The ranking reflected 15 percent to 36 percent reductions in mortality rates from 2000 to 2003 in four common hospital services - pneumonia, heart attack, heart failure and angioplasty. But the mortality rate went up about 33 percent for heart bypass surgery.

Nationwide, overall mortality rates in the five service areas declined an average of 18 percent - a sign that quality improvement efforts are making progress.

"While there has been general improvement and that's a good thing, consumers should understand that the quality of care can vary widely. Not all hospitals are good at everything," said Dr. Samantha Collier HealthGrades vice president of medical affairs.

Local data in the HealthGrades report was based on information from 24 hospitals, including Northern Kentucky and Southeast Indiana. The report did not break out data for individual hospitals.

In the report, mortality rates are shown as a ratio of expected deaths versus actual deaths - a measure that takes into account the severity of illness for patients treated at a particular hospital. Any measure above 1 means deaths were higher than expected.

For bypass surgery, the Cincinnati ratio grew from 1.05 to 1.40, which means the death rate grew about 33 percent. That compares to a national rate that dropped nearly 21 percent during that time, from 1.15 to 0.91.

Cincinnati's bypass death rate was twice as high as San Diego's, which had the lowest death rate of the 25 cities.

Cincinnati area mortality rates were lower than national averages for the other four categories. And for pneumonia, local hospitals posted the lowest death rate - 0.55 - down from 0.85 three years ago.

The HealthGrades report did not address what may have caused the changes in mortality rates. Lynn Olman, president of the Greater Cincinnati Health Council, also could not explain the shifts.

E-mail tbonfield@enquirer.com