Overview of Important Health
As a patient, you have many factors
to consider when thinking about your hospital care. Often
the factors include: what services are available, how long
will I have to wait for the service, how well will I be
treated, how far will I have to travel, what days and times
is the service available, how difficult will it be for
me to find the service once I get to the hospital, etc. However,
two of your most important considerations will most likely
have to do with the Quality and Cost of the services that
you will need or want.
While no standards are currently available
for determining what "good" health care is, many federal and statewide
efforts are underway to establish standards of care that
will be meaningful, fair, and scientifically sound. Your
Hospital Guide is the beginning of a process of information
sharing that is intended to inform and educate Marylanders
about hospital services in Maryland. The Guide’s
current focus is dedicated to providing information on Quality
Why Provide Information on Quality?
Providing information about quality can offer you a way of
comparing how well certain procedures are performed at Maryland
hospitals. You may not always have the opportunity to choose
the hospital from which you receive care, especially in an
emergency. However, when you or a loved one are planning
for admission to the hospital, getting some important information
first can help make your hospital experience a positive one.
Reviewing information about quality helps make you an active
participant in healthcare decisions.
This guide uses quality measures to identify a standard level
of care. The measures used in this guide are treatments that
have been proven through extensive use and research to be
effective treatments for common medical problems. The quality
measures reported in the Hospital Guide are for adults who
have been hospitalized for childbirth, heart attacks, heart
failure, or pneumonia. The reports deal with how care was
given to only those patients who needed standard treatment,
not intense treatment.
The guide also tells you about what questions
to ask your doctor if you do not receive the treatments outlined
here. The Hospital Guide is intended to help consumers select
a hospital or provide guidance on what to expect in a hospital
setting. However, you should not base your decision on the
data provided here alone. We recommend that you talk with
your doctor, seek out other resources,
and also use the consumers’ checklist to
help make your decision.
What is Quality?
Defining “quality” is always
difficult. For years, researchers, physicians, nurses, and
quality improvement specialists have struggled with how to
judge the quality of medical care. This guide attempts to
do so by showing the most up-to-date treatments for certain
medical conditions, and then providing reports that compare
how often each Maryland hospital provides treatments for
those conditions. In doing so, we hope to provide some indication
of the quality of health care that is delivered by the various
hospitals in the state.
Eventually, we anticipate having appropriate
data on specific outcomes associated with various medical
conditions. Because this data and information are not yet
available, we have decided to use ‘volume’ as an alternative indicator
of quality for your consideration. Please remember, however,
that ‘volume’ (i.e. how often the procedure is
performed) is an imperfect alternative for "outcomes” (i.e.
the results of the procedure).
Often, patients do
not know about the costs of health services because insurance
companies to which they pay premiums pick up the bill for
the true cost of health care. Most insurance plans require
participants to pay a co-payment (or coinsurance), which
is a small part of the overall cost. Co-payments vary based
upon the service you receive. For instance, you are generally
charged a high co-payment if you visit the hospital emergency
room and are released. That same co-payment is often waived
if you are admitted overnight.
And, many insurance plans
have differing service levels and agreements. When choosing
a hospital, find out whether or not your health care plan
participates with that hospital and if you need to be pre-qualified
for admission. You should also determine how much it will
cost you for various expected and unexpected services at
each hospital. How much for a bed in a semi-private room?
How much for a bed in the intensive care unit (ICU)? What
are the costs for specialty procedures—and
associated services—that you might need?
If you fail to look into these issues,
you may be faced with a large bill when you are discharged
that you are unable to pay.
The Relationship Between Costs and Diagnosis-Related Groups
In 1983, the federal government addressed problems of soaring
healthcare costs by changing the way hospitals are paid.
Instead of paying hospitals for what they charged for care,
the government set up guidelines for treatment of each type
of medical condition, called diagnosis-related groups (DRGs).
Under this system, hospitals are paid a certain amount of
money for patient care according to the patient’s diagnosis,
or DRG. About 500 DRGs exist that categorize patients with
similar conditions. These Federal guidelines encouraged hospitals
to use similar resources to take care of the patients with
the same DRG, and for their stay at the hospital to be of
similar length. This method encourages shorter hospital stays,
getting patients home as soon as possible, while providing
the care they need.
Each patient who is admitted to the hospital
is assigned one DRG for that visit. The choice of DRG is
based on a number of factors including the patient’s diagnosis, age,
and medical procedures that have been performed. The hospital
also considers the patient’s other conditions, which
are called “complications” and "co-morbidities." A
complication is a condition that occurs while the patient
is in the hospital; it can cause the hospital stay to be
longer than expected. A co-morbidity is a condition that
existed before the patient went to the hospital and which
also can cause the patient’s hospital stay to be longer.
How Does Information on Diagnosis-Related Groups Relate to Quality?
This guide provides information about DRGs to show the types
of cases that particular hospitals are seeing most frequently,
- how many times a hospital has recently discharged a patient
with a certain DRG;
- the average length of stay for that DRG; and
- the number of times the patient was readmitted to the
hospital for the same condition (or for complications as
a result of the condition or its treatment) within a certain
period of time.
of quality continue to be developed and are added to this
guide from time-to-time. Since this guide was created, the
list of medical conditions was expanded to include obstetric
care, and, this year, reports on surgical care will be included.
In addition, hospital based infections are planned to soon
be reported in the Guide. In 2003, Maryland hospitals participated
in a pilot program focusing on patient satisfaction. This
dimension of hospital performance reporting may be available
in the future.
Research on quality health care is an
ongoing effort. We encourage you to check this website frequently
to see additional updates. The home page for this guide will
notify you of changes as they occur.