80 hospitals in Massachusetts are going public with information about the frequency with which their patients develop pressure ulcers (bed sores, pressure ulcers, decubitus ulcers) while hospitalized. As part of a joint effort between the state's hospital association and a consumer information group called Patients First, acute care, rehabilitation, and long-term acute hospitals disclosed pressure ulcer data on their patients. Pressure ulcer rates from individual hospitals were then compared with state averages for similar hospitals.
The state's hospitals earlier went public with information on the number of falls sustained by hospitalized patients, as well as nurse staffing data. The purpose of the program, according to a representative of a health quality organization, is twofold: to provide the public with information about hospital performance based on quality indicators like pressure ulcer prevalence, falls, and staffing; and, to assist hospitals to improve the care they provide. Read more about the hospital disclosures.
The Massachusetts program is a great step in the right direction. For some time, information about the quality of care provided by nursing homes across the country has been collected and reported by Medicare on its Nursing Home Compare website. The website reports statistics on pressure ulcers, restraint use, and weight loss and compares that information among other facilities within the state and nationally. However, the information made available on the website is limited and needs to be interpreted with caution.
The About and Data Details sections of Medicare's website make clear "the quality of a nursing home may improve or deteriorate significantly in a short period of time" and the site's data does "not present a complete picture of the quality of care provided by the nursing home." For example, much of the information Medicare uses is self-reported by nursing homes and is not independently audited or verified. As long as the information is accurate, the information is helpful. But what if nursing homes fudge the statistics to make themselves look better than they are?
Nursing home inspection data also includes only the results from surveys or complaint investigations during which nursing homes are cited for violating regulations. What about the many times no one knows that poor care has occurred? Finally, Medicare doesn't report data on medication errors, wandering and elopement injuries, burns, falls, sexual assaults, and other injuries that are highly relevant to the quality of care provided by a facility.
Reporting programs like the Massachusetts initiative and Medicare's Nursing Home Compare are necessary but not sufficient because they provide only limited (and potentially misleading) information about the quality of care. More is needed. We need complete transparency about all injuries and events that reflect on the quality of nursing home care, like medication errors and falls. Self-reported information from nursing homes also needs to be audited and verified. Until we know about nursing homes all of the things they know about themselves, the public will never have enough information to make the right choice about admitting a loved one to a nursing home . . . and the facilities themselves won't have a real incentive to change.
Posted on Tue, January 22, 2008
by Robert Carter