Overview of the three selected facilities
The assignment at hand seeks to select three hospitals and compare their data as reported by the hospital compare tool. The three hospitals to be reviewed are Lenox Hill, New York University Langone Medical Center, and Mount Sinai, which is located in the metropolitan area of New York. New York is the most densely inhabited city in the United States and consists of five boroughs: The Bronx, Brooklyn, Manhattan, Queens and Staten Island (Census Bureau, 2011).
Lenox Hill, New York University Langone Medical Center and Mount Sinai Hospital are academic, not-for-profit, acute care hospitals located in Manhattan. They have been fully accredited by the Joint Commission and provide tertiary and ambulatory services (NYSDH, 2012). In addition, the three hospitals have been in existence for over 150 years. Mount Sinai and NYU Langone have schools of medicine and Lenox Hill is affiliated with the NYU School of Medicine. The three hospitals range in bed capacity from 652 to 1,171 beds. The nurses from Mount Sinai and Lenox Hill are represented by nursing unions.
Compare and contrast the strengths and weaknesses of the three hospitals
The U.S centers for Medicare and Medicaid services have developed software called hospital compare data, which is used to gauge the performance of hospitals in the country. A number of tools are used. They include, process of care measures, which evaluate hospitals’ services on pneumonia, heart diseases, asthma in children and surgical procedures. The software also evaluates outcome care measures based on readmissions, deaths and complications. In addition, the hospital compare tool examines the use of medical imaging, which includes patient satisfaction measures, number of Medicare patients, and hospitals’ expenditure on patients’ Medicare. Data from the hospital compare tool indicates that Mount Sinai and NYU have obtained Magnet designation. Magnet award is a reputable recognition that a hospital gets from the American Nurses Credentialing Center due to outstanding performance in nursing services. The two hospitals have high employee retention and satisfaction levels. Lenox Hill has not yet achieved the set benchmark for receiving the magnet ward. Out of the three hospitals only NYU Center and Mount Sinai Hospital have stroke care registries. All the hospitals have cardiac surgery registries and nursing care registries (U.S. Department of Health & Human Services, 2012).
Search results from the hospital compare tool indicate that NYU Hospital Center obtained a 65.3% in overall patient satisfaction while Lenox Hill Hospital obtained a 62.2% in overall patient satisfaction. Mount Sinai Hospital obtained a 65.7% in overall patient satisfaction (U.S. Department of Health & Human Services, 2012). The three hospitals had similar scores in patient satisfaction. The three hospitals have a vast room for improvement in patient satisfaction as reflected by their HCAHPS scores.
In terms of heart attack care, NYU Hospital Center obtained an overall score of 99.6%. Lenox Hill Hospital received an overall score of 99.4%, and Mount Sinai Hospital obtained a 98.6% on effective heart attack care (U.S. Department of Health & Human Services, 2012). The three hospitals have high scores of ineffective heart attack management. Heart failure is a common medical diagnosis affecting more than 23 million patients worldwide (Saunders, 2009). The hospital compare tool is an excellent resource to monitor the effective management of heart failure patients in hospital facilities nationwide. The hospital compare tool uses four indicators to measure effective heart failure management. The average score from the four indicators will be used to compare the three hospitals according to heart failure care. According to the search results, NYU Hospital Center obtained 100% in heart failure care. Lenox Hill Hospital obtained 97.5%, and Mount Sinai Hospital 97%. The three hospitals have excellent scores in heart failure management. NYU has the best management care in this category (U.S. Department of Health & Human Services, 2012).
Pneumonia is the third most frequent diagnosis for patients 65 years and older (Buckley & Schub 2012). The effective treatment of pneumonia is an important factor to consider when rating healthcare systems. In terms of pneumonia cases, the three hospitals have a comparable score. NYU Hospital Center again leads the pack with a score of 98.8%. Mount Sinai Hospital comes second with a score of 95.4%, and Lenox Hill Hospital’s score is 94.4% (U.S. Department of Health & Human Services, 2012). Thus, it is evident that the scores registered by the three hospitals in the management of pneumonia are slightly lower than scores registered in other categories such as heart diseases care. This category requires improvement in the three hospitals.
On the other hand, the timeliness of surgical care was averaged independently from the effectiveness of surgical care. The Hospital with the greatest success in surgical care timeliness was NYU Hospital Center with an average score of 99.8% followed by Lenox Hill Hospital with an average score of 96.8%, and Mount Sinai Hospital received an average score of 95.8%. In the effectiveness of surgical care NYU Hospital Center, Lenox Hill hospital, and Mount Sinai Hospital registered scores of 99.4%, 96.1%, and 96% respectively (U.S. Department of Health & Human Services, 2012).
Lastly, in the category of readmissions, deaths and complications, the three hospitals registered low scores. NYU Hospital Center and Lenox Hill Hospital scores in this category are slightly above the national average. However, Mount Sinai Hospital’s score in this category is below the national average. Heart attacks, heart failure, and pneumonia are a majority of the cases with readmissions in this hospital (U.S. Department of Health & Human Services, 2012).
Critically review the public data for potential flaws or inadequacies
The public data available from the U.S. Department of Health & Human Services (HHS) attempts to provide standardized data to allow for public comparison of different hospitals. The idea is good, however, studies show usage of these websites is low (Birnbaum, Cummings, Guyton, Schlotter, & Kushniruk, 2010). When accessed for information, the public has to be sure they are comparing similar hospitals to each other, which may prove difficult for the non-medical layperson. And while electronic reporting may be more efficient, it is not without error; it is important to constantly monitor the process to guarantee the integrity of the data (Stricof, 2012). Also, the measures reported contain different groups within each category for comparison.
