To our Patients, Families and Friends:
Choosing a hospital to provide care – especially for a child – is a very important decision. We at Johns Hopkins All Children’s Hospital are proud of the work we do. We are committed to delivering the highest quality care for children. We believe that – the more you know about us, the more likely you’ll be to choose Johns Hopkins All Children’s Hospital for your child.
In 2004, Florida voters passed an amendment to the state constitution that established a patient’s right to know about a healthcare facility’s history of adverse medical incidents. The Agency for Health Care Administration (AHCA) established a website for consumer use, Florida Compare Care (now known as Florida Health Finder), in November of 2005. At that time, many hospitals across the state had issues with the way the data was computed and reported. A great deal of cooperative communication between AHCA and concerned hospitals like us led to refinements of the existing data. However, there is still much work to be done.
As you view this site, keep in mind that an informed decision is only as good as the information upon which it’s based. And the information regarding children on the revised AHCA website can be misleading. Here’s why:
Which Services Are For Kids?
Each hospital profile begins with a laundry list of services and whether or not the service is offered there. While this seems clear enough, these descriptors don't always indicate if the service is specifically tailored to children or what level of service is provided. For instance, Johns Hopkins All Children's is only listed as providing Level II & III Neonatal Intensive Care - general terms that the state uses to describe levels of NICU care. What this does not indicate is that Johns Hopkins All Children's has met additional state requirements to be designated as a Regional Level IV NICU. That means that babies are often transferred to Johns Hopkins All Children's from other NICU facilities for more specialized care.
Who Teaches Doctors for Kids?
Consumers might assume that Johns Hopkins All Children’s does not train physicians since we are not listed as a “statutory teaching hospital.” This is a legislative designation reserved for a few programs devoted to training mainly adult-oriented physicians. In fact, Johns Hopkins All Children’s is one of only two Florida hospitals that qualify for federal Children’s Hospital Graduate Medical Education funding to train pediatricians and pediatric specialists. Teaching young doctors to care for children is a core part of our mission.
Not All Readmissions Are Alike
In providing consumers with readmissions data, it’s assumed that a high readmission rate would raise questions about the quality of a patient’s initial care. However, for many pediatric patients, readmission is a planned event. For example, a child with cancer may need to be readmitted frequently for chemotherapy treatment. The data as currently listed does not filter out these planned readmissions. Nor does it filter out readmission for unrelated causes – say, a child with cystic fibrosis who is readmitted for injuries from a bicycle accident.
Furthermore, Johns Hopkins All Children’s patients include the sickest children - those with complex medical problems or chronic conditions. Typically, Johns Hopkins All Children’s patient acuity is higher than in pediatric units within adult hospitals. That means youngsters hospitalized at Johns Hopkins All Children’s are - on average - much sicker than children hospitalized elsewhere. Readmissions are often unavoidable for children with such serious problems.
Comparing Risks, Kid to Kid
A substantial part of the AHCA website involves risk adjusted data. By its own definition, AHCA says
“…risk adjustment is a method to take a complex set of data and put it into terms where you can compare apples to apples… Some hospitals treat more high-risk patients... That makes comparing hospitals for patients with the same condition but different health status difficult. To compensate for this fact, each hospital's data is risk adjusted to reflect the score the hospital would have had if it had provided services to (an) average mix of sick, complicated patients…”
However, in calculating its risk-adjusted figures, AHCA did not separate out pediatric patient data. Instead of comparing “apples to apples,” the figures compare kids to patients of all ages. How meaningful is it to compare the length of a hospital stay for a toddler with uncomplicated viral pneumonia to the experience of an elderly patient with bacterial pneumonia?
We share the most important goal of providing consumers with the means to quickly find information specific to children. We look forward to working with AHCA and the state to assure that this information is simple to access, clearly defined, and provides accurate comparative measures through appropriate filtering of relevant data.
Numbers Don’t Tell the Whole Story
Choosing your child’s course of care or hospital provider shouldn’t boil down to a math problem. There is more to the equation -- including the advice of trusted individuals like your pediatrician or family physician, as well as family and friends who have experience with pediatric healthcare providers.
This information is not intended to provide medical advice or to offer any guarantee regarding the services that Johns Hopkins All Children’s Hospital provides patients. Deciding on treatment options and choosing a hospital are decisions you should make by talking with your physician. You should not attempt to choose a hospital based solely on statistics and descriptions.