Oregon Health & Science University (OHSU) is moving forward with a plan to share aggregate outcomes and patient experience data with the public. OHSU is the first hospital in Oregon to publicly release this type of data and among the first in the nation. The initiative reflects OHSU's commitment to help lead the nationwide effort to increase transparency in health care, a policy goal articulated in 2001 by the Institute of Medicine (IOM), a branch of the National Academies.

"As Oregon's health and research university, it is appropriate for us to take a leadership role on health care transparency," said Peter Kohler, M.D., president of OHSU. "Our goal is to advance the quality agenda, and support the realization of a more patient-centered health care model."

"Transparency will support excellence throughout all levels of our state's health care system and will provide the information necessary to reinforce and strengthen a culture of patient safety," said Roy Magnusson, M.D., OHSU chief medical officer.

A transparent health care system is usually defined as one in which patients and families have access to information that supports the full range of their health care decision making. Such information includes outcomes and performance measures, patient experience data, and charges.

Some data are already reported by OHSU and Oregon hospitals to the State of Oregon and other groups for a subset of procedures or clinical actions. OHSU has been actively involved in these reporting projects, but the practical use of this data to patients is somewhat limited because it reflects the experiences of a small number of patients.

"Health care providers must take the lead in helping the public understand what data are available, what is valuable, and what we must do to improve the process by which quality is measured," said Jeffrey Kirsch, M.D., chairman of the OHSU Quality Executive Committee.

"The science of measuring and comparing health care quality is in its infancy," said Tina Edlund, acting deputy administrator, Office for Oregon Health Policy and Research (OHPR). "But the process of change has to start somewhere, and when it does, providers will respond to patient demands for better kinds of data. OHSU has taken an important step toward making that a reality in Oregon."

As part of the initiative, OHSU is making new data available to the public that reflects the experiences of all OHSU Hospital patients, not just a sample. This data set is: aggregate data for 20 individual clinical service lines at OHSU as analyzed by the University Health System Consortium (UHC), including number of patients, mortality, and performance comparisons to like health centers. OHSU will also release some NRC+Picker Patient experience data.

This new data are posted on OHSU's expanded public reporting Web site, Quality and Service, available at www.OHSUhealth.com/Quality_Service. The site also brings together other public data into one place for ease of use. It includes descriptions of OHSU patient safety and improvement programs along with educational material.

The educational information is important because it addresses challenges health care providers face as they respond to the IOM recommendation. For instance, because national standards for measuring (and comparing) health care quality are not yet in common usage, patients may be initially misled, even confused, by some data.

"Our goal is to lead responsibly as we work to increase the volume and quality of data available to Oregonians," said Magnusson.

Another challenge is the current state-of-the-art of measuring health care quality. Physiological data that are comparable across hospitals do not exist. Thus, quality measurements rely on administrative (billing codes) data. Such data do not always include co-occurring disorders, complications, severity of conditions or socio-economic factors affecting health care actions and a patient's risk profile. Statistical methods, called risk adjustments, are used to smooth this administrative data for different patient populations but they are imperfect.

"OHSU has begun the process of identifying data bases to help measure performance using physiological data, not billing data, but it will take some time to generate meaningful outcomes data," said Kirsch.

"Despite the challenges, health care in Oregon and the nation will never reach its full potential without transparency," said Kohler. "This is why OHSU is moving forward with this important health initiative now."