Hospitals brace for life-and-death look

Federal Web site compares survival of heart patients

June 22, 2007|By Frank D. Roylance | Frank D. Roylance,Sun reporter

The first online tool for comparing mortality rates among America's hospitals went live yesterday, and the added public scrutiny is expected to inject urgency into hospitals' efforts to improve their performance.

Consumers can now go to a federal Web site to see how their hospitals compare with national averages on the percentage of heart attack and heart failure patients who die within 30 days of admission.

Three of Maryland's hospitals were among only 55 nationally whose mortality rates were better than the norms. They are St. Agnes and Good Samaritan hospitals in Baltimore and Suburban Hospital in Bethesda.

The new report card, displayed on Medicare's Hospital Compare site, is the latest made available to consumers to measure the quality of care and the first to measure mortality at individual hospitals. Its development is likely to prompt hospitals to examine their own procedures.

"Whenever a large organization tries to publish your outcomes, it makes a hospital acutely aware of how to improve," said Dr. Richard Lange, clinical chief of cardiology at Johns Hopkins Hospital.

Health and Human Services Secretary Michael O. Leavitt said Americans increasingly go online for hospital quality data to assess best treatment practices, and "when that many people start comparing the quality and cost of health care, the result can only be better quality and lower cost."

But consumers will find little to distinguish one from the next. That's because Medicare used statistical methods to process data that leave nearly all hospitals' mortality rates lumped together as "no different" from the national average.

In Maryland, 42 of the 45 hospitals studied were ranked "no different" from the national averages. None fell below. In a medical crisis, that could be all consumers need to know.

"If you're having the big heart attack, with crushing chest pain, you're going to go to the nearest hospital for treatment," said Joie Rotz, a nurse and quality management director at Washington County Hospital in Hagerstown.

In that case, she said, the new data suggest "you're probably going to get good care and treatment there. I think that's very comforting."

When people have time to choose, most rely on the preferences of their doctors or the experience of friends and family.

But Leavitt said Hospital Compare had 36 million page-hits last year - about 100,000 a day. And the growing availability of performance data has pushed hospitals to re-examine themselves.

At St. Agnes, Dr. Carlos S. Ince, a cardiologist, linked his hospital's performance to its work with ADHERE, a group of hospitals that track their doctors' adherence to treatment guidelines for heart failure patients.

"There is a huge variation" in the way different doctors treat the same heart issues, Ince said. For instance, "when you're having a heart attack, aspirin is one of the cheapest, most cost-effective interventions. But you would be surprised how many hospitals don't give aspirin when they should."

Using computer prompts and pre-printed order sheets, he said, staff at St. Agnes are continually reminded, for example, to prescribe beta blockers or ACE inhibitors for heart patients. If they don't, they must explain why.

"Sometimes you have to get in their face to make sure they're following the guidelines," said Ince, who is president of the medical staff at St. Agnes. He said the CMS results validate its efforts and "makes us want to work harder to improve outcomes even more."

A 2005 study in the journal Health Affairs found that Wisconsin hospitals whose performance data were made public improved significantly over a two-year period. Those whose ratings were not made public changed little or not at all.

"The motivation was their public image," said lead author Dr. Judith H. Hibbard, a health care policy professor at the University of Oregon.

The new data were posted yesterday on the Hospital Compare Web site (www.hospitalcompare by the U.S. Centers for Medicare and Medicaid Services (CMS) and the Hospital Quality Alliance, which represents consumer groups, hospitals, employers, accrediting organizations and federal agencies.

"This is really a collaborative effort ... all of us working together to put good information into the hands of the public, using national standardized measures," said Nancy E. Foster, vice president for quality and patient safety at the American Hospital Association.

New comparative information on hospital pricing was also added yesterday. Patient satisfaction data are coming next year.

Consumers have visited the Medicare site for several years to check hospitals' adherence to medical "best practice" standards for the treatment of heart attack, heart failure, pneumonia and the prevention of post-surgical infections.

Similar information for Maryland hospitals is available online from the Maryland Health Care Commission and the Maryland Hospital Association.

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