A state program designed to provide consumers with complete information about the quality of health and hospital care in Rhode Island may become a model for the rest of the nation, officials say. As directed by state law in 1998, the state Department of Health is collecting information in preparation for a 2001 report that will make it possible for Rhode Islanders to find out how each of the state’s hospitals rate in terms of how well patients are treated, as well as how successful the hospitals are in the various procedures they perform.
And as the state collects information, the federal Health Care Financing Administration, which administers the Medicare and Medicaid programs, is looking on. If the state succeeds, the administration may attempt to make the same information available to consumers nationwide, said Lt. Gov. Charles J. Fogarty.
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Hospitals already collect information on patient satisfaction and care success rates when they are preparing for the accreditation process. But with the Department of Health program now under way, the information will be available in a standardized form that will make it possible to compare one hospital to another.
”What we are hoping to do here in Rhode Island is create a unique program to measure patient satisfaction and clinical performance,” said Edward J. Quinlan, president of the Hospital Association of Rhode Island. “The key here is that the information will be standardized.”
The 1998 law, which Fogarty initiated, called for the health department to collect and publish information on all the agencies that it licenses, starting with the hospitals. Fogarty said he proposed the law after learning of a similar program in Cleveland that was done on a voluntary basis. The problem there, however, was that some of the city’s key health care institutions decided not to participate, which weakened the information. A state law requiring participation would make that program a success, he decided.
“The report is there to provide a benchmark; there’s a recognition that we need to get the information out,” Fogarty said. “When you have accurate information (on) how the health care dollar (is spent) I think that helps everybody. We will know exactly what is happening.”
Maureen Maigret, director of policy for the lieutenant governor’s office, said the state is working closely with the Joint Commission on Accreditation of Healthcare Organizations, the Oakbrook Terrace, Ill. nonprofit that accredits hospitals, to avoid redundancies in the way that information is collected. Maigret added that the Health Care Financing Administration, which is developing a quality monitoring program of its own, is “very, very interested in looking at what (happens) in Rhode Island. They’re looking at Rhode Island as a very key state in terms of developing quality measurement on the state level.”
The standard set of data the state collects will allow Rhode Island to compare its health care services to health care operations nationwide, she said.
Before the state can publish such a report, it must understand what people mean when they talk of “quality” hospital care. Last October, the health department published a study on that very subject, and found that doctors, nurses, patients, and non-users of hospitals often define quality care differently.
For example, the study shows that 63 percent of Rhode Islanders think of quality care in terms of how well they were treated, as opposed to how successful their treatment was. Conversely, doctors tended to view quality in terms of outcomes first.
When the data are published in the 2001 report, however, it will contain both quantitative and qualitative information, said Robert J. Marshall Jr., an assistant director for community affairs at the Department of Health. For example, consumers will be able to find out how much a hospital spends on administration and outpatient care, as well as, for instance, what percentage of its female patients get an annual pap smear.
“I expect in the future we’ll have good outcome data as well as the satisfaction and consumer-oriented data from all the institutions,” Marshall said. With the information being made readily available, “There’s going to be some pressure on all of the health industry to pay attention to the needs of the individual consumers – that’s what’s happened in the rest of the world, I don’t see why the health industry would be any different.”
The health department survey showed that of those who expressed an opinion, 49 percent of Rhode Islanders believe the quality of hospital care here is good, while 14 percent believe it to be excellent. Twenty-five percent said it was fair, and 8 percent rated it poor.
Nurses tell a different story. While 43 percent said hospital care in the Ocean State is good, only 7 percent say it is excellent, the survey found. Forty-two percent rated it fair.
The hospital association supported the 1998 Fogarty law, Quinlan said. He added that the latest survey findings on quality hospital care were consistent with other research the industry has seen. For example, Linda Shelton, a spokeswoman for Lifespan, the state’s largest hospital network, said Lifespan hospitals conduct surveys to determine how its hospitals are performing in both outcomes and patient satisfaction.
One hundred thousand surveys will be mailed to Lifespan hospital patients this year, she said, of which about 30,000 or 40,000 are expected to come back. Commenting on the health department’s effort to standardize the information that hospitals keep, she said, “That report is part of a process that is ongoing, and we are very much a part of that process.”
