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Why and How We Chose the Five Factors of Reliability

At HSS, improving the outcomes we achieve for patients is one of our most important goals. However, there is no single method for measuring quality that experts have agreed upon. That means it can also be difficult for patients to compare hospitals, since different ones may use different measurements, while others may not measure at all.

So, with the aim of creating a better system of measurement to quantify hospital quality, HSS sought input from patients, families and caregivers to hear what mattered most to them. The Five Factors of Reliability are based in part on that feedback as well as our own research into what matters most, with the goal of helping patients make better informed decisions about their hospital needs.

Five Factors of Reliability

  1. Success Rate: Success rate means the percentage of patients reporting improvement in their condition after having a procedure. HSS is one of the only hospitals in the country to collect success rate information as a standard of care. Because not all hospitals track data like this, it can be difficult to compare success rates between hospitals.

    How We Measure
    At HSS, we measure success rate according to how much better patients report feeling one year after treatment. We obtain success rate data through the use of a survey called a “patient-reported outcome measure” (PROM). All patients receive a PROM before their procedure asking questions about their quality of life. The survey helps to assess general health, ability to complete various activities, level of fatigue, and/or pain. One year after their procedure, patients are randomly selected to complete a follow-up PROM by email, phone or mail. This randomized selection ensures that we quantify our success rates with as little bias as possible.

  2. Patient Experience: Patient experience data focuses on key aspects of care that patients themselves say are important to them and for which patients are the best and/or only source of information. Patient experience data looks at how often patients experienced critical aspects of health care, including communication with their doctors, understanding their medication instructions, and the coordination of their healthcare needs. It does not include things like amenities.

    How We Measure
    All U.S. hospitals measure patient experience using a national survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This data is reported to the Centers for Medicare and Medicaid Services (CMS), a branch of the U.S. Department of Health and Human Services, and is available on the CMS Care Compare website.

    Of the 10 important data points that are collected through the HCAHPS survey, HSS focuses on the metric that tracks patients’ willingness to recommend the hospital to others. Likelihood to recommend is used to create a "net promoter score," a metric that is broadly recognized across industries as the best way to measure customer experience.

  3. Complications: Complications shows how often patients experience a medical problem after their procedure. It is one of several important data points that measures patient safety.

    How We Measure
    The Centers for Medicare and Medicaid Services (CMS) collects safety data from all U.S. hospitals. CMS complications data measures how often patients with Original Medicare experienced serious medical problems during a hospital stay or after having certain inpatient surgical procedures. It also factors in the mortality rate of patients who have been admitted to the hospital with certain conditions. This is the only publicly available source of patient safety data, except that which individual hospitals report on independently.

    For hip and knee replacements, HSS uses a CMS measure that tracks the percentage of hip and knee replacement patients who have a complication up to 90 days after their initial surgery. Procedure-specific data is not available for other HSS procedures, so for these, HSS uses a metric available on CMS Care Compare website, called the Patient Safety Indicator – 90 (PSI-90), which tracks a hospital’s overall ratio of serious complications.

  4. Avoidable Hospital Visits: Like complications, this is another piece of data that measures patient safety. It shows whether a hospital is doing what’s needed to reduce the risk of harmful events such as healthcare-associated infections and other serious problems that require re-hospitalization. Avoidable hospital visits are sometimes referred to as “hospital readmissions.”

    How We Measure
    The Centers for Medicare and Medicaid Services (CMS) collects data from all U.S. hospitals on how often a patient with Original Medicare is re-hospitalized for an avoidable reason within 30 days of being discharged from the hospital. For hip and knee replacements, CMS tracks the percentage of patients who have an unplanned readmission up to 30 days after their initial hip or knee replacement surgery. Procedure-specific data is not available for other HSS procedures, so for these HSS uses a metric available on CMS Care Compare website, which tracks a hospital’s overall rate of unplanned readmissions 30 days after their initial surgery.

    Similar to the complications measure, there is no other source of safety data for U.S. hospitals except for that which individual hospitals report on independently.

  5. Procedure Volume: This data shows how many procedures a hospital performs in a given period of time.

    How We Measure
    HSS uses different measures for tracking our volume for specific procedures.

    Regional Data Source: The New York State Department of Health (NYSDOH) publishes data annually about certain common procedures and conditions that New York hospitals treat along with the number of patients discharged. This data covers all patients, regardless of the type of insurance they have.

    National Data Source: The NYSDOH does not report hospital volumes for rarer procedures such as hip and knee revisions. For these procedures, HSS uses the most recently available data from the Centers for Medicare and Medicaid Services (CMS).

    Internal Data Source: Procedures that do not require an overnight stay (e.g., hip and knee arthroscopy) are not captured by the NYSDOH and many times are not available from CMS either. In the absence of a publicly available source to provide comparisons to other centers, HSS shares its own internally reported volume data.

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