News | December 12, 2006

Hospital Rating May Not Show Death Rate

New research offers this warning to consumers shopping for top-notch hospitals: Many that are highly rated by government regulators only have marginally lower patient death rates.

The researchers evaluated 3,657 hospitals nationwide that are listed on a Centers for Medicare & Medicaid Services Web site. The Hospital Compare site shows how hospitals stack up on recommended treatments and is designed to help consumers comparison shop for health care.

The study examined three conditions that often lead to hospitalization — heart attacks, heart failure and pneumonia — and found that death rates for patients with those diseases were only slightly lower at top-rated hospitals in 2004 than at the lowest-rated hospitals.

The results suggest that better ways of measuring performance are needed to help consumers make meaningful choices, the researchers said. "Only then will performance measurement live up to expectations for improving health care quality."

The study appears in Wednesday's Journal of the American Medical Association.

The University of Pennsylvania researchers, Dr. Rachel Werner and Eric Bradlow, looked at recommended treatments for hospitalized heart attack patients: aspirin and beta blocker drugs within 24 hours of arrival and prescribed at discharge and ACE inhibitor drugs given during the stay. The percentage of heart attack patients who died was close to 7 percent at both groups of hospitals, with high-rated ones losing 0.5 percent fewer patients over the one-year period.

Two heart failure treatments were evaluated: assessment of the heart's blood-pumping function and use of ACE inhibitors. The death rate was close to 3 percent for both, with the difference between best and worst hospitals just 0.1 percent.

Three pneumonia treatments were evaluated: appropriate timing for starting antibiotics, vaccinating against pneumonia, and measuring blood-oxygen levels. The death rate was 0.5 percent higher at low-rated hospitals, but both groups lost about 4 percent of pneumonia patients.

Werner, who also works as a physician at the Philadelphia Veterans Affairs Medical Center, said at first blush, the findings appear to suggest that roughly 9,000 more lives with those three conditions might be saved annually if patients treated at the lowest-rated hospitals got care at top hospitals instead.

However, she said the true numbers are likely much smaller since many patients lack access to the best hospitals because of distance, insurance issues and hospital overcrowding.

A JAMA editorial says the results "raise questions about the appropriateness of using Hospital Compare performance measures as the basis either for pay-for-performance systems or for consumers to identify better-quality hospitals."

But Michael Rapp, director of CMS's quality measurement and health assessment group, said the researchers likely would have found bigger differences between hospitals if they'd examined all 22 quality measures used on Hospital Compare. Finding only slight differences when using a few measures is not surprising, Rapp said.

Still, Rapp said he agrees that more quality measures are needed to evaluate hospitals.

"CMS is actively working to expand quality measures used on Hospital Compare," Rapp said.

Jerod Loeb, executive vice president for research at the Joint Commission on Accreditation of Healthcare Organizations, which regulates hospitals, noted that most hospitals studied performed well on most measures. Death rates are just one of many important benchmarks that should be of concern to hospitals and consumers, he said.

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