Measuring Quality

AdventHealth supports AHCA's efforts to make data on healthcare quality more available to the public. The AHCA data only represents one way to measure quality.

For instance, in the AHCA methodology, AdventHealth Orlando is shown as having worse than expected mortality rate for Acute Myocardial Infarction (AMI). Yet in other methodologies – MEDai, Premier, CORE and Apache – AdventHealth has a mortality rate for AMI that is either lower than expected or among the best in the comparison group.

What this illustrates is a need for the consumer to be able to look at a variety of accepted measures of quality before any conclusions are made about a provider or their care. AdventHealth will continue to work with AHCA to insure that the information being shared with the public is meaningful and accurate. AdventHealth will also continue to share with the public our progress in improving quality.

On the face of it, the definition of quality healthcare seems straightforward enough: “Patients getting the right medicine, treatment or test at the right time, given the patient’s condition.” So why is there such an “alphabet soup” – CMS, AHCA, JCAHO, AHRQ, NCQA, NQF, ASQ, and more1 – of groups working to measure hospital quality? And why do consumers have such a hard time finding and understanding the data?

The reality is, healthcare quality is actually very difficult to measure. In fact, there are so many variables that the groups listed above – and many other experts – have disagreed for years on meaningful comparisons of quality.

AdventHealth Quality Goals

  1. Rank in the Top 10% of hospital nationwide.
  2. Show ongoing cycles of improvement in all areas of patient care.

Some experts favor standardized data systems and/or hospital “report cards.” These reports provide many objective measures of the differences in quality of care, but they can be subject to “gaming” that leads to better report card scores but not necessarily better care. Secondly, the “standardized” data isn’t always “apples to apples.” Some data is mandatory, and other data is voluntary. In either case, the formats vary and may include different quality measures. Thirdly, different hospitals use different data systems and have multiple caregivers documenting their processes – not necessarily in the same way.

AdventHealth continues to voluntarily report data on the quality of patient care in conjunction with the National Hospital Quality Initiative supported by CMS, an agency of the U.S. Department of Health and Human Services that runs Medicare.

Although we are proud of the level of care and service we provide, we are always working to improve our excellent record of quality patient care. The CMS Hospital Quality Initiative gives us access to resources and hands-on training to support our quality improvement efforts.

Current performance improvement initiatives at AdventHealth include participation in the National Hospital Quality Alliance. It may be helpful to refer to the following as you view the report:

  • Measure sample size varies with the size of the hospital. Scores may be impacted by the margin of error that can occur with a small sample size for a small hospital versus a larger facility with greater patient volumes.
  • Sample sizes for Heart Attack Care discharge measures may be smaller than expected at some hospitals because patients who are candidates for open heart surgery are stabilized at one hospital and then transferred to a facility that specializes in interventional cardiac care.
  • Sample sizes also vary, because some patients in a disease category should not receive the standard treatment. For example, a heart attack patient should not receive a beta blocker if he has an allergy or other contraindication to that particular medication.

Finally, although the patient may have received the appropriate treatment, it may not have been clearly documented in the medical record.

Although the reports show that AdventHealth compares favorably to other accredited organizations, both in the state of Florida and across the country, there is always room for improvement.

Complexity aside, the reality is that hospitals must be more open about quality measures and be more “transparent” with their quality data. And consumers must recognize that quality measures are complex and comparisons among hospitals should be viewed cautiously.

1Center for Medicare and Medicaid Services (CMS), Agency for Healthcare Administration (AHCA), Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), Agency for Health Care Research and Quality (AHRQ), National Committee for Quality Assurance (NCQA), National Quality Forum (NQF), and American Society for Quality (ASQ).