Leader Blues

Tuesday, August 26, 2008

TOP STORY > >Local hospitals on par with U.S. mortality rates

Leader staff writer

A report released last week by the federal government on death rates for more than 4,000 U.S. hospitals found North Metro Medical Center and White County Medical Center on par with national averages.

For the first time, heart attack, heart failure, and pneumonia death rates for the nation’s hospitals are available to the public on the consumer-oriented Web site of the U.S. Department of Health and Human Services, Hospital Compare
(www.hospitalcompare.hhs.gov). The site gives the percentages of individuals who died within 30 days of hospital admission for these illnesses, during 2006 and early 2007.

The death rates were only for Medicare patients who are 62 years and older. The information for the study was taken from hospitals’ Medicare claims data.

Nationally, on average, 16 out of every 100 persons admitted to a hospital with a heart attack in 2006-07 died within a month from that or a related cause. For North Metro Medical Center, the rate was a fraction higher – 17.3 percent. White County Medical Center’s rate was 17.7 percent. For both hospitals, the rates were so close to the national average that the differences could have occurred by chance.

Similarly, the two hospitals’ death rates for heart failure and pneumonia were so near the national averages that the differences were no more than what could have occurred randomly.

For heart failure, the national 30-day death rate was 11.1 percent. North Metro Medical Center’s rate was 13.1 percent. White County Medical Center’s rate was 12.6 percent. For pneumonia, the national 30-day death rate was 11.4 percent. North Metro Medical Center’s rate was 10.4 percent. White County Medical Center’s rate was 13.1 percent.

North Metro’s rates were also right in line with those of its biggest competitors. Death rates for Baptist Health Medical Center North, in North Little Rock, were 17.0 percent for heart attack, 10.9 percent for heart failure, and 12.5 percent for pneumonia.

St. Vincent Medical Center North’s death rates were 16.3 percent for heart attack, 11.1 percent for heart failure, and 13.1 percent for pneumonia.

These revelations would seem to vindicate North Metro Medical Center in its battle with a public perception that the quality of care it provides is poorer than that of the two larger hospitals. North Metro’s CEO Scott Landrum, however, seemed unfazed by the news. He said he had hardly taken note of the release of the study that made national headlines a couple of days prior, because he had been focused on other hospital business.

“We are pleased that our numbers are good, but we’ve known that we compare appropriately with other hospitals in Arkansas and those around us – which is where we expect to be,” Landrum said.

Debbie Hare, director of quality/risk management for White County Medical Center, said that the data released last week is part of an ongoing effort by the medical center to improve patient care.

“We review and collect this information monthly,” Hare said. “This national study focuses on Medicare patients, but we examine and address the information concerning the outcomes of every single patient. The numbers in this study are from 2006 and the first quarter of 2007. However, White County Medical Center has shown positive continuous improvement in these areas since 2004.”

Since 2005, the Hospital Compare Web site has provided consumers with information about how well an individual hospital delivers recommended care to patients on 29 indicators as well as the findings of patient satisfaction surveys. Hospitals have long resisted publication of their patient death rates. However, the measure is considered by health care experts as the most meaningful measure of how well a hospital does its job. Researchers believe it is reasonable to conclude that dying within 30 days of a hospitalization could be associated with the care received.

A 30-day mortality rate is a more telling and fair measure than simply a percentage of patients who die while in the hospital, because hospitals differ on how long they keep patients for a particular condition. Hospitals may differ in their patient “mix,” in regards to overall health of who they treat. So, to make comparisons between hospitals fair, researchers “risk-adjusted” the death rates, meaning that the health conditions of a patient upon admission were taken into account when calculating the death rates.

The fact that few hospitals nationally or in Arkansas earned significantly worse ratings than national averages is not a reason to rest on one’s laurels. A few hospitals around the country did have rates significantly lower than the averages.

For example, Leigh Valley Hospital in Allentown, Pa., had an 11.6 percent death rate for heart attack. That means on average, four or five fewer persons died for every 100 admitted for heart attack to that hospital, compared with the national norm.

Three hospitals – Cedars-Sinai Medical Center in Los Angeles, Community Hospital in Munster, Ind., and Memorial Hermann Healthcare System in Houston – had a heart failure death rate of 7.1 percent. For pneumonia, Falmouth Hospital in Falmouth, Mass. had a death rate of 7.3 percent.

Regardless of how a hospital performed against the national averages, there is a pressing need to lower the numbers. A 1999 report, “To Error Is Human,” issued by the Institute of Medicine (IOM), concluded that at least 44,000 and perhaps as many as 98,000 Americans die each year from medical errors in hospitals, making medical error the eighth leading cause of death in the United States.

The IOM concluded that the errors were not the result of recklessness on the part of individuals but were due to systems and practices that increased the likelihood of making a mistake.

Most commonly, medical error deaths in hospitals were attributed to improper transfusions, adverse drug reactions, suicides, falls, injuries, pressure ulcers, wrong-site surgeries, and mistaken patient identity. Errors were most likely to occur in emergency rooms, operating rooms, and intensive care units. The report recommended stronger national oversight of the hospital system, clear standards of care, better reporting of errors, and putting systems in place that would make hospitals safer.

The IOM report was met with sharp criticism from within the medical establishment as unfounded exaggeration. A second study in 2004 by HealthGrades, a healthcare quality-monitoring company, agreed with the IOM’s findings, but placed the estimated number of deaths due to medical errors and injuries much higher – at 195,000 per year. The company concluded that medical error and injury was the sixth leading cause of death in the United States.

White County Medical Center takes a team approach to quality assurance. “We have teams that take the overall information, break it down, and give all care providers very detailed area-to-area information,” Hare said.

“These teams let everyone know where to focus improvement efforts. Each nursing unit is given specific recommendations.

Physicians are given specific recom-mendations. All levels of patient- care providers are involved in improving and maintaining high-quality care.”

Review of patient charts against what are considered best practices of care, is part of quality improvement at North Metro Medical Center, said Cindy Stafford, the hospital’s manager for quality management.

A patient’s care is checked against the 29 core processes of care, shown on the Hospital Compare Web site, for heart attack, pneumonia, surgical procedures, and congestive heart failure. For example, processes of care for heart attack include a patient getting aspirin and beta blocker medication at time of arrival and discharge.

“We don’t wait till after the fact; we do this while the patient is still in the hospital,” Stafford said.