Friday, September 26, 2003

Local hospital care graded


Christ, St. Elizabeth get high marks

By Tim Bonfield
The Cincinnati Enquirer

If you have a heart attack in Greater Cincinnati, your best chance of being alive six months later to talk about it is to get care from Christ Hospital or St. Elizabeth Medical Center.

If you need hospital care for pneumonia, your best survival odds come from getting care at Christ, Good Samaritan, St. Elizabeth or Dearborn County Hospital.

GO ONLINE
To see local hospital report cards, go to Web site. The site allows consumers to search for hospital information by hospital name and by type of illness.
So say the latest hospital ratings posted this week on the Internet by HealthGrades.com, a company that has been issuing report cards on thousands of hospitals nationwide for six years.

HealthGrades officials say outcomes can vary widely from state to state, from hospital to hospital and even within a single hospital, depending on the type of illness being treated. What this means is that consumers who do some research can benefit.

"The quality chasm at American hospitals is real, and it is very alarming," said Dr. Samantha Collier, HealthGrades vice president of medical affairs. "On average, you have a 54.9 percent increased chance of dying if you have an angioplasty in Texas rather than New York."

Patients coming to Ohio hospitals have a better-than-average chance of surviving heart attacks and pneumonia, according to HealthGrades. But even here, survival rates vary from hospital to hospital.

HealthGrades rates hospitals using a five-star system based on three years of Medicare data (from 2000, 2001, 2002). It ranks nearly 5,000 hospitals nationwide on 26 common treatments. Ratings are "risk-adjusted" to account for variations in the severity of illnesses that different types of hospitals can encounter.

The public can check individual hospital ratings for free via the company website (www.healthgrades.com). None of the copyrighted findings can be reproduced. The company gave the Enquirer permission to publish results from two categories: heart attacks and pneumonia.

For heart attack care, Christ Hospital and St. Elizabeth Medical Center were tied as the best of eight centers in town. Each won five stars on three measures of mortality risk: in the hospital, one month after treatment and six months after treatment.

Mercy Hospital Fairfield got the lowest scores: three stars for in-hospital care and one star each for survival at one and six months after discharge.

Hospitals that got five stars had mortality rates that were "significantly lower" than expected. Those that got three stars posted expected mortality rates. Those that got one star had "significantly higher" than expected mortality rates in that category.

Officials with Mercy Health Partners did not dispute the findings. In fact, in past years, managers have used some HealthGrades ratings in quality reports to their boards of trustees, said Dr. John Davren, Mercy Health Partners' chief medical officer for southwest Ohio.

The one-star ratings likely will trigger an internal review, Dr. Davren said.

"I don't have all the answers for why (the hospital got one-star ratings)," he said. "The only thing we can do to affect those out-of-hospital ratings is to make sure we are doing the right things when patients are in the hospital. And we believe we are doing that."

In another key treatment category - pneumonia, the nation's seventh-leading cause of death - Christ, Good Samaritan, St. Elizabeth and Dearborn County Hospital posted the highest scores.

Only two of 13 hospitals that were rated on pneumonia care got one-star ratings. Mercy Anderson got one star for mortality six months after treatment. Bethesda North Hospital got one star in both the one-month and six-month mortality categories.

Officials at TriHealth, the health system that runs Bethesda North, plan to look more closely at the HealthGrades data, said spokesman Joe Kelley.

TriHealth officials question whether the severity adjustments made by HealthGrades fully reflect the severity of pneumonia patients coming to Bethesda North. Officials remain uncertain whether the low rating at Bethesda North reflects incomplete coding of patient data or an actual concern about the quality of care.

Bethesda North is the primary hospital for about a dozen nearby nursing homes. Many of the pneumonia patients the hospital treats are coming from those homes and are more than 80 years old, Kelley said.

According to HealthGrades, Ohio hospitals as a group ranked third nationwide - behind North Dakota and Florida - in overall quality for five treatment categories: heart attacks, angioplasty, coronary bypass surgery, congestive heart failure and pneumonia. Indiana hospitals ranked 20th. Kentucky hospitals ranked 34th.

For years, hospital administrators have criticized and resisted efforts to publicly compare the quality of individual hospitals. In part because HealthGrades has been doing this for six years, its ratings have generated a level of respect, Davren said. However, the service may face a new level of competition next year.

Sometime next year, the federal Medicare system is planning to publish nationwide hospital ratings using a system similar to the one Medicare already has launched to allow people to compare nursing homes.

"Medicare will be comparing 10 different hospital measures. And it will be widely available to the public. We've got to be ready for that," Davren said. "The whole idea of public reporting of hospital quality is really taking off."

E-mail tbonfield@enquirer.com




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