Methodology
Recognizing Healthcare Excellence®
Since 2013, The SafeCare Group® published 100 SafeCare Hospitals® that excelled with evidence-based metrics of timeliness of care, safety of care, infections of care, unplanned visits of care, and outcomes of care. The SafeCare Group adopted these relevant metrics for its methodology framework, terming it Recognizing Healthcare Excellence®, as they reflected a Balanced Scorecard of hospital performance.
Hospitals that performed poorly on these evidence-based metrics receive a financial penalty from the Centers for Medicare and Medicaid Services in the Hospital Value Based Program, Hospital Acquired Conditions Reduction Program, and Hospital Readmissions Reduction Program. The top 50 hospitals represent the top one percent of hospitals and only about two percent of hospitals earn the prestigious 100 SafeCare Hospitals distinction.
Patient Satisfaction - rateahospital.com
The SafeCare Group, guided by a decade of emails and letters of complaints, suggestions, and feedback from patients, created Rateahospital.com is an easy tool for patients to find, compare, and review hospitals by sharing caring experiences. It currently reports results for 5 areas using 5 topics as follows:
· Quality - “How good is this hospital?”
· Compassion - “Do they care about you?”
· Trust - “Do you trust them?”
· Relief- “Did the treatment work?”
· Recommend - “Would you go back again?”
According to the Agency for Healthcare Research and Quality, timely care refers to a hospital’s ability to quickly provide care after recognizing a need. The more timely the care, the better their patients' health outcomes - and levels of engagement. The measures of timely care, also known as process of care measures, show how often or how quickly hospitals provide care that research shows gets the best results for patients with certain conditions, and how hospitals use outpatient medical imaging tests (like CT Scans and MRIs).
100 SafeCare Hospitals report measures in these categories because timely care in hospital emergency departments is essential for good patient outcomes. Delays before getting care in the emergency department can reduce the quality of care and increase risks and discomfort for patients with serious illnesses or injuries. Waiting times at different hospitals can vary widely, depending on the number of patients seen, staffing levels, efficiency, admitting procedures, or the availability of inpatient beds.
· Percentage of patients who left the emergency department before being seen
· Percentage of patients who came to the emergency department with stroke symptoms who received brain scan results within 45 minutes of arrival
· Fibrinolytic Therapy Received Within 30 Minutes of ED Arrival
· Average (median) time patients spent in the emergency department before leaving from the visit
· Average (median) time patients spent in the emergency department before leaving from the visit- Psychiatric/Mental Health Patients
· Median Time to Transfer to Another Facility for Acute Coronary Intervention
Modern healthcare employs many types of invasive devices and procedures to treat patients and to help them recover. Hospital acquired infections (HAIs) are infections people get while they are receiving health care for another condition. Infections can be associated with the devices used in medical procedures, such as catheters or ventilators.
Hospital acquired infections measures how often patients in a particular hospital contract certain infections during the course of their medical treatment, when compared to similar hospitals. These infections can often be prevented when hospitals follow guidelines for safe care. Hospitals currently submit information on central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), Methicillin-resistant Staphylococcus Aureus (MRSA) blood infections, and Clostridium difficile (C. diff.) intestinal infections.Approximately 1 of every 25 hospitalized patients in the United States has an hospital infection, meaning that nearly 650,000 patients contract one of these infections each year during the course of their treatment. The infections measures apply to all patients treated in hospitals, including adult, pediatric, neonatal, and geriatric. The infections occurred in intensive care units (ICUs), neonatal ICUs, and medical, surgical, and medical/surgical ward locations. 100 SafeCare Hospitals report hospital-specific infections rates for the following measures:
· Bloodstream infections
· Urinary catheter-associated infections
· Surgical site infections
· MRSA blood infections
· C. Diff intestinal infections
Calculations for the In-hospital Infections adjust for differences in the characteristics of hospitals and patients “that takes into account differences in the types of patients a hospital treats.”
Serious complications are serious injuries known as hospital acquired complications (HACs) that affect patients following initial hospital admission. Most commonly, these injuries are caused by healthcare-associated infections and other issues resulting as side effects from primary treatments and procedures. Hospitals can often prevent these events by following best practices for treating patients.
