your best guide.

Like many of the important decisions you make in your life, you want to check on several sources of information to make your decision. If several sources seem to agree and tell you the same story, there is probably a greater consensus among physicians, nurses and health care researchers that the information makes sense and is helpful.

Learn more about some of the different sources of information on hospitals' quality of care.

2. Find sources of information best suited to your needs.

The challenge for you as a consumer of health care is that, while there is more and better information available online at no charge, some is not created specifically for consumers.

Some sources try to make their information easier for consumers to use than others. For example, U.S.News & World Report has developed a system to help consumers pick hospitals.

Other sources of information are also public and online, but they are meant for physicians and health care researchers to use. For instance, the Dartmouth Atlas of Health Care is a widely used source of information for those involved in research about health care, but the project was not created to help consumers pick individual hospitals.

Health care insurance companies sometimes provide their members with information to help pick a hospital or physician in their system. In many instances, the aim of their online tools is to provide a listing of all the physicians who participate in the insurance company's coverage in areas near the patient and by medical and surgical specialties. Most insurance companies do not offer any information to members on the quality of care provided by hospitals or physicians.

3. "Risk-adjusted" information will help you make more meaningful comparisons between hospitals.

Consumers should keep in mind that hospitals specialize in different types of patients. Most hospitals are set up to handle routine illnesses and conditions. Others hospitals  such as academic medical centers  specialize in more unusual or complicated conditions and harder-to-treat illnesses. Because of this difference, quality of care comparisons can be misleading if you don't know what to look for.

Say Hospital A specializes in treating patients with the most serious, complicated and unusual conditions. Hospital B specializes in treating patients with more common conditions. In fact, doctors at Hospital B often refer patients to Hospital A when a higher level of care is required.

Both hospitals A and B have excellent quality of care records. However, Hospital B's overall mortality rate is much lower than Hospital A's overall mortality rate. You would expect this because Hospital A treats the most critically ill patients.

So how can you make a meaningful comparison between these two hospitals' quality of care? Use sources of information that report on hospitals with "risk-adjusted" outcomes data. Risk adjustment accounts for expected mortality, complications and other outcomes of care based on the patient make-up of each hospital in a report. This allows you to see if a hospital's care is better than expected and provides a meaningful comparison among different hospitals.

There is a consensus among doctors, nurses and medical researchers that making risk adjustments to data is a fair and appropriate way to look at quality information and provides more meaningful information to consumers. Throughout this site, we have identified which sources use risk-adjusted outcomes data.

Learn more about organizations that have published information online about the quality of hospital care in Internet Resources.

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