How to make the most of hospital-based data

Hospitals have different ways of tracking

Collecting outcomes data has been a matter of survival for hospitals, which face both managed care and accreditation demands as well as unprecedented cost constraints. How can you access that information?

Here is some advice on how to get started from Susan Bellile, MA, MBA, president of Q3, a consulting firm based in Westchester, IL, that specializes in helping physician groups gather and analyze outcomes data:

r Find out who handles the information and what indicators they are tracking.

Every hospital collects performance assessment information on several clinical indicators as a requirement of accreditation by the Joint Commission on Accreditation of Healthcare Organizations. Hospitals also often have a standard report on cost or charges and length of stay that they can generate by physician, department, or diagnostic code.

Some hospitals may have sophisticated information systems that provide much more extensive information. "There may be other kinds of specialized database efforts that the hospital is coordinating," says Bellile.

The hospital may have a quality improvement or outcomes management department, or the data may be managed by the finance, medical records, information systems, or utilization review department.

While, of course, this will provide information only for inpatients, "They would have the opportunity to link what happened in the hospital to what they collect outside the hospital," says Bellile.

r Put your information request in writing.

You need to specify the data you are interested in. At a minimum, you would likely request information for the last 12 months by physician and DRG, including the number of cases for each physician and the average hospital charges and average length of stay.

You should also be able to obtain a comparison figure for all patients in that DRG or procedure group who were treated at the hospital.

The letter should be signed by the physicians whose data you are requesting, says Bellile. Be aware that the hospital may place restrictions on your further reporting of the data, she says.

r Determine underlying methods that affect the data.

You'll need to find out how patients are linked to physicians in the data, says Bellile. The case may be assigned to the attending physician, the surgeon, or the admitting physician. This can ultimately affect individual physician profiles.

For example, Bellile recalls a group of plastic and reconstructive surgeons who discovered a couple of craniotomies on their report - surgeries they don't perform. On closer examination, it turned out that they were the admitting physicians in the emergency department and the surgery was performed as part of a trauma case.

Are the data being entered correctly?

"The data is only as good as the [skills of] the people putting it in," says Phyllis Brown, administrator of Arkansas Cardiology in Little Rock.

You also want to know whether the hospital uses risk-adjustment and what method is used. For example, the hospital may compute an "expected length of stay" based on measures of the patients' severity of illness.

Finally, if you're looking at financial data, be sure you understand the difference between cost and charges - and how the hospital defines them. Different hospitals may calculate their costs differently.

r Keep data from different hospital reports separate.

If you practice at several hospitals in town, you'll need to get data from all of them. And while you can look for common trends, unfortunately you can't combine the data into a single report, says Bellile.

The hospitals likely use different definitions or methodology in collecting and analyzing the data. For example, they may have differing methods of severity adjustment.

Even with its limitations, hospital data can jump-start or enhance an outcomes program at a physician practice. If you find significant variation within your practice or you don't compare favorably to available benchmarks, you can request more detailed clinical data.

You may even focus on a group of patients "and get down to specifics about what are we doing that keeps them in the hospital longer or costs more," Bellile says.