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Comparing the numbers

The Hospital Compare Web site of the U.S. Department of Health and Human Services has placed common performance measures within the reach of the majority patients and lately expanded to add post-surgical mortality. The site does not offer mortality rates at individual hospitals; it in its place compares the hospital with the national rate.

Some hospitals already publish quality indicators. Integris Health and St. Francis Hospital offer performance measures on their Web sites. However, the information is mainly what is reported to the Medicare agency and posted on the Hospital Compare site.

Dr. Kent Towsley, foundation principal clinical coordinator, said the agency's objective is to improve transparency, explaining, "Part of the reason we're doing this is, you can't manage something if you can't measure it."

While patients are extremely faithful to certain hospitals and doctors, he said, greater transparency would permit them to evaluate their care.

"Ultimately," he said, "Medicare is talking about rolling out physician-level data."

The foundation is one of 53 "quality-improvement organizations" that bond with the Medicare agency.

What happens with more information?

Results of greater disclosure are mixed. A February study in The New England Journal of Medicine found hospitals that engaged in public reporting and pay for performance showed "modestly greater" improvements in quality than did hospitals that only reported information. The study called for further research into which incentives stimulate the greatest improvement and whether the benefits are more important than the costs.

A study in the September issue of the Archives of Surgery found six hospital-comparison Web sites produced inconsistent results and used inappropriate or incomplete standards to assess quality.



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