Hospitals and doctors are not all alike_ Doctors vary in quality due to differences in training and experience; hospitals differ in the depth and breadth of services available.
The more complex and sophisticated your medical problem, the greater differences in quality become. And the more they matter.
A surgeon, for example, who performs a complex procedure, often has better success with it than a surgeon who performs the same procedure only occasionally. The complication rate for the same procedure may be higher at one hospital than another.
Clearly, the doctor and hospital that you choose have a direct impact on how well you do. Choosing a doctor and a hospital for complex, specialized medical care involves making some difficult and important decisions. No one has more at stake than you; it's one of the most important decisions of your life. We have developed this guide to help you make this choice an informed one.
How Do You Judge Quality?
Most of us seem to do more research when we buy a car than when we are about to entrust our lives to a doctor and a hospital. That may be because we don't know what questions to ask or where to turn for information. Few resources exist to help consumers rate doctors and hospitals the way Consumer Reports rates air conditioners.
There are many different ways to measure quality care, and there is no universal agreement on which should be used. At The Cleveland Clinic Foundation, however, we believe that you can use six points, or quality indicators, to compare health care providers:
· Credentials
· Experience
· Range of services
· Participation in research and education
· Patient satisfaction
· Outcome
Choosing a doctor or hospital is often influenced by values. You may want to
go to a hospital that is close to home. You may want a hospital with a specific
religious affiliation. But when you need specialized medical care for a complex
condition, it is essential that you also include in your decision a doctor's
qualifications and a hospital's track record.
Where Do You Begin?
Measuring quality in ways that are useful to consumers is a relatively new idea in health care. Because of that, it may not be possible to get complete information for each of these quality indicators. But when doctors and hospitals are willing to give you as much information as possible, it's a good sign. It shows that they are dedicated to maintaining and improving their quality, responsive to patients, and confident of their capabilities.
Begin by talking to your family doctor. Get the names of several doctors that have the most experience with diagnosing and treating your condition and the names of hospitals that offer the newest, most effective treatments. Ask the questions we suggest. Make comparisons. Then make your decision. Be an informed consumer for yourself and your family.
If a provider can't, or won't, give you any information, ask the doctor who
is guiding your care about alternatives.
Sidebar
One of America's Best
The Cleveland Clinic is often named among the top medical centers in the country:
Every year since 1990, U.S. News and World Report has designated the Cleveland Clinic as one of only 10 hospitals in America considered "The Best of the Best" in its annual ranking of hospitals.
Many Cleveland Clinic physicians and surgeons are listed in the book "The
Best Doctors in America."
How to Use Quality Indicators
How can you use these indicators to judge if one doctor or hospital is better than another to provide the care you need? By combining information from more than one quality indicator, according to a report about quality medical care produced by the U.S. Congress, Office of Technology Assessment.
For example, patients about to have heart surgery can be confident if the
hospital performs a high number of heart surgeries, if it has a low mortality
rate, and if the surgeon has extensive training and experience in the procedure.
On the other hand, the report states: "...if a hospital has a high
mortality rate and a low volume of procedures, the patient might wish to
question the surgeon about that hospital and about alternatives, even if other
hospitals require longer travel."
Sidebar
To help you choose high-quality specialists and hospitals, the Cleveland Clinic has produced a series of "How to Choose a Doctor and Hospital for Your Treatment" consumer guides. Each guide in the series deals with a different disease. To receive a free copy of any of these guides, please call one of the numbers below:
216/444-8919
(in Cleveland)
800/545-7718
(toll-free outside Cleveland)
1. Credentials
Do the doctor and hospital measure up?
Credentials have been set by nationally recognized medical professional organizations to verify that doctors and hospitals meet certain standards in healthcare delivery.
Doctors
Board certification, or the international equivalent, is a sign that doctors are highly trained in the specialty that they are practicing. Each specialty has a national board responsible for setting standards that doctors must meet in order to be certified. Doctors who are board certified in their specialties have had five or more years of training beyond medical school, have practiced for a specified number of years in that specialty, and have passed a difficult examination in their specialty area. To remain board certified, doctors must attend continuing medical education programs throughout their careers. Some excellent doctors are not board certified. Board certification, however, is generally a good indicator of competence and experience.
Hospitals
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the nationwide authority that surveys hospitals. The JCAHO decides whether a hospital gets, keeps or loses accreditation based on its meeting certain health and safety requirements. Although accreditation is voluntary, most hospitals go through the process. If the hospital you are considering is not accredited, it is important to know why. For information about a hospital's accreditation status, call the JCAHO at 708/916-5800.
Hospitals that do measure up are often in the public spotlight for their
medical advances and the quality of their care. Information about a hospital's
reputation is widely available through the mass media in magazines such as U.S.
News & World Report, the government and consumer groups.
Ask if the doctor is board certified.
Ask if the hospital is accredited by the JCAHO.
2. Experience
Does practice make perfect?
In the case of specialized medical and surgical care for a complex problem,
the more experience the doctors and hospitals have with the necessary
procedures, the better the results usually will be. For example, an experienced
surgeon who has handled many cases is prepared for the most difficult problems
that may arise during the operation.
Ask how many times the doctor has performed the procedure that you may need; compare that with the experience of other specialists.
Ask how often the procedure is performed at the hospital you are
considering.
