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Clinical Crossroads
Clinician's Corner
December 2, 2009

A 37-Year-Old Man Trying to Choose a High-Quality HospitalReview of Hospital Quality Indicators

Author Affiliations

Author Affiliations: Dr Howell is Director of Critical Care Quality, Silverman Institute for Health Care Quality and Safety, Associate Director of Medical Critical Care, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, and Instructor in Medicine, Harvard Medical School, Boston, Massachusetts.

JAMA. 2009;302(21):2353-2360. doi:10.1001/jama.2009.1684
Abstract

Mr A, a previously healthy 37-year-old man, was diagnosed as having Prinzmetal angina and a hypercoagulable state 3 years ago after an ST-elevation myocardial infarction. Now, his cardiologist is moving and Mr A must select a new physician and health system. Geographic relocation, insurance changes, and other events force millions in the United States to change physicians and hospitals every year. Mr A should begin by choosing a primary care physician, since continuity and coordination of care improves outcomes. Evidence for evaluating specific physicians is less robust, though a variety of sources are available. A broad range of detailed quality information, such as Medicare's Hospital Compare (http://www.hospitalcompare.hhs.gov/), is available for selecting a hospital. However, the relationship of these metrics to patient outcomes is variable, and different Web sites provide meaningfully different rankings and data interpretations. For Mr A in particular, a warfarin management team, the hospital's location, and a cardiologist with whom he feels comfortable and who can communicate with his primary care physician are important factors. Nevertheless, hospital quality information and metrics are an important component of the strategy Mr A should take to solve this challenging problem.

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