Online database aims to help health care consumers in Yakima Valley, across state make the right choices

Dec. 20--A new online database aims to give health care consumers and providers an easy way to compare quality across clinics and hospitals.

Patients at Family Medicine of Yakima could see, for example, that their clinic performs worse than the state average in screening for breast and cervical cancer, but better than average in screening for colon cancer.

Yakima Regional Medical and Cardiac Center is below average at explaining medications, but above average at getting frequent ER patients into a new care plan.

In creating the public, searchable database, the nonprofit Washington Health Alliance hopes to empower patients to make smart choices in seeking care.

"By itself, (transparency)'s not going to change everything, but you can't change things without it," said John Gallagher, the Alliance's director of communications and development. "And having comparative public data available really is important to identify the areas for improvement."

"In general, nobody's good at everything; everybody has an opportunity for improvement, but until that public comparative data is out there, people don't know," he said.

The "Community Checkup," published earlier this month, compares clinics, hospitals, medical groups and counties on 52 measures, from rates of hospital-acquired infections to use of recommended screenings to overall patient experience.

Yakima County as a whole doesn't come out too well. The county performs lower than average on access to preventive care for young adults and on hospital

readmissions; lower than average on screening for chlamydia and screening for breast, cervical and colon cancer; and lower than average on avoiding antibiotic use in nonbacterial infections, for example.

According to the Checkup data, the county performs above average only in prescribing generic drugs instead of name brands for attention deficit-hyperactivity disorder (ADHD), high blood pressure and antacids.

Individual clinics, hospitals and medical groups are all over the map. It's important to note the year from which the data on each category came, as changes could have been implemented since then; as well as the state averages against which the clinics are being compared.

The extensive database lets users sort by Medicaid or commercially insured patient results; by county or provider type; by dozens of different groupings of quality metrics; or just by looking at a single facility's full scorecard in a given category. It can be a little overwhelming -- though still much more user-friendly than most health care websites.

That's not saying much, Gallagher said. The Health Alliance is working to reorganize the website.

One notable limitation is that the database doesn't compare results on measures where there's data on fewer than 100 patients at the facility in question, which leaves big gaps in the report. It also doesn't include complete data on all uninsured patients or self-funded insurance plans.

The data came from different sources, primarily from commercial insurance and managed care health plans, and from self-reported figures collected by the Washington State Hospital Association. The state also provided data for measures such as immunization rates.

Patients aren't the only target audience for the tool. The Health Alliance wants providers to be able to learn from others in the state, if there's an obvious leader in particular measures.

"It gives folks an opportunity to at least have an internal conversation about where there might be some possibilities for improvement," he said. "It's not an overnight process; it takes time for people to kind of dig into the data and have conversations and really determine what they want to do."

Kevin Heidrick, interim chief medical officer for Yakima Valley Farm Workers Clinic, said he's still getting familiar with the site.

Once it's more fully populated, he said, he sees it being a "very useful concept," though he's not sure how accessible it will be to people who aren't computer-savvy.

"There's got to be some public education that goes along with this," he said. "You can post data; you can post quality metrics; but if patients don't understand the concepts behind those ... you may not achieve your purpose."

But if patients can learn to use it, he said, this tool fits right in with where health care is going, with getting patients actively engaged in their own care.

Consumers should keep in mind that it's tricky to directly compare health care providers without knowing the demographics of their patient populations, said Mary Kay Clunies-Ross, spokeswoman for the state Hospital Association.

For example, lots of communities across Washington may be aging faster than adjacent communities, which affects patient outcomes.

"As we get more sophisticated data, we'll really be able to compare not just hospital to hospital, but like-patient-base to like-patient-base," she said. "We'll really be able to tell ... if it's in the physician care or the patient base."

The Hospital Association has its own quality comparison site, though it's limited to hospitals. Clunies-Ross said they try to pair that site with tips for patients and questions to ask their providers. They also have a site listing average charges for procedures, such as the pricing data from the Centers for Medicare and Medicaid Services.

Patients should be informed by these sites, she said -- "like you're informed by Amazon ratings" -- but it takes a more personal conversation to decide on the best provider for their specific needs.

"I think the hardest thing is what we really want when we're sick, is for someone to tell us if we're going to get better or not, and I haven't found that website yet," she said.

"I don't think there's any be-all, end-alls, but it is a really good start."

The end goal of increasing health care transparency is to make it clearer where providers and health systems can make changes to improve care and reduce cost.

Past studies have pegged the average time it takes for best practices to become standard in medicine at about 17 years, so Gallagher said they recognize the journey toward health care transparency and better quality will be slow.

"We're talking about changing systems, and it takes a lot of hard work to make change within a system. ... I'm not saying we should wait that long; we don't have that kind of time to waste," he said. "But you're turning around a massive ship, and that's a pretty large undertaking."

-- Molly Rosbach can be reached at 509-577-7728 or [email protected].

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