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Quality gap found between award winners and others
Facilities compared across 26 procedures, diagnoses
A substantial difference in clinical quality was found between the winners of the Health Grades Inc./J.D. Power & Associates Distinguished Hospital Award for Clinical Excellence winners and all other hospitals, Health Grades Inc. reports.
What is more difficult to determine is whether this represents a significant change over last year’s report — the first conducted. "Every year, we go through a rating summit, because medicine changes so frequently and we want to make sure to account for changes from year to year," explains Samantha Collier, MD, vice president of medical affairs for Health Grades Inc. in Lakewood, CO.
She adds, however, that there was "a lot of overlap between last year’s winners and this year’s winners." (The list of winners is available on Health Grades Inc.’ web site, www.healthgrades.com.) "Maybe three years from now, we’ll be better able to compare winners from previous years."
The Distinguished Hospital Award for Clinical Excellence is part of the larger Distinguished Hospital Program established between J.D. Power and Associates and Health Grades Inc. in February 2003 to recognize hospitals for both service and clinical excellence. J.D. Power and Associates, which measures patient satisfaction and perceptions of the hospital stay experience, recognizes qualifying hospitals for providing an outstanding patient experience.
According to Health Grades, The Distinguished Hospital Award for Clinical Excellence is the first award of its kind to focus exclusively on clinical quality. The award winners fall among the top 3.4% of all hospitals in the country in seven major clinical specialties: cardiac surgery, cardiology, orthopedic surgery, neurosciences, gastroenterology, pulmonary, and vascular surgery. The award was designed to highlight the best hospitals in the nation and to encourage consumers to research the quality of their local hospitals before undergoing a procedure.
Health Grades bases the awards on a detailed study of each hospital’s risk-adjusted mortality and complication rates of Medicare patients as reported to the federal government.
"We looked at either vast mortality or complications across 26 procedures and diagnoses," Collier explains. "Then each hospital is ranked for every single cohort." (See example, below.)
For a facility to even qualify, it had to not only be an open-heart hospital, but it also had to have a minimum number of diagnoses and procedures. "We wanted to show that those facilities had a breadth of procedures; right away, that got us down to 800," Collier notes. "They also had to do 22 out of the 26 procedures and diagnoses, and a minimum of 30 cases."
Why were these specific service line areas chosen? "Frankly, those are the highest volume areas to hospitals — coronary artery disease, heart failure, heart attack," she continues. "The same thing with community-acquired pneumonia, COPD, and so on."
Health Grades uses the most recent three years of data from the U.S. Department of Health and Human Service’s Centers for Medicare & Medicaid Services (CMS) and risk adjusts it to create accurate and fair comparisons between hospitals.
Of the award winners, 73% are part of larger hospital systems. They also tended to be larger hospitals, with an average of 504 beds compared with an average of 181 beds for those that did not receive the designation. In addition, 77.44% are in the eastern third of the United States.
Taken as a whole, Distinguished Hospitals have mortality rates that are 19.09% lower than those that did not qualify for the awards. Complication rates were 5.38% lower.
There are a total of 164 winners from the starting number of 869, or essentially the top 20%. However, that represents 3.4% of the 4,773 acute care hospitals in the country.
This does not mean, Collier is quick to point out, that only large facilities can provide high-quality care.
"Some of our partnerships [Health Grades is a quality information company with an advisory services component] are with hospitals that promote good quality outcomes but are smaller and may not meet the criteria," she explains.
The term distinguished implies more than quality, however; it also employs breadth of service. "For example, if you broke your hip and went to hospital A and then had a heart attack, as a consumer, you’d want a hospital that is good at everything," Collier says.
Health Grades’ web site includes quality outcomes information on every hospital in the United States, and it is free to consumers. It seems they are taking advantage of the service: In the past two years, total users increased from 650,000 in 2002 to 4.31 million in 2003; total visits increased from 0.80 million in 2002 to 5.07 million in 2003; and total page views increased from 6.71 million in 2002 to 30.62 million in 2003.
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