U.S. Hospital Outcomes Vary Widely

How well you do may depend on where you're admitted, report finds

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By Steven Reinberg
HealthDay Reporter

MONDAY, Oct. 16, 2006 (HealthDay News) -- Before you check into a hospital, it may be wise to check out the hospital's quality.

That's because treatment outcomes at U.S. hospitals vary widely, depending on which state, city or individual hospital provides the care, a new report finds.

The report, HealthGrades Hospital Quality in America Study, found that patients have a 69 percent lower risk of dying at "5-star" hospitals compared with "1-star" institutions.

Moreover, the gap between the best- and worst-performing hospitals has actually widened by about 5 percent since last year's report -- even though overall hospital death rates have dropped by almost 8 percent.

For their ninth annual report, HealthGrades -- an independent health care ratings group -- analyzed 40.6 million Medicare hospital records from 2003 through 2005. Based on this data, they assessed the quality of care at more than 5,000 hospitals.

The report uses a star rating system that tells people whether a particular hospital's performance has been "best" (5-star), "as expected" (3-star), or "poor" (1-star) on a particular procedure or diagnosis across 28 categories. The ratings are based on patient outcomes, specifically, the risk of dying, or having serious complications.

"Across 28 conditions, like heart failure and heart attack, and procedures, like bypass surgery, knee replacement, etc., there is a large variation between hospitals," concluded the report's author, Dr. Samantha Collier, vice president of medical affairs at HealthGrades. "Some of these differences can be quite large -- up to 90 percent."

In fact, if all hospitals were 5-star rated, the lives of 302,403 Medicare patients could have been saved from 2003 through 2005, the researchers estimated. Moreover, 50 percent of preventable deaths were linked to just four diagnoses: heart failure, community-acquired pneumonia, sepsis (blood infection) and respiratory failure, the researchers found.

For example, a patient undergoing coronary bypass surgery has a 72.9 percent lower risk of dying if the procedure is done at a 5-star hospital, compared with a 1-star hospital. If all Medicare-covered bypass patients had the procedure done in 5-star hospitals, 5,308 lives would have been saved between 2003-2005, according to the report.

Collier found that the risk of dying in a hospital improved nearly 8 percent from 2003 to 2005. However, this improvement varied widely by procedure and diagnosis.

In addition, 5-star hospitals had significantly lower death rates for all three years of the study and showed a 19 percent improvement in quality compared to just "average" hospitals. They also marked a 57 percent gain in quality improvement over 1-star hospitals during the study period.

Furthermore, a typical patient has 69 percent lower risk of dying in a 5-star hospital compared with a 1-star hospital, and a 49 percent lower risk of dying in a 5-star hospital compared to an average-quality U.S. hospital, Collier found.

The reasons for these disparities are many, Collier said. One common problem: in-house management systems that don't adequately keep track of patients and treatments. In other cases, understaffing or the use of doctors who are unskilled in a particular procedure adds to a hospital's woes, she said.

Collier advised patients to check out prospective hospitals before going in for a procedure. They should also check out the hospital's record on that particular procedure, she said.

"There are resources where you can get objective information about outcomes," Collier said. "You need to check it out."

One expert called the HealthGrades report useful for consumers.

"It stands to reason that most hospitals have relatively average outcomes, while some perform remarkably well and some disturbingly poorly," said Dr. David L. Katz, an associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine.

However, making such an assessment is not easy, because often the most sophisticated hospitals -- those found at academic centers -- often receive the sickest patients, Katz said.

"It would be unfair to penalize a hospital for a high death rate if that related not to the hospital, but to what is called 'case mix' -- the prevailing severity of illness among patients seen," he explained.

However, the report is useful in two ways, Katz said. "First, it gives the consumers of health-care knowledge needed to make better choices. Second, by revealing disparities in hospital performance, the report is a mandate to all hospitals to aim for the highest standards achievable," he said.

All too often, medical practice standards simply adhere to the average and do not strive for excellence, Katz said. "By showing us all how well hospitals can perform, and how poorly they sometimes do, HealthGrades is providing not so much a critique as an opportunity," he said.

"The next step is to identify what practices enable certain hospitals to achieve optimal performance, so that those practices can be widely shared," Katz said. "Our collective goal should be that the highest standard of health care achievable is, quite simply, standard health care and accessible to all. This report is a step in that direction."

More information

To see the full report, visit HealthGrades.

SOURCES: Samantha Collier, M.D., vice president, medical affairs, HealthGrades, Golden, Colo.; David L. Katz, M.D., M.P.H., associate professor, public health, and director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; October 16, 2006, HealthGrades Hospital Quality in America Study

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