3. Range of Services
What services are available?
Hospitals with a broad range of services can treat more complex medical conditions and better handle complications that may occur. If complications arise, you want the best medical care, and you want it immediately.
Range of specialty departments
Medical conditions don't always exist in isolation. Related conditions could endanger the health of other organs; managing these related problems requires a multidisciplinary team approach involving physicians from several specialties. Therefore, immediate access to a full range of specialty departments within a facility is critical.
Range of diagnostic and treatment options
There may be more than one way to treat your medical condition. If the
hospital can diagnose and treat your condition in several ways, it is more
likely that the treatment you receive will be the most effective, appropriate
and cost-effective.
Ask the hospital to list the full range of specialty department backup available in the hospital if complications arise.
Ask the hospital to list the full range of options for diagnosing and
treating your condition.
4. Participation in Research and Education
What type of hospital is it?
There are many advantages to selecting a hospital that combines patient care with research and education.
Ideally, the individuals engaged in patient care, research and teaching are organized around a given disease or class of patients, facilitating the sharing of knowledge, research and clinical findings. This approach results in the most rapid transfer of basic scientific knowledge from the laboratory to care delivery at the patient's bedside.
Those individuals on the staff of such hospitals are exposed to an important interchange of ideas. They also are exposed to the newest treatments and forms of technology. At teaching hospitals, physicians are available 24 hours a day.
There may be other advantages to choosing a teaching hospital. Private,
not-for-profit teaching hospitals had lower mortality rates than other types of
hospitals, according to a study in a December 1989 issue of the New England
Journal of Medicine.
Ask if the hospital is associated with a teaching hospital.
Ask if the hospital conducts research or clinical trials related to your condition.
Ask if the hospital has a fully accredited residency training program.
5. Patient Satisfaction
Is everybody happy?
If you ask one person about his or her experience with a doctor or hospital, you get one person's point of view. Patient satisfaction surveys allow you to judge quality based on the experience of many previous patients. This provides you with a more objective measure to use.
Most hospitals routinely use surveys to find out if patients are satisfied with their medical experiences. The hospital can use these results to improve its services. Patient satisfaction often reflects the personal side of care such as, How willing are the doctors and nurses to listen? Do they answer questions and explain treatments? How much time does the doctor spend with the patient? Is the hospital clean? Is the food good?
Patient satisfaction information can predict what your experience in a
particular hospital is likely to be.
Ask what methods, such as surveys and questionnaires, the hospital uses to monitor patient satisfaction.
Ask for the results of the latest survey.
Ask how satisfied patients are with their hospital care.
Ask how satisfied patients are with the outpatient services.
Ask if there is someone who handles complaints that may arise during a
hospital stay.
6. Outcome Indicators
What are the risks and how did the patient do?
It is important to find out how well other patients recover from the surgery or treatment that you need. Many outcome indicators can be used to measure a treatment's success.
The mortality rate, or the percentage of deaths associated with a certain procedure is an important measure of risk.
The morbidity, or complication, rate following treatment such as the rate of infection or unplanned readmission is a sensitive measure of quality.
The health status and quality of life patients experience following treatments are also outcome measures. Returning to work, being able to perform the usual activities of daily living and being free from pain are some important indicators of successful care.
Your risks and your chances for a good outcome are also affected by the type of patient you are. Mortality rates are generally higher for patients over age 65. People with certain conditions have a higher risk for developing complications. For people with cancer, the stage of the disease at the time it is diagnosed is usually the most important factor in determining outcome.
Although all risks associated with a procedure can't be eliminated, especially for seriously ill patients, they can be reduced by choosing a hospital with good outcomes for the treatment you are about to undergo.
Try to compare outcomes for patients most like yourself so that you know
what your outcome is most likely to be. This may be difficult because rates may
be reported differently from hospital to hospital.
Ask the doctor or hospital for the mortality rate at the time of discharge for the specialized procedure that you might need.
Ask for the complication rate following this procedure.
Ask about 5-year survival rates for specific types of cancer.
Ask about health status and quality of life that can be expected following
treatment.
Credentials
Is the doctor board certified?
Yes No
Is the hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)?
Yes No
Experience
How many times has the doctor performed this procedure?
How does that compare with the experience of other specialists?
How often is the procedure performed at this hospital?
Range of Services
If complications arise, what specialty department expertise is available?
What is the full range of options available for diagnosing and treating this
condition?
Participation in Research and Education
Is the hospital associated with a teaching hospital?
Yes No
Does the hospital have a fully accredited residency training program?
Yes No
Does the hospital conduct basic research or clinical trials related to this condition?
Yes No
Patient Satisfaction
What methods, such as surveys and questionnaires, does the hospital use to
monitor patient satisfaction?
What are the results of the latest survey?
How satisfied are patients with their hospital care?
very dissatisfied dissatisfied
satisfied very satisfied
How satisfied are patients with the outpatient services?
very dissatisfied dissatisfied
satisfied very satisfied
Is there someone to handle complaints that may arise during a hospital stay?
Yes No
Outcomes
What is the mortality rate for this specialized procedure?
What is the complication rate following this procedure?
What is the 5-year survival rate for this specific type of cancer?
What is the health status and quality of life that can be expected following
treatment?
Reprinted with permission by: Med Help International
