Best Hospitals Report Finds Variability in Clinical Outcomes

By Debra Wood, RN, contributor

March 11, 2013 - Healthgrades found dramatic differences in clinical outcomes among hospitals across the country in its America’s Best Hospitals 2013: Navigating Variability in Hospital Quality report; the healthcare ratings company also confirmed that healthcare consumers consider such quality information important when selecting a healthcare provider.

“People are becoming very savvy when it comes to choosing their healthcare organizations and who will care for them and their families,” said Judy Frum, RN, RRT, BSN, MBA, chief nursing officer at Memorial Hospital Pembroke in Pembroke, Fla, which is rated among the 50 best hospitals on the Healthgrades list. “Consumers want the best care in the safest possible facility.”

Rather than just touting safe, quality care, she said, the data proves which hospitals provide great care.

Kathleen McDonald: Hospital rankings lead to informed choices.
Kathleen McDonald, MBA, BSN, RN, CPHQ, said that patients are making better-informed choices about their healthcare.

Kathleen McDonald, MBA, BSN, RN, CPHQ, a performance improvement specialist at Sarasota Memorial Hospital in Florida, a Healthgrades top 50 hospital since the program’s inception in 2007, agreed that patients are becoming more informed and asking more questions.

“People always have a choice, and they can see where we are,” McDonald said. As a consumer, “you want to pick a place where safety is a concern.”

With some public data, it takes a level of learning for consumers to understand what they are looking at, but the Healthgrades listing makes it clear, said Donna H. Griffith, MSN, RN, NEA-BC, CENP, FACHE, FAAN, chief nursing officer at Martin Medical Center in Stuart, Fla., which has earned a Healthgrades top 100 hospital rating for four straight years. 

Healthgrades reported that more than 200 million consumers annually use its data to find, compare, select and connect with physicians and hospitals.

Achieving top-tier hospital rankings

More hospitals in Florida than any other state--a total of 13--achieved America’s 50 Best Hospital designation from Healthgrades, among the top 1 percent of U.S. hospitals, followed by California with 12, Michigan with nine, and Ohio and Texas with eight each.

Griffith reported that Martin has focused on a patient-centered team approach to taking patients. It fosters a culture of safety and continual learning, all of which helps it achieve national recognition and excellent clinical outcomes.

“Nurses are core to the care process and are at the frontlines of care, 24 hours a day, seven days a week,” Griffith said. “The role of professional nursing in achieving great care for our patients is essential.”

Donna Griffith: Best Hospitals embrace evidence-based care.
Donna H. Griffith, MSN, RN, NEA-BC, CENP, FACHE, FAAN, says that the best hospitals embrace evidence-based care that puts patients first.

To remain among the best, Griffith added that nurses must embrace evidence-based care and seek out organizations with a healthy environment to feel fulfilled.

“Ideally, nurses will choose their employers based on factors of excellence,” Griffith said.

Frum credited Memorial’s organizational commitment to quality and safety--and putting the processes in place to ensure the best clinical outcomes every time, with every patient--with helping the facility become one of the best hospitals in the country.

“It’s part of who we are and what we believe,” Frum said. “We are outcome-driven and want the best possible results. Our nurses are engaged with the metrics. It’s ingrained in them, and everything we do revolves around it.”

Quality and safety improvements are the responsibility of all employees at Sarasota Memorial, from the executives who round and evaluate progress on safety goals to housekeepers who have come up with fall-prevention ideas.

“Nurses are integral, because they are always at the bedside,” McDonald said. “We couldn’t do it without them and other staff. Everyone plays a part.”

Consumer choice

Healthgrades determined that more than 165,000 lives could potentially be saved if all hospitals performed at the level of Healthgrades’ 100 Best Hospitals. The 2013 study found patients had a 75 percent lower risk of dying if they were treated at a five-star hospital than a 1-star hospital, and a 61 percent lower risk of experiencing a complication. Therefore, the organization encourages consumers to locate these top performers and “know before you go.”

“This report unequivocally shows that there is no substitute for using quantitative data to select a care provider,” said Archelle Georgiou, MD, a strategic advisor to Healthgrades of Denver, in a written statement. “Instead of relying on name recognition, location or size, consumers should carefully review a hospital’s performance across different procedures and conditions. The result may, in some cases, mean the difference between life and death.”

Healthgrades evaluates hospital performance in 28 common procedures and conditions annually for nearly 4,500 facilities across the nation. Overall, the report found quality was improving but disparities exist regionally and within local service areas.

Arizona, Montana and Colorado had the best risk-adjusted mortality rates, between 4.16 and 4.3 percent, and Alabama, the District of Columbia and Mississippi had the worst, between 6.7 to 7.0 percent.

California hospitals had among the lowest myocardial infarction and sepsis mortality rates and Delaware enjoyed low complication rates for total knee replacement and hip fracture treatment.

Some states did not fare so well, however, with Alabama having among the worst mortality rates for myocardial infarction and pneumonia and Pennsylvania experiencing exceptionally high complication rates for total knee replacements and cholecystectomies. But even in those states, some of the individual hospitals performed very well.

Within cities, performance varied significantly. For example in Chicago, the best performing hospital had a myocardial infarction mortality rate of 2.1 percent, while a hospital in the same community had a 23.9 percent rate, an 11-fold difference.

That’s why the report calls it critical that consumers compare hospital and physician performance.

Patients’ awareness of and response to hospital ratings data

In addition to the performance report, this year Healthgrades commissioned a survey, conducted by Harris Interactive, to assess consumers’ understanding about evaluating hospitals’ performance before seeking care; they found 81 percent of adults surveyed would ask to go to a hospital farther away if they knew another hospital had a better survival record, and 85 percent would rather have a surgeon they didn’t know operate on them at a highly rated hospital than a surgeon they knew at a poorly rated facility.

However, Healthgrades also reported that 45 percent of American consumers did not know there is data available about the chance of dying in the hospital and 42 percent did not know that there is data about complication rates. More than 90 percent of Americans say they think choosing a hospital or doctor is an important life decision. However, 34 percent spend less than an hour researching a physician but 42 percent will spend 10 or more hours researching a car.

Roger Holstein, CEO of Healthgrades, said he expects consumers will face unprecedented changes in how they select healthcare services in the future, and reiterated the company’s commitment to provide them with resources to compare hospitals.

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