When in need of medical care, picking a good hospital is one of the most important choices a savvy consumer can make. And while patients with especially complex cases or rare conditions may need to get care at one of America's Best Hospitals, most straightforward or common procedures—such as hip replacements and heart bypass operations—happen at community hospitals close to patients' homes. Yet relatively few of the 35 million people admitted to a hospital annually do much in the way of comparison shopping among their local medical centers. Nearly 60 percent of people say they would choose a hospital based on familiarity, whereas only 35 percent would seek out a higher-rated facility, according to a 2008 survey by the Kaiser Family Foundation, a healthcare nonprofit based in Menlo Park, Calif.
The reality is that not all hospitals—or doctors or nurses, for that matter—deliver high-quality care. The United States has a "very inconsistent, uneven quality of healthcare," says Anne Weiss, who leads the quality/equality healthcare team at the Robert Wood Johnson Foundation, a healthcare philanthropy based in Princeton, N.J. Even the type of treatment that similar patients get can vary from hospital to hospital and region to region. In some parts of the country, for example, heart patients are more likely to receive angioplasty than coronary bypass surgery, while in many places the opposite is true. (U.S. News wrote about this phenomenon and the fact that some heart patients may get the less appropriate procedure because they may not be fully informed about their options.)
The good news, says Weiss, is that the "inconsistency [in care] is not a mystery." By tapping a few readily available resources, patients can make informed—and empowering—decisions about a good local hospital for the treatment they need. According to the National Committee for Quality Assurance, a healthcare nonprofit based in Washington, D.C., patients who make informed choices and get engaged in their care ultimately reap better health outcomes.
Weiss likens the process of selecting a good hospital to the legwork that goes into helping a university-bound teen pick the right college. "Both are important life choices," she says. Yet many patients don't put as much effort into researching the facility where a potentially life-changing treatment will take place as they do into picking the place their high schooler will spend the next four years.
Any of the following resources could help you make an informed decision if you, a family member, or a friend need to visit a hospital. Using several of these resources is even better than relying on just one. So roll up your shirt sleeves and do your research as if your life depends on it.
Your primary-care physician. Consult this trusted source if a specialist ever tells you that surgery or treatment is necessary, and ask your primary-care doc where she recommends you have it done. "I'm always struck at how often people don't do that," says James Conway, senior vice president at the Institute for Healthcare Improvement. Primary-care physicians have a good working knowledge of the hospitals in the area, including each institution's overall reputation and how it stacks up against its local peers for specific procedures and treatments. Take the conversation deeper than just asking for their top hospital pick—find out why, says Weiss. Ideally, their reasoning will be based on other patients' outcomes, not because they play a weekly game of tennis with the chief of surgery.
Your insurance company. Inquire about the quality data they've collected on each facility where they would cover your treatment. "Most health plans have some information available about the quality of care delivered by different providers," Weiss says. That info can typically be found on the plan's website or by phone. The data might be limited to the pool of patients your plan covers and the doctors and hospitals in the plan's network, but it's nevertheless a source of details that can inform your choice.
That friend of a friend who is a nurse. Hospitals are the nation's second-largest private-sector employer, according to the American Hospital Association, so your extended social network may include more hospital employees than you realize. "Most people know someone in the local healthcare system," says Conway. Find that person and chat them up. But realize they provide a narrow view, seeing perhaps only one slice of all the variables that make up a hospital's level of care.
A trusted family member or friend. Bringing someone you trust to an important appointment, or simply going through the hospital-selection process with another person, can be quite powerful. "Never come alone" and "Never worry alone" were instructions given to patients when Conway worked at the Dana-Farber Cancer Institute in Boston, he says. If nothing else, your companion is likely to be more clear-headed than you are when you're faced with daunting new information about your health. He or she need not be a medical professional.
Highway billboards touting a hospital's latest award. They're hard to miss—and plentiful in many regions of the country. But beware the source, warns Weiss. Before you let that billboard or full-page newspaper ad sway your decision, "Can you find information on how [the group giving the award] defines good quality?" she suggests. The prize may or may not have any real bearing on the quality of care a patient could expect at that hospital.
One such award you might see is a badge or banner indicating that your local hospital is on the U.S. News & World Report Honor Roll of America's Best Hospitals. (Our hospitals ranking methodology is readily available.) Other websites also rank or rate good hospitals across the country, and such sites have potential value to people who are seeking a good hospital in their area. In a companion article, we discuss several such resources, including Hospital Compare and HealthGrades. We also list hospitals that did well in our latest America's Best Hospitals results even though they aren't part of an academic medical center—and in fact aren't involved in teaching students or residents to any significant degree.
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