For example, timely & effective care measures only include the specific patients who qualify for the recommended treatment (HHS, 2012). Data from patients’ medical records are obtained using CMS-defined specifications and are audited and edited, but not validated (HHS, 2012). The 30-day readmission quantifiers include patients who are discharged from the hospital to a nursing home, however, patients who left against medical advice or who are transferred to another hospital are not included. Non-Medicare patients and patients in Medicare-managed care plans are not included in the data (HHS, 2012). Hospital-acquired conditions (HAC) information is only calculated for hospitals that are paid through the Inpatient Prospective Payment System (IPPS), which excludes critical access hospitals, long-term care hospitals, Veterans hospitals, and others (HHS, 2012). Currently, HAC rates are not risk-adjusted to take into account individual patient differences (HHS, 2012). Healthcare-associated infections (HAIs) include all patients in acute care hospitals and are risk-adjusted (HHS, 2012).
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was developed by CMS along with the Agency for Healthcare Research and Quality (Studer, Robinson, & Cook, 2010), and is a standardized tool used to measure patients’ s perspectives on hospital care (HHS, 2012). A random sample of adult patients is chosen to complete the survey and is not limited to Medicare beneficiaries (HHS, 2012).
Conclusion and Recommendations
In the climate of recent healthcare reform, hospitals in the United States are making efforts to improve the quality of care. Shortly, Medicare reimbursements will be tied to the demonstration of adherence to clinical performance guidelines, as well as patient satisfaction and perception of quality of care (Geiger, 2012). For example, the Patient Protection and Affordable Care Act (ACA) mandates that Medicare withhold 1% of standard reimbursement for incentive funds (Geiger, 2012). These funds would be offered to hospitals that achieve high scores on quality standards and Hospital Consumer Assessment of Healthcare Providers and Services (HCAPS) surveys (Brooks, 2012).
Hospitals can improve the quality of services and enhance clinical outcomes by utilizing evidence-based guidelines. For example, implementing the American Heart Association’s Get with the Guidelines (GWTG) program has been shown to improve the care of patients with heart failure (Heidenreich, et al., 2012). The program provides guideline recommendations from the American College of Cardiology (ACC) and the American Heart Association (AHA), as well as tools to measure compliance with guidelines independently and against national benchmarks. Additionally, the GWTG model can be used to assist in improving processes in the care of patients with acute myocardial infarction, thus improving the quality of care and survival rates (Chin, et al., 2011).
Clinical guidelines for the management of community-acquired pneumonia (CAP) in the elderly are discussed by Thiem, Heppner, & Pientka (2011). Quality indicators and clinical pathways have been found to improve care of patients with CAP. The use of evidence-based guidelines can lead to more precise identification of illness severity and more appropriate use of antibiotics, thus reducing mortality rates in hospitalized patients.
References
Birnbaum, D., Cummings, M., Guyton, K., Schlotter, J., & Kushniruk, A. (2010). Designing Public web information systems with quality in mind: Public reporting of hospital performance data. Clinical Governance: An International Journal, 15(4), 272-8. Web.
Brooks, D. (2012). With Medicare revenues at stake, ED managers place new importance on elevating the patient experience. ED Management, 24(1), 1-12. Web.
Buckley, L., & Schub, T. (2012). Pneumonia in Older Adults. Web.
Chin, C., Chen, A., Wang, T., Alexander, K., Mathews, R., Rumsfeld, J…….Roe, M. (2011). Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: The Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get with the Guidelines (GWTG) acute myocardial infarction mortality model and risk score. American Heart Journal, 161, 113- 122. Web.
Curry, L., Spats, E., Cherlin, E., Thompson, J., Berg, D., Ting, H…….Bradley, E. (2011). What Distinguishes top-performing hospitals in acute myocardial infarction mortality rates? Annals of Internal Medicine, 154, 384-390. Web.
Geiger, N. (2012). On tying Medicare reimbursement to patient satisfactions surveys. American Journal of Nursing, 112 (7), 11.
Giordano, L., Elliott, M., Goldstein, E., Lehrman, W., & Spencer, P. (2010). Development, Implementation and public reporting of the HCAHPS survey. Medical Care Research & Review, 67(1), 27-37. Web.
Heidenreich, P., Hernandez, A., Yance, C., Liang, L., Peterson, E., & Fonarow, G. (2012). Get With the guidelines program participation, process of care, and outcome for Medicare Patients hospitalized with heart failure. Circulation: Vascular Quality Outcomes, 5, 37-43. Web.
New York Department of Health (2012). Information for a healthy New York. Web.
Saunders, M. (2009). Indicators of health-related quality of life in heart failure family caregivers. Journal of Community Health Nursing, 26(4), 173-182. Web.
Stricof, R. (2012). Mandatory public reporting: The New York State experience. Clinical Governance: An International Journal, 17(2), 109-12. Web.
Studer, Q., Robinson, B., & Cook, K. (2010). The HCAHPS handbook: Hardwire your hospital for pay-for-performance success. Gulf Breeze, FL: Fire Starter Publishing.
Thiem, U., Heppner, H., & Pientka, L. (2011). Elderly patients with community-acquired Pneumonia. Drugs & Aging, 28(7), 519-537.
U.S. Census Bureau. (2011). State & county Quick facts: New York, New York. Web.
U.S. Department of Health & Human Services. (2012). Healthcare-associated infections. Web.
U.S. Department of Health & Human Services. (2012). Hospital-acquired conditions. Web.
U.S. Department of Health & Human Services. (2012). Patients’ survey. Web.
U.S. Department of Health & Human Services. (2012). Timely and effective care- process of care Measures. Web.
U.S. Department of Health & Human Services. (2012). 30-Day death and readmission measures. Web.
U.S. Department of Health & Human Services. (2012). Hospital Compare. Web.