Eight Inland hospitals show higher than expected death rates
11:01 PM PST on Sunday, January 9, 2011
A recent report shows that eight Inland area hospitals had higher than average death rates for problems and conditions that government agencies have identified as possible quality indicators, according to state analysis.
Five of those hospitals had been identified as poor performers in a previous report for 2006 and 2007 by the California Office of Statewide Health Planning and Development, which evaluates health care data.
The report assessed outcomes for patients who were admitted to California hospitals for esophageal and pancreatic resections, brain surgery, acute strokes, gastro-intestinal bleeding, hip fractures, surgeries to widen narrowed or blocked blood vessels and remove carotid artery plaque, congestive heart failure and pneumonia.
It is the second such report to be released by the department. The 12 conditions and procedures assessed in the report are among hospital quality measurements developed by the Agency for Healthcare Research and Quality, a federal agency charged with improving health care quality, safety, efficiency and effectiveness.
Administrators whose hospitals did poorly disputed the findings. They said the analysis used inaccurate office data, not clinical information, on which to base results. It also unfairly included seriously ill elderly people and clinically dead patients whose medical records indicated they not want to be resuscitated, which negatively skewed results.
"(The agency) might believe that giving something is better than nothing. I don't," said Dr. Dev GnanaDev, medical director at Arrowhead Regional Medical Center in Colton. He also is past president of the California Medical Association, an organization that represents more than 30,000 doctors.
Review of clinical data would have explained the deaths of 22 Arrowhead patients listed in the report as having died from brain surgeries, GnanaDev said. Nine of them had terminal brain cancer, he said. Six suffered severe brain injuries, such as gunshot wounds. The other seven didn't have brain surgery at all, GnanaDev said.
"That's why the report just bothers us," he said. "I do not know what they are trying to do."
Jerri Randrup, spokeswoman for Hemet Valley Medical Center and Menifee Valley Medical Center, also took issue with the report.
"We take these reports very seriously and we agree that health care information should be easily accessible and transparent to aid consumers," she said. "That is why when it is communicated; it should be as complete as possible. In this case, the ratings do not account for several contributing factors, including the wishes of the patients, many of whom had legally binding 'do not resuscitate' orders in place. Had such factors been considered, our facilities would have secured substantially higher ratings."
The report examined deaths that happened during hospital admission and considered risk factors such as age and co-existing illnesses. Thousands of records from more than 300 hospitals, including 32 in the Inland area, were analyzed.
The Office of Statewide Health Planning and Development did not audit records for accuracy, which it typically does, because it didn't have the manpower or money for it, said Joseph Parker, the department's director of its health care outcomes center. By law, the agency is required to periodically issue reports on health care.
All hospitals received copies of the report in November and had at least a month to respond. Few did.
The agency doesn't regulate hospitals, so it can't force them to improve.
Parker said the strategy behind the reports is to give patients and employers with large health care plans information they can use when deciding on hospitals to use.
"We are empowering them to ask questions when they have options," he said. "These are not the definitive measures of quality. They should be used as a starting point for asking questions."
Of the eight Inland-area hospitals named, the agency identified Hemet Valley Medical Center, Menifee Valley Medical Center, Arrowhead Regional Medical Center in Colton and Desert Regional Medical Center in Palm Springs as having worse than expected mortality rates in 2008 and 2009. Riverside Community Hospital and Redlands Community Hospital had worse than expected mortality rates in 2008. Community Hospital of San Bernardino and Hi-Desert Medical Center in Joshua Tree were identified as having worse than expected mortality rates in 2009.
Kathi Sankey-Robinson, spokeswoman at Redlands Community Hospital, said her hospital takes all quality reports and assessments seriously and uses them to develop ways to improve, including special assessment teams created to catch problems more quickly.
"They're good for the industry and good for the person," she said. "They are one thing for people to look at, but not the only thing."
Reach Lora Hines at 951-368-9444 or lhines@PE.com