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Mortality, Quality Gulfs Persist in Hospitals

John Commins, for HealthLeaders Media, October 21, 2009

Patients at highly-rated hospitals have a 52% lower chance of dying compared with the U.S. hospital average, a quality gulf that has persisted in the last 10 years, even as mortality rates have declined, a new HealthGrades study shows.

The 12th annual HealthGrades Hospital Quality in America Study of patient outcomes at each of the nation's 5,000 nonfederal hospitals found a wide gap in quality between the nation's best hospitals and all others. The study examined nearly 40 million Medicare hospitalization records from 2006, 2007, and 2008, identified trends in mortality and complication rates, and provided the foundation for HealthGrades' quality ratings of procedures and diagnoses at each individual hospital.

"The fact is, patients are twice as likely to die at low-rated hospitals than at highly rated hospitals for the same diagnoses and procedures," says Rick May, MD, an author of the HealthGrades study. "With Washington focused on rewarding high-quality hospitals and empowering patients to make more informed healthcare choices, this information comes at a turning point in the healthcare debate."

Using data gleaned from the study, Golden, CO-based HealthGrades' public Web site allows patients to compare the quality of care at their local hospitals for 28 different procedures and treatments, from hip replacement to bypass surgery.

The study found that:

  • Overall, in-hospital, risk-adjusted mortality at the nation's hospitals improved, on average, 11% from 2006 through 2008.
  • Across all 17 procedures and diagnoses in which mortality were studied, there was an approximate 72% lower chance of dying in a five-star rated hospital compared to a one-star rated hospital.
  • Across all 17 procedures and diagnoses studied, there was an approximate 51% lower chance of dying in a five-star rated hospital compared to the national average.
  • If all hospitals performed at the level of a five-star rated hospital across the 17 procedures and diagnoses studied, 224,537 Medicare lives could potentially have been saved from 2006 through 2008.
  • Approximately 57% (127,488) of the potentially preventable deaths were associated with just four diagnoses: sepsis (44,622); pneumonia (29,251); heart failure (26,374); and respiratory failure (27,241).
  • Over the last three studies, Ohio and Florida consistently have had the greatest percentage of hospitals in the top 15% for risk-adjusted mortality.
  • Across all procedures in which complications were studied, there was a 80% lower chance of experiencing one or more in-hospital complications in a five-star rated hospital compared to a one-star rated hospital.
  • Across all procedures studied, there was a 61% lower chance of experiencing one or more in-hospital complications in a five-star rated hospital compared to the U.S. hospital average.
  • If all hospitals performed at the level of a five-star rated hospital, 110,687 orthopedic in-hospital complications may have been avoided among Medicare patients over the three years studied.
  • Joint Commission stroke-certified hospitals were almost twice as likely to attain five-star status in stroke (30% of certified hospitals were five-star versus 15.7% of non-certified), and fewer of the stroke-certified hospitals fell into the one-star category (12% versus 19%).
  • Joint Commission stroke-certified hospitals have an 8% lower risk-adjusted mortality rate compared to hospitals that were not stroke-certified.

John Commins is a senior editor with HealthLeaders Media.

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