State’s hospitals earn inconsistent grades
The results of an annual report card on hospitals in New York State, including facilities in Buffalo, show improvements in quality on many measures.
But variations in quality among hospitals, as well as from service to service within individual hospitals, remain high, according to the latest report from the Niagara Health Quality Coalition.
In addition, many hospitals in the state continue to offer complex procedures too infrequently to become good at them and, as a result, have worse outcomes.
“We think the results are an indication that public reporting works, especially if done by an independent group,” said Bruce Boissonnault, president and chief executive officer of the coalition. “Nevertheless, there are still wide variations.”
Among the findings:
• Statewide, the death rates of patients in hospitals for many procedures and conditions declined from 2002, the first year the group published data for the public, and 2007.
• Based on federal data from 2007 and 2008, hospital patients rank New York State worse than the national average at managing pain and overall satisfaction with their care.
• Hospitals in Western New York generally ranked near the state average and few did better than the state average for most of the 26 mortality and procedure volume measures, as well as 14 patient safety and medical error indicators.
For instance, five hospitals in the region had death rates for acute stroke that were worse than the state average of 15.4 percent, including Lake Shore at 28.8 percent and Lockport Memorial at 26.3 percent.
Buffalo General’s 2.5 percent death rate for carotid endarterectomy — a procedure to remove plaque and prevent stroke — was above the state average of 0.5 percent.
Pneumonia mortality at three hospitals was worse than the state average of 5.6 percent, including 15.1 percent at Lake Shore and 11 percent at Inter- Community Memorial.
Ranking near the state average is not indicative of average care, Boissonnault said, but, instead, means a hospital is meeting the state’s generally high standard of care for different procedures and conditions.
This is the first year the report card has included 14 measures for patient safety and medical errors.
Among the measures, six hospitals in this region ranked worse than the state average on post-operative respiratory failure, including Buffalo General, Women & Children’s, Erie County Medical Center, Mercy, Roswell Park Cancer Institute and Niagara Falls Memorial Medical Center. Three hospitals ranked better than the state average: Brooks Memorial, WCA and Kenmore Mercy.
Six hospitals did better than the state average on post-operative blood clots: ECMC, Millard Fillmore, St. Joseph, WCA, Kenmore Mercy and Mount St. Mary’s.
For accidental cuts and punctures of patients, two hospitals ranked worse than the state average — Millard Fillmore Suburban and Wyoming County Community — and two fared better—Sisters and WCA.
The report also offers preventable hospital admission rates by county, a measure of how well communities do at keeping people with chronic medical conditions treated so that they don’t need to be hospitalized.
The release of the report card coincides with efforts to reform health care. President Obama has made quality improvement a major goal of his administration.
The coalition’s effort is considered one of the best of its kind nationwide. It favors mortality data over difficult-to-compare measures of how well a hospital performs a particular process, such as what proportion of heart attack patients receive aspirin.
Nationally, the influence of report cards remains mixed, partly because the effort is still in its infancy. Patients don’t use them very much, but hospitals do take the reports seriously to protect their reputations.
Improvements at hospitals in Western New York, where the coalition report card got its start more than a decade ago, reflect how the facilities have used the measures to assist their own quality programs, Boissonnault said.
Employers and their employees are using the reports to educate themselves, said Randy Wolken, president of the Manufacturers Association of Central New York, a member of the coalition. Over time, he and others said, report cards will drive patient behavior.
“We need increased consumer engagement and confidence, and that will happen when payers use incentives to encourage patients to use the information,” said Dr. Norbert Goldfield, medical director of 3M Health Information Systems and an expert in health care risk adjustment.
The nonprofit, independent coalition started in 1998 and was one of the first in the nation to publicly report quality measures. It compiled the report with hospital patient billing and discharge information from 2007. It also adjusted the death rates to account for underlying illnesses.
The report card now contains the most comprehensive set of patient safety and error measures available in any state, Boissonnault said.
The complete report is available at www.myHealthFinder.com .
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