Hospital Compare data may not help surgical patients find hospitals with better outcomes
Research Activities, April 2011, No. 368
How well hospitals comply with recommended care processes, as reported on the Federal government's Hospital Compare Web site, does not seem to influence three types of key surgical outcomes, according to a new study. Hospital Compare is a Web site maintained by the Centers for Medicare & Medicaid Services (CMS), which allows potential patients to choose a hospital for treatment by comparing each facility's rates of compliance with processes of care thought to influence patient outcomes. In this case, the care processes examined were use of prophylactic antibiotics to reduce surgical site infections and use of anticoagulants and compression stockings to prevent venous thromboembolism (either deep vein blood clots or blood clots in the lungs).
The Michigan researchers found that, over a 2-year period, 325,052 fee-for-service Medicare beneficiaries underwent one of 6 relatively common, high-risk surgical procedures at 2,189 hospitals nationwide. Data on care processes meant to reduce the risk of surgical site infections or venous thromboembolism was available for 229,665 admissions at 2,038 hospitals during the same period. The mean surgical compliance rates varied from 53.7 percent for hospitals in the lowest fifth for compliance to 91.4 percent for those in the highest fifth.
There was no significant relationship between a hospital's compliance and three clinical outcomes: 30-day mortality, venous thromboembolism, and surgical site infection following surgery. The only significant difference was for extended length of stay, which could result from a number of postoperative complications. The risk of extended stay was 12 percent less likely at highest compliance hospitals than at middle or lowest compliance facilities. The findings were based on comparison of Hospital Compare data from January 2005 through the end of December 2006 with information on all Medicare fee-for-service hospitalizations for six surgeries in the Medicare Provider Analysis and Review data set for the same time period. The study was funded in part by the Agency for Healthcare Research and Quality (HS17765).
More details are in "Hospital process compliance and surgical outcomes in Medicare beneficiaries," by Lauren H. Nicholas, Ph.D., Nicholas H. Osborne, M.D., John D. Birkmeyer, M.D., and others, in the October 2010 Archives of Surgery 145(10), pp. 999-1004.