Serious complications are avoidable safety events (medical errors) following surgeries, procedures, and childbirth. The overall score for serious complications is based on how often adult patients had certain serious, but potentially preventable, complications related to medical or surgical inpatient hospital care.13% of hospital admissions are associated with hospital complications that seriously harmed patients. The in-hospital complications score is based on how often adult patients had certain serious, but potentially preventable, complications related to medical or surgical inpatient hospital care. These complications include: heart attack, pneumonia, sepsis/septicemia/shock, surgical site bleeding, pulmonary embolism, mechanical complications or death. 100 SafeCare Hospitals reports hospital-specific complications rates for the following measures:
· Hip/knee replacement complications
· Pressure sores
· Hospital-acquired lung puncture
· Broken hip from a fall
· Bleeding or bruising after surgery
· Kidney and diabetic complications after surgery
· Respiratory failure after surgery
· Blood clots, in the lung or a large vein, after surgery
· Blood stream infection after surgery
· A wound that splits open after surgery
· Accidental cuts and tears during surgery
The measures of serious complications are risk adjusted “to account for differences in hospital patients’ characteristics. In addition, the score is “smoothed” to reflect the fact that measures for small hospitals are measured less accurately (i.e., are less reliable) than for larger hospitals.”
Unplanned rehospitalizations show how often patients who are hospitalized for certain conditions or procedures were hospitalized again within 30 days. Rehospitalization (also called readmissions) rates are measured within 30 days because hospitalizations after a longer time period may have less to do with the care the hospital provided and more to do with other complicating illnesses, patients’ own behavior, or other care services patients received after they leave the hospital.
A hospital readmission occurs when a patient is discharged from the hospital and then admitted back into the hospital within a short period of time. A high rate of patient readmissions may indicate inadequate quality of care in the hospital and/or a lack of appropriate post-discharge planning and care coordination. An unplanned readmission is an urgent readmission within 30 days from a previous admission or 7 days of an outpatient procedure. Returning to the hospital after a longer period may have less to do with the care the hospital provided, and more to do with other complicating illnesses, patients’ own behavior, or other care services patients receive after they leave the hospital.
Unplanned Readmissions are associated with increased mortality and higher health care costs. Hospital readmissions are frequent, harmful and costly - 2.3 million patients annually, are re-hospitalized within 30 days after discharge. The Medicare Payment Advisory Commission, a nonpartisan legislative branch agency, reported that about 75 % of such readmissions can and should be avoided. 100 SafeCare Hospitals reports hospital-specific readmissions rates for all causes in the following measure:
· 30-day Hospital Wide Readmissions
100 SafeCare Hospitals reports
hospital-specific 30-day readmissions rates for the following conditions and
surgeries: · Chronic obstructive pulmonary disease · Myocardial infarction · Heart failure ·
Hip/Knee Replacement ·
Coronary Artery Bypass
and Grafting ·
Colonoscopy ·
Outpatient surgery ·
Outpatient
chemotherapy
To make comparisons fair, hospitals’ 30-day readmission results are risk-adjusted to account “for differences in hospital patients’ characteristics that may make readmission more likely, including age, gender, past medical history, and other diseases or conditions (comorbidities) that patients had when they arrived at the hospital.”
Death (mortality) rates show how often patients who are hospitalized for certain conditions or procedures die in the 30 days after treatments. Deaths can be for any reason and can occur in the hospital or after discharge.
Hospital deaths are defined as any death occurring within 30 days of entering the hospital for a specific condition, diagnosis of an infection, and surgery. Death rates are measured within 30 days, because deaths after a longer time period may have less to do with the care the hospital provided and more to do with other complicating illnesses, patients’ own behavior, or other care services patients received after they leave the hospital.
There are an estimated 715,000 to 776,000 hospital deaths each year in the United States. Hospital deaths can be for any reason, including preventable medical errors, and can occur in the hospital or after discharge. Estimates of preventable hospital deaths from medical errors range from 250,000 to 440,000 each year. 100 SafeCare Hospitals reports hospital-specific 30-day death rates for the following conditions and surgeries:
· Chronic obstructive pulmonary disease
· Myocardial infarction
· Heart failure
· Pneumonia
· Stroke
· Coronary Artery Bypass and Grafting
To accurately compare hospital performance, the 30-day deaths “adjust for patient characteristics that may make death more likely. These characteristics include the patient’s age, past medical history, and other diseases or conditions (comorbidities) the patient had when they were admitted that are known to increase the patient’s chance of death.”
