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    Mailing Address
    THCIC
    Dept. of State Health Services
    Center for Health Statistics, MC 1898
    PO Box 149347
    Austin, Texas 78714-9347

    Location
    Moreton Building, M-660
    1100 West 49th Street
    Austin, TX 78756

    512-776-7261
    512-776-7740 (fax)
    Email: thcichelp@dshs.state.tx.us

Guide to Understanding the Hospital-Specific Quality Reports

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The Texas Health Care Information Collection (THCIC), created by the Texas Legislature in 1995, gathers information from hospitals and health maintenance organizations and publishes reports to help consumers compare and choose their hospitals and health plans. The hospital-specific reports published here show how Texas hospitals performed in calendar year 2010, based on indicators of hospital quality developed by the federal government.

Many factors affect the selection of a hospital, and these quality indicators are only one source of information to consider. Other factors that may affect your selection of a hospital include which services (benefits) your health plan covers, convenience, where your doctor practices and recommendations from family and friends. You can use this information to talk with your doctor and hospital, and take a more active role in making health care decisions.

For this report, THCIC used a widely accepted definition of quality care: "The degree to which health services for individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge." In other words, quality care meets the needs of the patient and is based on evidence of effectiveness. The performance of the hospitals in this report as suggested by the quality indicators may reflect whether the care ordered by a physician and delivered at a given hospital was consistent with standards of care. However, it also may reflect factors that do not relate to hospital performance, such as patient or physician preference, stage of illness, age, other accompanying illnesses or conditions, or the availability of specialized equipment or doctors. While the data analysis method attempts to adjust for many of these factors, it is not possible to do so perfectly.

You should remember that doctors direct and oversee the medical care that is delivered at hospitals, and prescribe tests, medications and treatments. This report does not separate the effect of the doctor from the effect of the hospital. The quality of care provided in a hospital comes from how well its doctors, nurses, support staff and management work together as well as the technology and other resources available in the facility. If a major change occurs that impacts any of these–such as the departure of a key surgeon or the addition of new technology–the indicators may change dramatically and rapidly. As you talk with your doctor and hospital about your care, ask questions about what changes, if any, have occurred that could impact the care you receive. Medical practice and standards of care change over time as new technology and medicines become available, and as research studies demonstrate effectiveness of specific treatments or procedures. The THCIC data is particularly valuable for looking at hospital performance trends over time. Data for 2006 through 2010 can be compared, but, because of changes in methodology, data for these years should not be compared with earlier years.

Where do the THCIC data come from?

The data collected by the THCIC comes from information that hospitals record primarily for billing purposes. This type of record, referred to as "administrative data," consists of diagnoses and procedures along with information about the patient's age, gender, accompanying medical conditions and discharge status. Hospital administrative data offer a window into the medical care delivered in our hospitals. These data, which are collected as a routine step in the delivery of hospital services, provide information on diagnoses, procedures, age, gender, admission source, and discharge status. From these data elements, it is possible to construct a picture of the quality of medical care. Although quality assessments based on administrative data cannot be definitive, they can be used to flag potential quality problems and success stories, which can then be further investigated and studied. The THCIC data reflect only the care provided to patients who were discharged from the hospital in calendar year 2010. No patient and physician identifying information is available to preserve confidentiality. As a further step to protect patient and physician confidentiality, when fewer than five patients had a specific procedure in a facility, no data are included in the report. If a hospital had fewer than 30 patients with a specific diagnosis or procedure, no comparative rates were calculated because the results would have been less reliable.

After THCIC checks the data for errors, hospitals are given a short time to review and fix mistakes in the data they supplied. Hospitals are also able to review this report before its release. Hospital comments regarding their performance on these indicators are included in the report and are available on the THCIC's Web site (2011 comments) (2010 comments) (2009 comments).

Most rural hospitals are not included in this report because state law does not require them to report data to the THCIC.

What do the hospital-specific comparative reports mean?

For many years, the federal government has supported research into what factors affect quality of health care services, including care delivered in hospitals. The federal Agency for Healthcare Research and Quality (AHRQ) has conducted extensive research; in December 2009, AHRQ released updated software, used to prepare this report, that analyzes administrative data and assesses performance on certain indicators that studies have shown are related to quality. AHRQ has identified four categories of quality indicators which appear to have relationships to the outcomes of care provided within hospitals: volume, mortality for specific procedures, mortality for specific conditions, and utilization.

Research has confirmed that the rate of patient deaths for certain procedures and conditions may be associated with quality of care. While research can predict an expected range of patient deaths for a given procedure or condition, mortality rates above or below the expected range may have quality implications. For some procedures, research has shown that overuse, under use and misuse (utilization) may affect patient outcomes. For certain procedures, there may be a direct relationship between the number of times (volume) the procedure is performed in a hospital and the patient's positive outcome.

