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Hospitals get low grades

Only one facility in west-central Florida scored above the national average in three categories.

By KRIS HUNDLEY
Published March 21, 2007

For patients who think all hospitals are pretty much the same when it comes to treating routine medical conditions, the nation's leading hospital accreditation agency has some surprising news: Think again.

According to data gathered by the Joint Commission, which has been evaluating hospital performance since the 1950s, seven west-central Florida hospitals fall below national performance benchmarks in their treatment of heart attacks, heart failure and pneumonia. Only one, South Florida Baptist Hospital in Plant City, performed above the national average in treating all three conditions.

In a report issued Tuesday, the Joint Commission provided its first assessment of how the nation's hospitals stack up when treating heart attacks, heart failure and pneumonia. The group began gathering data on a fourth area of concern, surgical infections, in 2005 and expects to add information on other critical treatment areas over time.

Based on standardized performance data gathered from 2002 through 2005 regarding treatment of heart attacks, heart failure and pneumonia, the Joint Commission found that hospitals have progressively improved the quality of care they provide. But many hospitals still have a long way to go.

"We can and must do better," said Dr. Dennis O'Leary, president of the group based in Oakbrook Terrace, Ill., which accredits about 5,000 hospitals through on-site visits at least once every three years.

Using hospital-reported data on seven performance measures for heart attack care, four measures for heart failure and four related to pneumonia treatment, the group found significant differences between the highest and lowest performing hospitals. Among the benchmarks used: How often are heart attack patients given aspirin upon arrival in the emergency room? How specific are the instructions given to heart failure patients before they're sent home? What percent of pneumonia patients have blood tests before being given antibiotics?

Hospitals seem to be tackling the easiest benchmarks first. Though hospitals have done a great job since 2002 of telling more pneumonia patients to stop smoking, for example, they have been much less aggressive about giving pneumococcal vaccines to pneumonia patients to prevent recurrence of the disease.

Hospital-specific data, available through the Joint Commission-sponsored Web site, www.qualitycheck.org, identified the following west-central Florida hospitals as performing below most accredited organizations nationwide in all three treatment areas:

- HCA Regional Medical Center at Bayonet Point

- HCA Oak Hill, Brooksville

- HCA South Bay, Sun City Center

- HCA Brandon Regional

- Sun Coast Hospital, Largo

- Florida Hospital Zephyrhills

- University Community Hospital, Tampa

Dr. Brad Bjornstad, UCH's chief medical officer, said the Joint Commission report revealed problems with the way data was being collected by UCH's doctors.

"These are process issues and so we had to change our internal processes," he said. "I think you will see improvement going forward. The patients are getting proper care, but it was not being documented."

BayCare Health System's South Florida Baptist hospital, with 147 beds, was the best performer in the Tampa Bay area, receiving above-average marks for its handling of heart attacks, heart failure and pneumonia.

Denise Remus, interim chief quality officer for BayCare, said being part of a nine-hospital network will allow South Florida Baptist to share what it does right with other facilities that want to improve.

"It's how you set up a care-delivery system that works 24/7, identifying patients in a clinical area and moving them on a path of care where they get the treatment that's needed," she said. "They have smaller volume at South Florida Baptist, and it may not transfer readily to a big hospital like Morton Plant. But there's still lots we can learn from them."

Though executives with the Joint Commission boasted that the benchmarking of hospital performance would create "truly informed health care consumers," Uwe Reinhardt, professor at Princeton University and longtime observer of the U.S. health care system, thinks patients and doctors actually pay little attention to the results.

"Eighty percent of the benefit of quality ratings is that they hit the provider the hospital with a 2 by 4 across the forehead," he said. "Publicly they'll run down the study, but secretly they will believe it. Then they'll work on the issues and two years later, they will rank better.

"Providers imagine patients poring over this data," Reinhardt said. "It's not important if they do as long as providers believe they do."

Kris Hundley can be reached at hundley@sptimes.com or (727) 892-2996.

The commission

Headquarters: Oakbrook Terrace, Ill.

Status: Independent, not-for-profit organization

What it does: Evaluates and accredits nearly 15,000 health care organizations, including nearly 5,000 hospitals, during unannounced, on-site surveys at least every three years.

How it collects performance data: The Joint Commission requires accredited hospitals to collect and report data on three of five standardized performance measures that apply to common clinical conditions

What it is gathering now: Since 2002, hospitals have been reporting on their standard treatments for heart attacks, heart failure and pneumonia; more treatment areas are being added

Where to find out more: Hospital rankings can be found at www.qualitycheck.org.

Ranking care

Why they ranked the way they did:

South Florida Baptist: High marks for giving beta blockers to heart attack patients when they arrive, clear instructions to heart failure patients when they leave and antibiotics to pneumonia patients within four hours of arrival.

Bayfront Medical Center: Lower than average rate of prescribing aspirin to heart attack patients upon discharge but did an above-average job of measuring the amount of oxygen in a pneumonia patient's bloodstream; met all national benchmarks for treatment of heart failure.

Regional Medical Center Bayonet Point: Below average rate of dispensing aspirin to heart attack patients; inadequate discharge information to heart failure patients; below average in blood tests for pneumonia patients.

St. Joseph's Hospital: Above-average rate of prescribing ACE inhibitors to heart attack patients upon discharge; below-average in discharge instructions to heart failure patients; 100 percent of all pneumonia patients have oxygen measured in blood stream.

Source: www.qualitycheck.org

[Last modified March 21, 2007, 05:50:09]