NC hospital issues quality report cards

Quality reports cover variety of conditions

In a move that may become more common in the near future, a hospital in Salisbury, NC, is issuing its own quality report cards to show its community how well it fares in meeting national standards for patient care. The quality improvement leaders at the hospital say they chose to release the information now partly because they expect quality data to be released by third parties before long.

Rowan Regional Medical Center recently began issuing quality reports for a variety of health conditions, based on national standards for patient care. With future quality reports, the data show how Rowan Regional compares with other hospitals in the state and nation for treatment of more than a dozen patient conditions.

The first report, from data collected since last summer, provides a comparison of Rowan Regional’s treatment of patients with congestive heart failure, says LaVaughn Beaver, RN, CPHQ, manager of case management at the hospital and the administrator responsible for data collection.

"When the core measures came about, we began to look at how we could proactively affect our patient outcomes using these measures," she says. "We began to incorporate them into our current pathways and current trends for taking care of patients. Our administration decided to make them public, knowing that they would be made public anyway because the Joint Commission and others would be publishing that data eventually."

Charles W. Elliott Jr., chief executive officer at the hospital, says the time was right to release the data, and not just because Rowan Regional fared well in comparison to the national standards.

"For several years, hospitals, physicians, health care professional associations, and government agencies have been discussing how to select criteria that would provide an accurate comparison of quality measures for patient care," he says. "Our physicians and staff have always made quality patient care our No. 1 priority, and this first comparison shows the results of those efforts."

Much of Rowan Regional’s performance will be compared to national data on specific conditions. The national collection of data covers 10 measures of medical treatment for four serious conditions — congestive heart failure, acute heart attack, pregnancy and related conditions, and pneumonia. Each quarter, as additional data are collected, Rowan Regional will issue a quality report about a specific patient condition.

Quality improvement experts say the treatment guidelines are factors that can be monitored to evaluate the quality of health care delivery. For congestive heart failure patients, medical records are monitored to make sure patients receive these:

  • discharge instructions, which must include activity level, diet, follow-up appointment, medications, worsening symptoms, and weight monitoring;
  • a left ventricular function (LVF) assessment — done by an echocardiogram or other tests;
  • ACE inhibitors for left ventricular systolic dysfunction;
  • adult smoking cessation advice.

Comparisons between hospitals are made on a percentage basis, showing how much the hospitals comply with the guidelines. Rowan Regional fared well on three of the four measures for congestive heart failure, coming up short on the ACE inhibitor measure. (For the outcomes that Rowan Regional reported recently, see box, below.)

Rowan Regional Medical Center Outcomes

CHF-1 (discharge instructions)
Rowan Regional 76%
Hospitals in North Carolina 40%
National data 26%

CHF-2 (LVF assessment)
Rowan Regional 85%
Hospitals in North Carolina 69%
National data 79%

CHF-3 (ACE inhibitors)
Rowan Regional 64%
Hospitals in North Carolina 66%
National data 86%

CHF-4 (smoking cessation advice)
Rowan Regional 80%
Hospitals in North Carolina 47%
National data 38%

Each day, Rowan Regional’s case management department reviews patient records to see if the selected criteria are followed by physicians, nurses, and other health care professionals. Action is taken immediately for cases that need attention, such as a patient who didn’t get proper instructions about his or her activity level and diet. The goal is to address all appropriate issues during the patient’s stay in the hospital.

Rowan Regional releases data about congestive heart failure now because comparative data are available from other institutions, Elliot says. Results of future quality reports will be made public and posted on the hospital’s web site.

"Our case management process has been in place for nearly 10 years," Elliott says. "As a result, we were already collecting much of the data required for these reports and already had a comprehensive review mechanism for addressing issues of quality care. We expected to do very well in comparison with other hospitals. Overall, we are extremely pleased, and we recognize there are opportunities to improve all processes for patient care."

Beaver says the reaction from the community has been good so far, with many business leaders and others pleased that the hospital is reporting good patient outcomes.

"We felt that the core measures would be best to use because we have benchmarking data that are pretty substantial," she says. "It wasn’t just a matter of wanting to report our good results. We knew that we would report it at some point, so when we did comparisons and saw how we looked, that was even more encouraging."

Beaver says the hospital’s data collection process, in place for years, was instrumental in making the report card feasible. Without substantial, reliable data to compare to the national standards, an organization will find it impossible to release a quality report that is meaningful, she says. Rowan Regional’s good report can be traced to good data collection and using the national data to improve care on a local level, she says.

"Using the core measures data to put processes in place to make improvement is the big thing," she says. "You have to use the data and let the data help you make changes that improve patient care. When it’s used in that manner, you’re going to constantly get better."

When the first complement of national indicators came out, Rowan Regional used them to be proactive with improving patient care. Beaver recommends taking some time to improve your processes, based on the national data, before deciding to release your own report card.

"Be proactive. Have your processes in place before you go on to the reporting system. We’re always comparing ourselves to nationally known data to see how we can improve, and then implementing the processes that will improve patient care," she adds. "So releasing the data on how well that works was just a natural extension of what we were doing all along."

[For more information, contact:

Rowan Regional Medical Center, 612 Macksville Ave., Salisbury, NC 28144. Telephone: (704) 210-5000.]