AHRQ originally developed and refined these indicators for use in quality improvement and national tracking. While the focus of the initial QI development work was not on hospital-level comparative reporting or for uses such as health care purchasing or payment, the increased demand for standardized hospital-level comparative data in a time of growing quality concerns has led to their adoption for these new purposes. AHRQ has listed several considerations when using the the quality indicators for public reporting of hospital-specific performance in its publication Guidance on Using the AHRQ QI for Hospital-Level Comparative Reporting, released June 2009.

The Texas Legislature directed the THCIC to report the performance of Texas hospitals on quality measures, and THCIC and its advisory groups of medical and hospital professionals determined the AHRQ indicators represent the current state-of-the-art in assessing quality of care using administrative data. Because the reports are based on administrative data, the results have limitations. Recording administrative data–or coding–varies among hospitals, primarily due to different requirements by insurance payers. Individual judgment often is required. Codes do not provide specific details about a patient's condition at the time of admission, nor capture everything that occurs during the hospital stay. Especially when reviewing mortality rates, remember that medicine is not an exact science and death may occur even when all standards of care are followed. These reports provide some information about hospital performance, but consider the limitations of the data in your decision-making process.

Are the comparisons between hospitals appropriate?

Because of their expertise, some hospitals treat more high-risk patients. And, some patients arrive at hospitals sicker than others. That makes comparing hospital mortality rates for patients with the same illness, but different health status, difficult. To compensate for this fact, the THCIC has "risk adjusted" the mortality and utilization data for each hospital to reflect the score the hospital would have had it provided services to the average mix of sick, complicated patients. The risk and severity adjustments allow researchers and statisticians to separate the effects the patient and his degree of illness have from the hospital stay. THCIC used a risk adjustment methodology developed by 3M Corporation and AHRQ. Detailed information about the process used to organize and adjust the data for study purposes can be obtained on the AHRQ website.

What is the best way to use these reports?

    1. Familiarize yourself with the 25 indicators provided in this report.
    2. Decide which quality indicator is most relevant to you, and review that chart. Look to see if the hospital you are interested in is listed. If not, it means that the hospital did not have any cases for that indicator. You might wish to look at another quality indicator for that hospital's performance.
    3. Hospitals are arranged alphabetically by metropolitan area. You may wish to compare the performance of hospitals in your area or those that are covered by your health insurance plan. Each chart provides the results for specific hospitals as well as a statewide average. Note that each chart provides guidance on how to interpret the findings.
    4. View the hospital's comments. The hospital name will be followed by (C) in the table if the facility provided comments. It is especially important to view the hospital's comments if performance is lower than expected. Go to the list of comments (2011)  (2010) (2009) or find the hospital in the table of hospital characteristics to access specific comments.
    5. A table of hospital characteristics provides the number of licensed beds for each hospital. If the hospital is a teaching facility (one that teaches medical students), it is noted. It is more appropriate to compare the performance of similar sizes and types of hospitals.
    6. Do not try to compare the results of these reports with other reports you may find on the Internet or elsewhere. The results are sure to be different, unless the exact same methodology is used. It is more appropriate to track hospital performance over several years using the same data source.

Definitions of terms used in the charts and tables of data

  • Confidence Interval - A range that depicts the likelihood that a hospital's performance could be influenced by random chance. The larger the range is, the greater the possibility that the hospital's performance may be influenced by random chance. The range will vary for each hospital depending upon the number of cases or deaths for that condition or for that procedure, and the standard error rate for that year. If the confidence interval range is below the state average, the hospital's rate is significantly lower than the state average. If the confidence interval range is above the state average, the hospital's rate is significantly higher than the state average. If the state average is within the hospital's confidence interval range, the hospital's rate is not significantly different from the state average.

  • Expected Rate - The hospital's expected rate is calculated by applying an average performance rate to the hospital's case mix. This rate reflects an expectation of the hospital's mortality or utilization rates if it had performed at the level of the state average.

  • Metropolitan Statistical Area (MSA) - Geographic area consisting of a large population nucleus together with adjacent communities having a high degree of economic and social integration with the nucleus.

  • Observed Rate (Mortality Indicators) - The number of patient deaths for a specific condition or procedure divided by the total number of patients admitted for the condition being treated. Consumers can consider observed rates as simple measures of performance. When compared to the risk-adjusted rates, consumers can see the impact of patient casemix on that hospital's performance.

  • Observed Rate (Utilization Indicators) - The number of patient cases for a specific procedure divided by the total number of patients admitted for the condition being treated. Consumers can consider observed rates as a simple measure of performance. The utilization indicators are not risk-adjusted.

  • Risk-adjusted rate - Adjustments made to the THCIC data based on national patient demographics such as age, gender and medical codes (diagnostic groups) for a specific condition or procedure. The risk-adjusted rate is the best estimate of what the hospital's rates would have been if the hospital had a mix of patients identical to a national-average patient mix for that year.

    Hospitals with significantly lower risk-adjusted rates than observed rates may have a more complex patient casemix. Hospitals with significantly higher risk-adjusted rates than observed rates may have a less complex patient casemix.


Return to Hospital Level Report

Last Updated September 9, 2010

 

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Last updated June 09, 2014