Nichole Wilson would rather not set foot in a hospital again--unless she has information about its quality of care. The reason:  The 24-year-old West Sider developed an infection in 1999 at a Chicago hospital after her son was delivered by cesarean section.

If state lawmakers have their way, consumers will be able to get information that would let them compare hospital quality and performance. The Hospital Report Card Act would require hospitals to report a variety of measures, including staffing levels and worker turnover ratios, infection rates and mortality data.

The proposed legislation is backed by business and labor groups, and even the hospital industry, which has long been skeptical of the usefulness of so called report cards.

"This is ground breaking territory, especially for the hospital community to embrace," said Kenneth Robbins, president of the Illinois Hospital Association, the trade group representing more than 200 Illinois hospitals. *"The hospital community has been gun-shy in the past. It has been extremely difficult to measure quality outcomes and performance in a meaningful way."

The report card legislation gained momentum from reports showing medical errors on the rise at the same time patients are paying more for care. Low quality health care in the U.S. costs nearly $400 billion a year, or about 30 percent of the $1.3 trillion spent annually, according to a study last year by the Chicago-based Midwest Business Group on Health.

The stories documented widespread, life threatening sanitation problems in U.S. hospitals.

"Given the amount of money in the system and the increasing share health-care costs take out of individual budgets and corporate budgets, I think [hospital report cards] are appropriate," said Sen. Barack Obama (D-Chicago), chairman of the Illinois Senate Health and Human Services Committee and a key backer of the report card legislation."The market will work only where it has good information," he said.

Obama sees the report card as just the first step in providing consumers with information that they can use to get better medical care. The state may look at measuring other health facilities and even finding a way to provide more public information about physicians.

Consumer Database

"Clearly, one of the things we want to do is build a consumer database that can be added to over time," Obama said."There are ways over time of building additional information," Obama said. "If you can compare quality and price of an automobile, you should be able to compare quality and price of a heart surgery."

Hospitals opposed an earlier version of the report card bill and have opposed past governmental comparisons of hospital reported mortality rates. Hospitals say such rates should be adjusted for risk because some facilities treat more complex cases than others.

"There are numerous variables," said Robbins, of the Illinois Hospital Association. "At an academic medical center, you get more complex cases that a community hospital would refer to [the academic medical center]. The likelihood of higher mortality rates is greater if the condition of the patient is worse when admitted."

And hospitals such as Northwestern Memorial Hospital that offer hospice care for cancer patients in their final days obviously would have higher mortality rates that could skew their mortality measurements.

To address such concerns, the Illinois Hospital Report Card Act calls on the Illinois Department of Public Health to calculate and report risk adjusted mortality rates. The purpose is to better reflect the seriousness and complexity of cases each hospital treats.

Under the bill, hospitals must disclose rates for surgical site infections and ventilator-associated pneumonia, lawmakers say. Certain intravenous-related bloodstream infections will be reported quarterly according to national benchmarks established by the Centers for Disease Control.

Ed Domansky, spokesman for Advocate Health Care, which owns Trinity and seven other Chicago area hospitals, said Advocate supports the Hospital Report Card Act--with "the distinction that such proposed hospital reporting be limited to hospital acquired infections so that hospitals aren't held responsible for infections that come into the hospital with a patient."

"The information needs to be accurate, reasonably collectable and useful," Robbins said. "This effort is part of a mosaic of activities that are under way." Elsewhere in the U.S., hospital report cards and similar government initiatives to measure quality are gaining momentum.

Nursing home data

Last year, the U.S. Department of Health and Human Services began for the first time publishing data comparing the quality of the nation's 17,000 nursing homes, enabling consumers to see how patients fare at such facilities.

The federal nursing home data show 10 performance measures, comparing everything from the percentage of nursing home residents who suffer from bed sores or infections to the percentage of patients who are unable to perform basic tasks, such as feeding themselves.

Next year, the federal government plans to unveil performance measures for hospitals.

The trend toward more government-backed health information comes at a time patients are inundated with commercial advertising they do not know they can trust, consumer groups say. Patients can become confused by magazine rankings and awards touted in hospital advertising campaigns, these consumer groups say.

"You can pick whatever you want and put it on your billboard," said Gail Siegel, executive director of the Coalition for Consumer Rights, a Chicago-based consumer advocacy group. "A lot of hospitals cherry-pick information, marketing from different surveys and different polls. If there was something standardized, like a report card, you would know what you are comparing."

"If it becomes something people will use, there will be a demand for more information," Siegel said. "If hospitals don't look good in one area, they may want more information on others."

Comparison information for consumers

The Hospital Report Card Act, which passed the Illinois Senate last month(*)(3/13/2003) and may face a vote in the House this week, requires that hospitals provide information that will help consumers gauge the quality of care.

Information would be available online sometime next year(*)2004) through the Illinois Department of Public Health at a Web site to be determined.SEE NEXT LINK

Staffing levels by clinical service area, such as pediatrics, critical care, obstetrics and medical/surgical departments, in a hospital where patients have common treatment need. So a patient might want to checkthe staffing of hospital A and compare it to hospital B.