Monday, 29 September 2014

Hospital Benchmarking: Top 20 Iasist and "US News Best Hospitals"

Benchmarking is a healthy exercise but to do it in the healthcare field it’s necessary to have solid databases, to know how to select consistent indicators and how to adjust and refine the data to the maximum so that the results are really comparable. In this post I want to discuss the essence of two famous private competitions, one Spanish and one North American.

Iasist, a company specializing in health information management has announced the 15th edition of the Top 20, a competition amongst Spanish hospitals which is voluntary, free and anonymous where only the results of the nominees and the winners are published. The purpose of this competition is in the winners’ institutional prestige.

What differentiating criteria does Iasist use?

Hospitals who enter the competition know they are competing with risk-adjusted data, quality (mortality, complications and readmissions), efficiency (lenght of stay risk-adjusted, productivity and costs) and apropriateness (day surgery).

What would I like to highlight from the Top 20?

Iasist technicians increase their resourcefulness by using data from the TOP hospitals. That is, within the framework of the public hospital system, they tell us when there is a group doing things better and, following the awards, this group then becomes a benchmark for others. But, notice in the 2012 Report, where it stated that the TOP hospitals have 32% lower costs and 29% higher productivity, although they carry a 4% cases of higher complexity. But it does not end here: the mortality rate in TOP hospitals is 22% lower; there are 20% patients in these centres with fewer complications their other data also goes in the same direction. Wow! One may recognize immediately that benchmarking is an ideal tool to reduce waste and improve the adequacy and system quality. 

Due to the nature of the American healthcare market, it’s very important for hospitals to obtain recognition and awards to increase their attractiveness, especially for a public with greater economic capacity, as the US News awards are very well known. The number of participating hospitals is close to 5,000, but only 18 were chosen in "The Honor Roll" in the latest edition.

What technical criteria does US News use?

For this competition, they create an index consisting of 32.5% by reputation resulting from a survey of doctors, 32.5% mortality (30 days) and 35% of various performance, quality and clinical safety indicators. Interestingly, this synthetic indicator is constructed for each of the 16 medical specialties chosen, and for a hospital to step onto the honour roll, it must have at least six specialties placed top in their respective speciality.

What does John Wennberg make of this?

In the midst of discussing how hospitals tackle the care of chronic disease in his book "Tracking Medicine" on pages 172-173, Wennberg shows us in a table, how the top 5 hospitals in "The Honor Roll" of US News treat chronic patients during their last two years of life. The conclusion is that hospital systems that have more or less developed integrated care models, such as the Mayo or Cleveland Clinics, present  a pattern of inappropriate use for the end of life of chronic patients which is about half that of Massachusetts General Hospital and Johns Hopkins Hospital which are less evolved in these respects.

Jordi Varela

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