Some 25 hospitals, including 520-bed Ronald Reagan UCLA Medical Center in Los Angeles, received a failing grade of F, while another 121 hospitals, including the Cleveland Clinic, got a barely passing D in the release this week of the controversial Leapfrog Group Hospital Safety Score, an effort to inform patients and payers which hospitals are most likely to cause avoidable harm.
A nonprofit quality improvement group formed by employers 12 years ago, Leapfrog launched its first hospital safety report card in June. That gave 2,651 hospitals an A, B, C, or a "grade pending," which Leapfrog officials said was a surrogate for a D or F grade, to give the hospital six months for more recent data to show improvement. In yesterday's update, all "grade pending" scores now are listed as a D or an F.
Executives of several hospitals that received F scores were incensed and said they were caught off guard. One declared that Leapfrog was attempting to "extort" hospitals to join Leapfrog's voluntary reporting system, while others said the methodology is flawed or unknown to anyone except Leapfrog.
The grades are based on how each hospital scores on 26 separate measures of safety divided among three categories of harm or risk of harm:
- Preventable adverse outcomes of hospital care such as postoperative respiratory failure, pressure ulcer development, puncture or laceration, foreign object retention, bloodstream infections, or falls and trauma.
- Process measures such as appropriate use of antibiotics or prophylaxis for patients at risk of blood clots.
- Structural measures, such as whether the hospital uses computerized physician order entry systems or staffs an around-the-clock intensivist in its intensive care units.
The measures combine data that hospitals voluntarily report to Leapfrog or to the American Hospital Association with that which is publicly reported through Medicare data from the Centers for Medicare & Medicaid Services Hospital Compare website.