ALBANY, N.Y., June 27 (UPI) -- The Centers for Medicare and Medicaid Services released its first comparison of death rates from heart attack and heart failure, which some characterize as a baby step in addressing hospital care.
The good news is that almost all U.S. hospitals meet the national average for 30-day mortality from heart attack or heart failure -- only 35 hospitals had higher than anticipated heart failure mortality and only seven had higher than anticipated mortality following heart attack.
The bad news is this information being heralded by the U.S. government as "a milestone addition to the Hospital Compare consumer Web site at hospitalcompare.hhs.gov," doesn't really say much. Just as in Garrison Keillor's Lake Wobegon, where "all the women are strong, all the men are good looking, and all the children are above average," almost all U.S. hospitals meet the national average for heart attack and heart failure.
The data, collected by Medicare and Medicaid, was drawn from death rates of heart attack and heart failure patients who died between July 2005 and June 2006 of any cause, within a month of entering the hospital. The 30-day mortality for heart attack was 16 percent, and 30-day mortality for heart failure was 11 percent.
The findings show that only 17 of 4,477 hospitals had heart attack death rates that were better than the national rate, while 38 of 4,804 hospitals had heart failure death rates that were better than the national rate.
With such little bad news, the coverage of this experiment in hospital transparency has resulted in media stories that all sound the same. For example, in Kalamazoo, Mich., reports said: "The Kalamazoo hospitals were at the national average for patient mortality for heart attack and heart failure." In other reports, only the name of the city changed. The story was the same. Many of the reports quoted Health and Human Services and Secretary Mike Leavitt as saying, "this revised comparison tool will give consumers even better insight into the quality of care provided by their local hospitals."
The media reports on the 42 hospitals that have higher mortality rates from heart attack and heart failure were also similar. Almost all the reports from these 42 hospitals say they have patients who are older or sicker than average, therefore their heart attack and heart failure mortality rate is higher than average.
Nonetheless, the federal government said hospitals that treat sicker patients do not necessarily have worse death rates. "The hospital-specific 30-day death rates used in this report have been adjusted to account for differences in patients' health before their hospital admission," the Web site said.
In addition to the mortality rates, the Web site gives 21 measures to help patients and caregivers evaluate hospital care. The federal government, which has all the data from Medicare and Medicaid patients, has provided measures for consumers including: eight measures related to heart attack care, four measures related to heart failure care, seven measures related to pneumonia care, and two measures relates to surgical infection prevention.
This isn't very useful either.
If a member of my family needs to be hospitalized I want to know: what is the hospital-acquired infection rate, how long is the wait in the emergency room, how long does it take a nurse to respond, what is the hospital rate of medication errors, and what is the hospital's rate of hand-washing. This information is not available nationally.
If I want to know the odds of getting one of the 2 million hospital-acquired infections each year, knowing if my hospital gives aspirin when a patient arrives at an emergency room with a believed heart attack or whether the hospital provides smoking cessation help before leaving the hospital doesn't seem too useful to me.
However Dr. Vicki Rackner, founder of MedicalBridges.com, and a surgeon who left the operating room to help patients and their caregivers partner with their doctors effectively, calls the Web site information big news that will ultimately help parents and caregivers make better choices.
But the data is really information about how often a hospital/doctor meets measurable objective outcomes, and that's like asking how often an airplane departs/arrives on time, according to Rackner.
"What we are told in med school was that at least 50 percent of what medicine does is right, we just don't know which 50 percent -- medicine has been practice and tradition, but evidence-based medicine is determining what helps versus what harms," Rackner told United Press International's Caregiving.
"What's good about the information on the (HHS) Web site is that it tells us which hospitals are using evidence-based medicine -- giving an aspirin before and after a heart attack is evidence-based medicine."
To be able to go to a Web site and see how many in a hospital die after an appendectomy, or how many get a wound infection, or how long it takes a nurse to respond, is a long way off, according to Rackner.
"We're at the entrance ramp of the highway of measuring and finding outcome information; these are baby steps we're taking, and we're a long way from real patients using patient-information to make real choices."
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Alex Cukan is an award-winning journalist, but she has also been a caregiver since she was a teenager. UPI welcomes comments and questions about this column. e-mail: [email protected]
