Hospitals get A, B or C grades on patient safety

An employer-backed rating system seeks to give patients an easier way to pick facilities that prevent falls, medication errors and other safety hazards.

By — Posted June 27, 2012

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Hospitals are getting another grade.

Dozens of quality and safety report cards already scrutinize hospital performance. Now patients and physicians will see a letter grade to sum up how well a hospital does on 26 patient-safety metrics based on publicly collected data.

The grading system was compiled by a panel of patient safety experts working on behalf of the employer-backed Leapfrog Group, which for years has issued reports on how well hospitals meet safety standards but never before issued summary grades. Anyone can find out how hospitals in their area score at Leapfrog’s free website, Hospital Safety Score (link).

Of the 2,652 general hospitals graded, 53% got either an A or B. About 40% got C’s, while the grades for 5% of hospitals are “pending.” That means the hospitals were in D or F territory, but they have until November — when Leapfrog will issue updated grades — to improve their performances. The grades will be updated annually thereafter.

Critical-access, specialty and government hospitals were not graded. Hospitals in Maryland, Guam and Puerto Rico are not federally required to report certain safety data, so they are not graded.

The Leapfrog grades stand in stark contrast to the Dept. of Health and Human Services’ Hospital Compare website, where the vast majority of hospitals are rated as “average” on most measures and there is no composite score or grade.

Research on quality and safety report cards has found that they have little impact on where patients seek care and do not directly lead to care improvements. One big reason for that, experts say, is that the reports are frequently difficult for patients to understand. Issuing a summary grade is supposed to address that problem.

Response by physicians is key

Significant improvement on safety will come from the doctors working in hospitals, said Ashish K. Jha, MD, MPH, one of nine prominent medical experts who devised the grading methodology.

“Physicians are going to be the linchpin here. Consumers might understand that a hospital might be at a C, but they are not going to know what to do about it. Physicians have a fiduciary responsibility to patients to ensure safety, and they can be very powerful change agents,” said Dr. Jha, associate professor of health policy and management at Harvard University School of Public Health in Boston.

“If you’re a physician working at a hospital that got a C, that grade will become a D or F if the hospital doesn’t improve,” he continued. “It’s incumbent on doctors to ask, ‘What can we do better?’ If physicians start asking those questions, hospitals are going to respond.”

The grading system draws on Leapfrog’s hospital survey data on matters such as teamwork training, medication reconciliation, hand hygiene and ventilator care.

Measures devised by the Centers for Medicare & Medicaid Services, the Joint Commission, the Centers for Disease Control and Prevention, and the Agency for Healthcare Research and Quality also are included. These metrics gauge how well hospitals prevent safety hazards such as patient falls, pressure ulcers, central line-associated bloodstream infections and postoperative deep venous thromboses.

The American Hospital Assn. said the new hospital grades will mislead patients.

“Many of the measures Leapfrog uses to grade hospitals are flawed, and they do not accurately portray a picture of the safety efforts made by hospitals,” said Nancy Foster, the association’s vice president of quality and patient safety policy.

Dr. Jha acknowledged shortcomings in the metrics and data publicly available for safety grading, but defended Leapfrog’s approach.

“If the question is, ‘Are the measures in here all perfect?’ then no, not even close,” he said. “The major problem with the patient safety movement is we’ve been stuck, because everyone’s looking for the perfect measures. Leapfrog is saying we can’t wait for perfection. These are good data, and we have to move forward.”

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How hospitals score on patient safety

More than half of the 2,652 hospitals graded by the employer-backed Leapfrog Group received honor-roll grades of A or B. Hospitals whose grades are “pending” earned D’s and F’s, but they have until November to improve before updated grades are issued.

Grade Hospitals Hospitals graded
A 729 27%
B 679 26%
C 1,111 42%
Pending 132 5%

Source: Leapfrog Group

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