Mortality rates 71 percent lower at top-rated hospitals

Oct 16 2007

Patients have on average a 71 percent lower chance of dying at the nation's top-rated hospitals compared with the lowest-rated hospitals across 18 procedures and conditions analyzed in the tenth annual HealthGrades Hospital Quality in America Study, issued today by HealthGrades, the healthcare ratings company.

The study, which documents a wide variation in the quality of care between the highest-performing hospitals and all others, also found that if all hospitals performed at the level of hospitals rated with five stars by HealthGrades, 266,604 Medicare lives could potentially have been saved over the three years studied.

The HealthGrades study of patient outcomes at the nation's approximately 5,000 hospitals, the most comprehensive annual study of its kind, covers more than 41 million Medicare hospitalization records over the years 2004 to 2006. The study examines procedures and conditions ranging from heart attack to pneumonia to valve-replacement surgery. Based on the study, HealthGrades today made available its 2008 quality ratings for virtually every hospital in the country at www.healthgrades.com, a Web site designed to help individuals research and compare local healthcare providers.

According to the study, mortality rates at America's hospitals have improved 11.8 percent from 2004 to 2006, with the nation's top-rated hospitals improving at a faster rate (12.8 percent) than the lowest rated hospitals (11.4 percent). Of the 18 procedures and conditions studied, those that saw the most improvement in mortality rates were pancreatitis (19.2 percent), pulmonary embolism (17.4 percent) and diabetic acidosis and coma (16.6 percent). Those with the smallest improvement were resection/replacement of the abdominal aorta (0.4 percent), coronary interventional procedures such as angioplasties and stents (0.8 percent) and treatment of heart attack (8.9 percent).

Full reports on mortality rate trends in each of the 50 states and the District of Columbia are available in the study.

“While we are pleased to see that the hospital industry's focus on improving care quality has continued to reduce mortality rates, a significant variation in quality among the nation's best and poorest-performing hospitals persists,” said Samantha Collier, MD, HealthGrades' chief medical officer and one of the authors of the study. “Concentrating on emulating practices from exemplary hospitals can result in improvement. If this focus were targeted to four key quality areas -- heart failure, respiratory failure, sepsis, and pneumonia -- the nation could achieve up to a 50-percent reduction in potentially preventable deaths.”

The study also found wide variation in risk-adjusted mortality at the state and regional levels:

• Across all procedures and conditions, the average number of states performing statistically significantly better than predicted was 14, while an average of 19 states performed statistically significantly worse than predicted.

• The region with the lowest overall risk-adjusted mortality was the East North Central Region (IL, IN, MI, OH and WI) while the East South Central region (AL, KY, MS and TN) had the highest mortality.

• The region with the most overall improvement for all procedures and conditions was the West South Central region (AR, LA, OK and TX), where the risk-adjusted mortality dropped by 13.5 percent. The least improvement was seen in the Mountain region (AZ, CO, ID, MT, NE, NV, NM, UT, and WY), with a decline of 8.8 percent.

• The East North Central region (IL, IN, MI, OH, and WI), had the highest percentage of best-performing hospitals – those hospitals that are among the best 15 percent for risk-adjusted mortality overall – at 26 percent.

• Less than seven percent of hospitals within the East South Central region (AL, KY, MS, and TN) and the New England region (CT, ME, MA, NH, RI, and VT) were top-performing hospitals.

In the study's analysis of mortality rates, the following 18 procedures and conditions were analyzed: atrial fibrillation, bowel obstruction, chronic obstructive pulmonary disease, coronary bypass surgery, coronary interventional procedures (angioplasty/stent), diabetic acidosis and coma, gastrointestinal bleed, gastrointestinal surgeries and procedures, heart attack, heart failure, pancreatitis, pneumonia, pulmonary embolism, resection/replacement of the abdominal aorta, respiratory failure, sepsis, stroke, and valve replacement surgery.