Entries for January 2009

The America's Best Hospitals rankings are hardly the only hospital report card around, as I've noted before. Another one is published annually by HealthGrades, for instance. That one came out yesterday, and I was curious, as always, to see how well our approach and HealthGrades' match up. I took a look at a HealthGrades category called "distinguished hospitals for clinical excellence," defined as the top 5 percent in terms of deaths and complications across 26 procedures and illnesses such as heart attack and knee replacement. There are 270 hospitals included.

I compared the "clinical excellence" roster with our Honor Roll of 19 hospitals that scored at or near the top in at least six of the 16 Best Hospitals specialty rankings (such as cancer, heart disease, and orthopedics). Of the 19 Honor Roll hospitals, just four (and only two of the top 10) appear on the HealthGrades list.

That's explainable by the two different approaches used. HealthGrades casts a wide net. The procedures it considers are done in relatively high volume, and it is therefore logical that many of the hospitals that do well by HealthGrades are community hospitals, where such procedures tend to be performed. Best Hospitals, on the other hand, evaluates hospitals only on their ability to perform difficult procedures and treat patients who present a challenge because of age, existing medical conditions, or other factors. If someone close to me needed routine, uncomplicated bypass surgery, I very well might check out local hospitals at the HealthGrades site along with Best Hospitals. But when the bar is set higher, I'd keep my eyes on our rankings. Everyday competence wouldn't be good enough.

Health blogs? Sites that rate hospitals and doctors? If you're the kind of Web user I suspect you are—you found your way to this page, didn't you?—there's a good chance you're aware of them. Most of the public has no idea they exist, however, and their quality is all over the map. This was among the issues hashed out at an all-day conference last week devoted to a "healthier Web." The conference was sponsored by Consumer Reports and held at the magazine's headquarters in Yonkers, N.Y. I was on a panel that addressed ratings. Almost all of the panelists and attendees were bloggers, and quite a few were physicians.

A comment by one of the blogger docs, an Augusta, Ga., internist/pediatrician named Rob Lamberts (Musings of a Distractible Mind), registered with me. Many physicians who blog, he said, do not actively practice. They may be retired, in administrative or policy positions, at think tanks, or removed in other ways from the world of examining rooms, insurance hassles, and, of course, patients. These doctors also may not stay current with medical findings. Yet because they have an M.D. and post their thoughts in a public space, they wear the mantle of authority. Dr. Rob, as Lamberts calls himself in his blog, expressed concern about their accuracy, judgment, and credibility.

Even the crustiest reporter can get throat-chokey and eye-misty, and I confess that it happened to me yesterday as a singular moment in American history unfolded on the steps of the U.S. Capitol. But now the alchemy of turning political promises into pragmatic programs begins. I was most interested in the president's touting of "technology's wonders to raise healthcare's quality and lower its cost." It was just a line in a speech, but reflective of a worshipful and widely shared view.

Yes, technology can raise quality. Surgery performed through small incisions, made possible in part by advanced fiber optics and miniaturized tools, can reduce complications and send patients home faster. Technology can lower cost. If medical records are digitized and centralized, if prescription orders in hospitals are entered at the bedside and tracked by computer, time would be saved and errors reduced, both of which would cut expenses.

Understandably, authors of medical studies prefer to cast their findings in strong, unambiguous terms rather than admit that their results probably can be interpreted any number of ways and that the interpretation they preferred had a good shot at generating media buzz, or it best fit their hypothesis, or some other possibility. Where researchers stand depends, as the expression goes, on where they sit. A recently published online paper in the Journal of General Internal Medicine, based on a phone survey of several thousand individuals who had a regular primary-care physician and visited at least one specialist in the previous year, offers an example.

The finding highlighted by the authors was that "less than half" of the responding patients—46 percent—said their primary-care doctors "always seemed informed and up to date" about the care the specialists had provided. Overall, that is, coordination and information flow between primary-care providers and specialists, as reported by patients, was "less than ideal."