Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

What if you bought a used car and it broke down just a few days after you drove it home? That would be frustrating and costly, at the very least.

Now, imagine if just days after you were sent home after a hospital stay you ended up right back there. Unfortunately, this situation happens more often than it should.

Thanks to an easy-to-use Web site called Hospital Compare, you can now find out how often patients treated at your hospital end up returning within 30 days of going home.

Why is this important?

These "readmission rates" are good clues for the hospital's overall care quality. Low readmission rates typically mean that good patient care was given during the first hospital stay, and that important information for post-hospital care was communicated effectively. Low rates also may mean that patients got the right care at the right time from doctors, nurses, and other providers based on the latest knowledge in treating the condition. Checking these rates on Hospital Compare, a tool from Medicare, is a bit like kicking the tires of your local hospital.

That's important, because readmissions are too common and costly. A recent study found that one in five Medicare patients goes back into the hospital within a month of his or her first stay. Only 10 percent of those return visits were planned.

Readmissions carry high price tags, too. For instance, in 2004 Medicare paid $17 billion for unplanned return hospital stays. Your health and wallet also pay a price when you repeat a trip to the hospital.

Many readmissions can be prevented, according to research from my Agency, the Agency for Healthcare Research and Quality (AHRQ). We found that hospitals can cut their readmission rates if they do a good job of explaining medical information and the next steps to expect before patients go home. My agency supported development of a checklist for hospitals that helps deliver that essential information to patients.

There are also steps you can take to prevent an unnecessary return to the hospital.

You can check your hospital's performance. Hospital Compare provides you with information on more than 4,000 hospitals. Based on standards used to measure quality, the Web site tells you how well a hospital cares for patients with certain medical problems or who need certain surgeries. It also contains patients' ratings on the care they received during their hospital stay.

The site recently added information on how many patients with heart failure, heart attack, and pneumonia end up back in the hospital within 30 days of being sent home. This information tells you how your hospital stacks up against the national rate.

You can also help prevent an unnecessary hospital return by:

  • Asking questions about your condition and knowing what procedures and tests will be performed.
  • Making an appointment with your primary care doctor for follow-up care after you leave the hospital.
  • Asking questions about your medicines and their side effects, including which medicines you should take and which ones you should stop taking. Often hospital admissions lead to changes in medications you were taking before the admission. Making sure you understand the changes is really important.

The Centers for Medicare and Medicaid Services offers a useful hospital discharge planner checklist (PDF file) for patients and their caregivers. Don't assume your hospital will give you this information before you leave. My Agency found that one in five patients leaving a hospital never got written information about which health problems to watch for.

Knowing how your hospital performs is important for you to make good decisions about the health care you need. It also helps you to understand whether you are getting good value for your money. That's information worth having.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcasts

Care Transitions—What You Need to Know (Transcript)

New Web Site Helps Consumers Navigate the Health Care System (Transcript)

Agency for Healthcare Research and Quality
Questions are the Answer
http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html

Department of Health and Human Services
Hospital Compare
http://www.medicare.gov/hospitalcompare/

Centers for Medicare and Medicaid Services
Planning for Your Discharge: A Checklist for Patients and Caregivers Preparing to Leave a Hospital, Nursing Home, or Other Health Care Setting
http://www.medicare.gov/Publications/Pubs/pdf/11376.pdf

Boston Medical Center
Project RED (Re-Engineered Discharge)
http://www.bu.edu/fammed/projectred/index.html

Current as of November 2009
Internet Citation: Does Your Hospital Do A Good Job?. November 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/110309.html