Quality Measurements for Regional Hospitals
In January 2007, and for several months before, the Courier-Journal, Louisville’s principal newspaper, directed its readers to its “Web Extras” content. The print version headline promised: “Get the scoop on hospitals’ heart care” and states that the reader “can find out which hospitals do the best job treating heart attacks and heart failure.” The website link, still there as of this writing, is a special report in its business section. The link asks: “Do you know how your local hospital rates for heart care?” It promises that the reader will: “Find out in a Gannett News Service database which hospitals do the best job treating heart attacks and heart failure.” I (initially*) could not find local commentary or analysis in the Courier-Journal. The Louisville healthcare industry is otherwise obsessed with claims of “best” medical care and “highest” ratings. Because of my long-standing clinical and research interest in hospital quality and cost, I took a look. I was quite surprised and the average reader might be too.
The quality data presented come from the hospitals themselves and are collected, standardized, and compared by the US Department of Health and Human Services-- the people who give us Medicare. The Gannett Company’s analysis adds a reasonable summary of ten separate quality factors evaluating the treatment of heart attacks and heart failure. Even so, the information is presented in a way that makes it difficult to compare local hospitals directly. I put all their information for Louisville hospitals on one page to make it more usable to me, and perhaps to others. (Details of Gannett’s analysis and my summary will presented elsewhere on these pages.)
The quality scores of Louisville’s metropolitan area hospitals do not seem to reflect the way the hospitals advertise themselves. Kentucky as a state has lower quality scores than Indiana or the rest of the country. In Jefferson County itself, Baptist Hospital East and the Norton Hospitals were in the highest (of five) quality tiers for Kentucky hospitals, although not necessarily in the top tiers nationally. Jewish Hospital was in the second tier for treatment of heart attack, but only in the fourth tier for heart failure. University of Louisville Hospital was only average for the state in treatment of heart attack, but in the highest state tier for heart failure. St’s Mary and Elizabeth was at the state average for both conditions but only in the fourth tiers nationally.
Some of the smaller regional hospitals did quite well, but the results were mixed. Jewish Hospital Shelbyville was in the top tier for heart attack and in the second state tier for heart failure. Clark Memorial was in the top tier nationally for heart attack, but fell to the lowest tier for heart failure! Baptist Hospital Northeast was only in the fourth state tier for heart attack, but in the second for heart failure. More outlying regional hospitals had similar mixed results. Hardin Memorial and Carroll County Hospitals had average to excellent ratings, while the Medical Center of Southern Indiana and Scott Memorial were in the lowest tiers for both conditions.
So, what should the reader of the Courier Journal or Louisville resident do with this information? Follow it? Ignore it? On the Gannett News Service website, impressive claims are made for the value of the information. The reader is told: “When it comes to treatment for heart attack or failure, your hospital choice makes a difference. Hospitals vary in how well they treat heart attacks and heart failure. With this report, you can find your best local care providers before heart problems strike.” Most observers, including me, would strongly agree with the first two claims. The last claim, that the data offered by Gannett and the Courier-Journal will help the public take advantage of the best hospitals for their personal cardiac care, is more open to analysis and discussion. I personally would not ignore the quality rankings, but neither would I follow them blindly as might to be suggested by the method of their offering. As you can imagine, none of this analysis is simple but I hope to elaborate in more detail on these pages in the weeks ahead. Louisville’s community will be well served by objective, complete, and verifiable disclosure of additional health care quality and cost measures. It is not well served by the profusion of marketing material now offered as a basis for making personal healthcare choices.Peter Hasselbacher, MD
*Addendum: After I posted this piece, I found an article from Sept. 30, 2006 in the Courier-Journal. In it many of the points of comparison above were also made. Hospitals were given an opportunity to comment. Predictably, hospitals that did well were proud of their effort. Some others tended to make excuses, devalue the measures, or hoped to do better in the future. The Federal database containing the results above has had two quarterly updates since then and is now current through March 2006. The newer results are of interest and will be presented later.