Big Gaps Found in Hospital Mortality, Complication Rates

October 22, 2013

For patients, paying attention to hospital ratings can be a matter of life and death, according to a new report published online today by Healthgrades, a healthcare quality reporting group.

The study considers a hypothetical person in Atlanta, Georgia, for example, who has a stroke and can be taken to more than 30 area hospitals that were analyzed for this condition. The risk of the patient dying increases 17 times if he or she goes to the facility with the highest inpatient mortality rate for stroke treatment compared with the facility boasting the lowest rate.

Likewise, a person in Seattle, Washington, requiring colorectal surgery can see his or her risk of dying increase 12-fold by choosing the hospital with the highest mortality rate over the one with the lowest.

These wide divergences emerge in an annual report scrutinizing clinical performance in 31 of the most common procedures and conditions at more than 4500 hospitals. For 19 performance categories such as stroke, colorectal surgery, pancreatitis, pulmonary embolism, and pneumonia, the focus is on mortality rates. Healthgrades analyzed complication rates in the 12 remaining categories, which include hip replacement, spinal fusion, and carotid surgery.

For any particular procedure or condition, Healthgrades uses a star system to assign hospitals to 3 tiers: 5 stars indicate institutions with clinical outcomes statistically better than expected, 3 stars are given to those with outcomes that are statistically as expected, and those with outcomes worse than expected receive 1 star. The star grades are based on an analysis of 3 years' worth of risk-adjusted mortality and complication rate data from the Centers for Medicare & Medicaid Services.

The Healthgrades Web site allows visitors to select the hospitals in their metropolitan area and sort them by star tiers for an individual procedure or condition. Visitors can drill down further to find more precise performance data for a hospital. Among those within a 50-mile radius of Atlanta, for example, Piedmont Fayette Hospital posted an inpatient mortality rate of 0.5% for stroke care, which is the lowest rate in the area. The average for the nation's hospitals is 6.8%.

In general, patients are roughly 2 to 5 times more likely to die in a 1-star hospital compared with a 5-star hospital, depending on the procedure or condition.

Table 1. Differences in Inpatient Mortality Rates Between 1-Star and 5-Star Hospitals

Procedure or Condition Average Inpatient Mortality Rate, 1-Star Hospitals Average Inpatient Mortality Rate, 5-Star Hospitals
Myocardial infarction 11.0% 5.7%
Chronic obstructive pulmonary disease 3.1% 0.6%
Pneumonia 8.0% 2.7%
Stroke 10.1% 4.6%
Colorectal surgery 9.1% 2.7%
Sepsis 24.2% 14.1%

Source: American Hospital Quality Outcomes 2014: Healthgrades Report to the Nation

Healthgrades also found similar gaps in complication rates.

Table 2. Differences in Complication Rates Between 1-Star and 5-Star Hospitals

Procedure or Condition Average Complication Rate, 1-Star Hospitals Average Complication, 5-Star Hospitals
Total knee replacement 12.2% 4.5%
Hip replacement 13.6% 4.2%
Carotid surgery 15.0% 5.0%
Gallbladder removal 30.2% 14.4%

Source: American Hospital Quality Outcomes 2014: Healthgrades Report to the Nation

These performance data are especially valuable as previously uninsured Americans shop for coverage on health insurance exchanges established under the Affordable Care Act, according to Archelle Georgiou, MD, a Healthgrades strategic advisor. After all, each plan on the exchanges comes with its own network of hospitals and physicians.

"Consumers need accurate information to make meaningful choices between plans," Dr. Georgiou said in a news release. (The federally operated Web site for 36 state exchanges has malfunctioned on a massive scale since it debuted October 1, but the Obama administration has promised to fix the problems.)

Comparing hospitals not only guides patients to top performers but also motivates poor performers to improve. Healthgrades estimates that if all hospitals collectively performed as well as the 5-star hospitals it studied, some 234,000 lives might be saved and some 157,000 complications avoided.

The study, called American Hospital Quality Outcomes 2014: Healthgrades Report to the Nation, is available on the organization's Web site.

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