Methodology


 

Recognizing Healthcare Excellence®


Since 2013, The SafeCare Group®published 100 SafeCare Hospitals®that excelled with evidence-based metrics of outcomes of care, safety of care, infections of care, unplanned visits of care, and cost of care. The SafeCare Group adopted these relevant metrics for its methodology framework, terming it Recognizing Healthcare Excellence®, as they reflected a Balanced Scorecard of hospital performance.

 

Hospitals that performed poorly on these evidence-based metrics receive a financial penalty from the Centers for Medicare and Medicaid Services in the Hospital Value Based Program, Hospital Acquired Conditions Reduction Program, and Hospital Readmissions Reduction Program. The top 50 hospitals represent the top one percent of hospitals and only about two percent of hospitals earn the prestigious 100 SafeCare Hospitals distinction.


Patient Satisfaction (rateahospital.com)

The SafeCare Group, guided by a decade of emails and letters of complaints, suggestions, and feedback from patients, created SafeCare Patient Experience. Rateahospital.com is an easy tool for patients to find, compare, and review hospitals. It currently reports results for 5 areas using 5 topics as follows:

 

·         Quality - How good is this hospital?” 

·         Compassion - Do they care about you?” 

·         Trust -Do you trust them?” 

·         Relief - Did the treatment work?

·         Recommend -Would you go back again?” 

 

Hospital Deaths

Hospital deaths are defined as any death occurring within 30 days of entering the hospital for a specific condition, diagnosis of an infection, and surgery. Death rates are measured within 30 days, because deaths after a longer time period may have less to do with the care the hospital provided and more to do with other complicating illnesses, patients’ own behavior, or other care services patients received after they leave the hospital.

 

There are an estimated 715,000 to 776,000 hospital deaths each year in the United States. Hospital deaths can be for any reason, including negligence, and can occur in the hospital or after discharge. Estimates of preventable hospital deaths from medical errors range from 250,000 to 440,000 each year. 100 SafeCare Hospitals reports hospital-specific 30-day death rates for the following conditions and surgeries:


·         Chronic obstructive pulmonary disease

·         Acute myocardial infarction

·         Heart failure

·         Pneumonia

·         Stroke

·         Coronary artery bypass and grafting

 

To accurately compare hospital performance, the 30-day deaths “adjust for patient characteristics that may make death more likely. These characteristics include the patient’s age, past medical history, and other diseases or conditions (comorbidities) the patient had when they were admitted that are known to increase the patient’s chance of death.”

 

Hospital Complications

Hospital complications are avoidable safety events (medical errors) following surgeries, procedures, and childbirth. The overall score for serious complications is based on how often adult patients had certain serious, but potentially preventable, complications related to medical or surgical inpatient hospital care.

13% of hospital admissions are associated with hospital complications that seriously harmed patients. It is estimated that there are between 250,000 and 440,000 hospital deaths from medical errors each year. The in-hospital complications score is based on how often adult patients had certain serious, but potentially preventable, complications related to medical or surgical inpatient hospital care. These complications include: heart attack, pneumonia, sepsis/septicemia/shock, surgical site bleeding, pulmonary embolism, mechanical complications or death. 100 SafeCare Hospitals reports hospital-specific complications rates for the following measures:

·         Hip/knee replacement complications

·         Pressure sores

·         Hospital-acquired lung puncture

·         Broken hip from a fall

·         Bleeding or bruising after surgery

·         Kidney and diabetic complications after surgery

·         Respiratory failure after surgery

·         Blood clots, in the lung or a large vein, after surgery

·         Blood stream infection after surgery

·         A wound that splits open after surgery

·         Accidental cuts and tears during surgery

The measures of serious complications are risk adjusted “to account for differences in hospital patients’ characteristics. In addition, the score are “smoothed” to reflect the fact that measures for small hospitals are measured less accurately (i.e., are less reliable) than for larger hospitals.”

Hospital Infections

Hospital Infections measures how often patients in a particular hospital contract certain infections during the course of their medical treatment, when compared to similar hospitals. These infections can often be prevented when hospitals follow guidelines for safe care. Hospitals currently submit information on central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), Methicillin-resistant Staphylococcus Aureus (MRSA) blood infections, and Clostridium difficile (C. diff.) intestinal infections.

 

Approximately 1 of every 25 hospitalized patients in the United States has an in-infection, meaning that nearly 650,000 patients contract one of these infections during the course of their treatment. The infections measures apply to all patients treated in hospitals, including adult, pediatric, neonatal, and geriatric. The infections occurred in intensive care units (ICUs), neonatal ICUs, and medical, surgical, and medical/surgical ward locations. 100 SafeCare Hospitals reports hospital-specific infections rates for the following measures:


·         Central line-associated bloodstream infections

·         Catheter-associated urinary tract infections

·         Surgical site infections

·         Methicillin-resistant Staph blood infections

·         Clostridium difficile intestinal infections

 

Calculations for the In-hospital Infections adjust for differences in the characteristics of hospitals and patients “that takes into account differences in the types of patients a hospital treats.”

 

Hospital Readmissions

A hospital readmission occurs when a patient is discharged from the hospital and then admitted back into the hospital within a short period of time. A high rate of patient readmissions may indicate inadequate quality of care in the hospital and/or a lack of appropriate post-discharge planning and care coordination. An unplanned readmission is an urgent readmission within 30?days from a previous admission or 7 days of an outpatient procedure. Returning to the hospital after a longer period may have less to do with the care the hospital provided, and more to do with other complicating illnesses, patients’ own behavior, or other care services patients receive after they leave the hospital.

 

Unplanned Readmissions are associated with increased mortality and higher health care costs. Hospital readmissions are frequent, harmful and costly - 2.3 million patients annually, are re-hospitalized within 30 days after discharge.  MedPAC reported that about 75 % of such readmissions can and should be avoided. 100 SafeCare Hospitals reports hospital-specific readmissions rates for the following measures:


·         Hospital Wide All-Cause 30-day Readmissions

 

To make comparisons fair, hospitals’ 30-day readmission results are risk-adjusted to account “for differences in hospital patients’ characteristics that may make readmission more likely, including age, gender, past medical history, and other diseases or conditions (comorbidities) that patients had when they arrived at the hospital.”

 

Hospital Charges

The cost of hospital stay summarizes payments made on behalf of patients for healthcare services paid during the period from 3 days prior to an inpatient hospital admission through 30 days after discharge. Cost of Care represents average spending levels during hospitals’ episode level rather than at the service category/claim level.

 

Total health care spending in America was approximately $3.5 trillion in 2017 and about 32 percent of that amount - or $1.1-trillion - was spent on hospital services. Hospital costs averaged $3,949 per day and each hospital stay cost an average of $15,734. Payments made on behalf of patients for healthcare services includes payments for services and supplies in multiple settings, including: inpatient, outpatient, skilled nursing facility, home health, hospice, physician, clinical laboratory, ambulance services, and durable medical equipment. 100 SafeCare Hospitals reports hospital-specific efficiency of care for the following measures:


·         Spending per patient

 

Cost of hospital stay measure calculates hospital-level, risk-standardized payments that account for patient characteristics that are clinically relevant and strongly related to the outcome. These characteristics include the patient’s age, past medical history, and other diseases or comorbid conditions the patient had during the hospital admission that are known to increase payments in the 30 days (or 90 days for hip/knee replacement) following admission. The measures also remove payment differences unrelated to care, including geographic factors and policy adjustments.