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Looking for a Great Hospital? Good Luck -- the Quality Data Sucks

Comparing hospitals for quality and safety isn't easy, because even the best data available has big holes in it. Which a flap over the Quality Check website of the Joint Commission -- a nonprofit organization that accredits about 80 percent of U.S. hospitals -- amply illustrates.

According to the Joint Commission, Quality Check provides more data on hospital performance than any other Web site, including Medicare's Hospital Compare and Health Grades, a private rating service whose rankings are often touted by hospitals. Quality Check offers data on how well hospitals do on treating chronic diseases such as stroke and congestive heart failure, and it also supplies data on safety measures.

Sounds great. Yet as investigative reporter Charles Ornstein points out, Quality Check obscures quality and safety gaps at many hospitals. For starters, every accredited hospital gets the JC gold seal of approval (pictured above right) -- even if it's only been "conditionally" accredited or is at risk of being denied accreditation.

Moreover, there's no way to know which hospitals are having problems without reading the full accreditation report of each individual facility. And within a year or two after a hospital loses its accreditation, the Joint Commission expunges the history behind that loss from its site. All of this makes it impossible for the average consumer to get an accurate picture of many hospitals' performance.

How can this be? According to Chuck Mowll, a JC executive vice president, hospitals that are already accredited can keep the gold seal even after a commission survey team finds deficiencies in quality and/or safety. These facilities have 45 days in which to correct the problems; if they fail to do so, they can lose their accreditation, along with the gold seal.

Hospitals, however, can appeal that decision, and it can take months for the appeal to be heard. Even if the commission's appeal board sides with the hospital, another survey team must go back to the hospital and re-examine it. During that entire period, the hospital continues to bear the gold seal on the commission's website and can display it in marketing materials.

In the wake of the controversy aroused by Ornstein's post and another post by healthcare quality expert Michael Millenson on The Health Care Blog, the JC is considering adding a feature to Quality Check that would enable consumers to immediately find out whether a hospital has full accreditation or is on probation while it fixes problems or appeals a denial of accreditation. In addition, Mowll says, the Joint Commission may have Quality Check maintain historical data indefinitely on hospitals that have lost their accreditation.

What's troubling about this episode, however, is that the Joint Commission has allowed misleading information to appear on its consumer website and didn't consider correcting it until outside observers set off an alarm. This raises the question of whether the commission -- entrusted with ensuring hospital quality and safety to the public -- is too close to the institutions that fund it.

Image supplied courtesy of UNC Health Care.

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