The nation's largest health care accrediting organization has launched a Web site that lets consumers compare patient care at hospitals statewide and nationally. Despite limited data and sometimes tricky navigation, the site is broad enough in scope and sufficiently thorough in describing its methodology to qualify as one of the most reliable resources of its type, consumer advocates said.

While a government report issued last week faulted other data collected by the group, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), consumer advocates called the site a step in the right direction.

The Quality Check site (www.qualitycheck.org) offers easily understood information for 3,357 hospitals on some or all of these four areas of patient care: heart attack, heart failure, pneumonia, and pregnancy and related conditions. For heart attack, inpatient mortality rates are factored into care grades. For pregnancy and related conditions, infant mortality is factored in.

A check mark in a care category means a hospital's patient treatment in that area is on a par with others in the state or nation. A minus sign means its care is relatively substandard; a plus sign signifies superior care.

JCAHO, which accredits nearly 16,000 facilities nationwide, including nursing homes and clinics, says it hopes eventually to offer similar data on other health care facilities. For now, information on non-hospital facilities is restricted to data such as accreditation dates and decisions, contact information, services offered and locations.

At a press conference , JCAHO president Dennis S. O'Leary said the site takes "the guesswork out of making health care choices" and expressed hope that consumers would use it to find quality medical facilities in advance -- before they need them.

"It is not a subtle message," O'Leary said. "It is . . . an opportunity to have a real conversation with your doctor. Take your data, bring it with you, sit down and talk about your options given various things that might happen into the future."

Arthur Levin, director of the Center for Medical Consumers, a nonprofit consumer advocacy organization, called the site a "good first step" but one whose value is limited until JCAHO includes more conditions.

He was also critical of JCAHO's decision to let each hospital withhold information on up to two care categories. When hospitals first supplied data for the site in 2003, they were required to submit information for at least two of the four care categories. Starting in January 2004, hospitals had to submit data for at least three categories, but that update won't be reflected on the site until October.

"It's somewhat confusing when you allow hospitals to choose what they're going to report on," said Levin. "You can't compare every hospital to every hospital because the measures [categories for which hospitals submitted data] are somewhat different."

Quality Check's launch came just before the release of a report last week faulting JCAHO for overlooking "serious deficiencies" in hospitals' compliance with Medicare requirements in the group's 2000-2002 hospital accreditation reports. In that report, the Government Accountability Office (GAO) -- formerly known as the Government Accounting Office -- found JCAHO had missed problems, later flagged by state agencies, in 123 out of 500 hospital reports the GAO reviewed.

JCAHO disputes the findings. But it supports a proposal to put its hospital accreditation process under control of the federal Centers for Medicare & Medicaid Services (CMS). The government already oversees JCAHO's surveying of other types of facilities seeking accreditation.

Better Screening

Quality Check is not the first Web site to allow consumers to compare quality ratings of health facilities. Last year CMS introduced the National Voluntary Hospital Reporting Initiative (accessed via www.cms.hhs.gov; click on "quality initiatives"), which provides data on similar patient care measures. But more hospitals are listed on Quality Check's site and, with its check marks and stars used to indicate quality, is more user-friendly. (Data on the CMS site are framed as percentages of different patient population bases, making comparisons difficult; plus, the site includes only hospitals that submit data voluntarily. Unaccredited hospitals may be listed on the CMS database.)

Some private organizations, such as Health Grades Inc., have also developed Web sites on which they rate health care facilities. But Levin said their data have tended to lack credibility because rating methods have not been thoroughly explained. Health Grades CEO Kerry Hicks said that, starting last month, the company began offering a fuller explanation.

JCAHO rated each hospital according to how often it complied with standard procedures for treating the four selected conditions compared with other hospitals. Ratings were based on hospital records submitted to JCAHO.

Among treatments it examined: how often heart attack patients received aspirin upon arrival and discharge from the hospital; and how often heart failure patients received prescriptions for ACE inhibitors -- antihypertensive medications used to treat several health conditions -- upon release.

In a national comparison, for example, Suburban Hospital in Bethesda earned check marks for its performance in heart failure and pneumonia care -- meaning it was judged on par with most hospitals in the nation in those types of care. But when its performance in those same categories was compared with hospitals statewide, it earned minuses, suggesting that it was not as good as its local peers.

Loudoun Hospital Center earned pluses -- indicating care superior to peers -- in both the national and statewide categories for heart attack care; Georgetown University Medical Center earned check marks in those categories compared with its District peers.

Georgetown earned a minus for heart failure care in comparison with facilities nationwide; Anne Arundel Medical Center in Annapolis earned a check mark in that measure. Anne Arundel also received a check mark for heart failure in a statewide comparison, as well as in the national and statewide comparisons for pneumonia care.

Site users can directly compare treatment among as many as six hospitals in four different states.

Expansion Plans

By next spring JCAHO plans to add data on surgical infection prevention, which involves adherence to such procedures as administering antibiotics before surgery, according to JCAHO spokesman Mark Forstneger. The group plans to add ratings for pediatric asthma and pain management treatments after that, though no time frame has been determined for those additions, Forstneger said.

Navigating Quality Check can be tricky; on some pages, users who click the "go back" function on their browsers are bumped off the site. Organizers said they are closely monitoring e-mail feedback from consumers and will correct problems where possible. Consumers may also find it necessary to read the site's online 34-page user guide to understand all its features.

Eventually, Forstneger said, JCAHO hopes to include treatment ratings for all types of facilities it accredits. But collecting that information is time-consuming and expensive, he said.

"We have to strike a balance between what we can do and what we'd like to see," Forstneger said.

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