Study indicates drop in mortality rates

But gap between best, worst hospitals has grown

The ninth annual HealthGrades Hospital Quality in America Study contained some encouraging news, but also some troubling data, according to officials of the Golden CO-based organization.

It showed, for example, that the nation's in-hospital risk-adjusted mortality rate improved, on average, 8% from 2003 to 2005. However, the degree of improvement varied widely by procedure and diagnosis studied (the range was from -19.6% to 24.72%.)

A total of 40.6 million Medicare hospitalization records from the years 2003 through 2005 were analyzed for the HealthGrades study. Each of the 5,000+ hospitals gets a one-, three- or five-star rating indicating poor, average or excellent outcomes in each of 28 medical categories. Researchers analyzed such diagnoses as: Acute Myocardial Infarction, Community Acquired Pneumonia, Coronary Bypass Surgery, Heart Failure, and Coronary Interventional Procedures.

The study found much lower risk-adjusted mortality rates for the five-star rated hospitals across all three years.

In a continuing trend that Samantha Collier, MD, the author of the study and the vice president of medical affairs at HealthGrades, calls "a concerning finding," the "quality chasm" between the best and poorest-performing hospitals has grown by approximately 5% since last year's study.

"The Eighth Annual HealthGrades Hospital Quality in America study (last year's study) showed an overall average gap of 65% between five-star and one-star hospitals across multiple diagnoses and procedures," Collier explains.

Two measures

Collier points out that the "contradictory" statistics do, in fact, measure two different things. "Medicare beneficiaries in the U.S. during the time period studied have seen a decline in absolute and risk-adjusted mortality rates, which is great," she notes. "However, that looks from the '5,000 ft. level' across a wide array of diagnoses and procedures."

But when the top-rated hospitals are compared to the one-star hospitals, things come into clearer focus. "While in the aggregate everyone is doing better, the best are getting better at a faster rate than the bottom performers," she explains.

This would appear to run contrary to the conventional wisdom which argues that as the top performers come closer to perfection they will find it harder to improve. "I don't know that anyone knows where the cap is, and where [improvement] starts to get marginal," says Collier.

What the data does underscore, she continues, is that "There is still a lot of opportunity in hospitals for continuous quality improvement." Some of the reasons why top performers keep getting better, she says, are that "They continuously look to find where opportunities to improve are, they tackle the problems, find a solution, and move on to the next problem. There is never an end."

The ideal goal, she says, would be to actually reach a limit "where you would have to put whole lot of effort in to just get marginal improvement."

There are periods in any organization's growth where with little effort big gains can be made, she continues. What sets apart the "true level-five organizations," says Collier, is, "As the effort needed to improve becomes greater, the investment becomes greater."

The key finding of this latest study, she asserts, "Is that it is possible to achieve that."

Inspiring others

That finding, that such excellence is achievable, should be an inspiration for those hospitals that have farther to go, says Collier. It should also make them realize, she adds, that they have to make an investment and a commitment and continually examine their progress.

"I think some of the characteristics of top performing hospitals involve not just a verbal commitment, but an action commitment from the board all the way down that quality is our strategy," says Collier. "You've got to make the necessary capital, labor, and technology investments to get the best quality and safety outcomes." For example, she notes, "Some facilities are committed to having the lowest RN to patient ratios possible, while others simply say they can't do that."

What are the keys to a lower performer turning things around? "First of all, if they are not benchmarking — which most hospitals do — they've got to do that," says Collier. "There are still some smaller facilities that have difficulty acquiring a database that has the ability to do that, but at least they can use HealthGrades' ratings. If you are not where you should be or could be, use that information to drill down to get the necessary resources to improve."

[For more information, contact: Samantha Collier, MD, Vice President, Medical Affairs, HealthGrades, 500 Golden Ridge Rd., Suite 100, Golden, CO 80401. Phone: ( 303) 716-6548. Fax: ( 303) 716-6648. HealthGrades ratings are posted free on its website, A copy of the study, which includes tables, is also available on the HealthGrades web site.]