By RANDY GRIFFITH
JOHNSTOWN — While poor marks on the annual state hospital performance report are cause for concern, administrators at local hospitals say that feedback provides inspiration and direction to do better.
Last year, Windber Medical Center had high mortality rates for six major conditions, and was able to bring them all into line on this year’s Pennsylvania Health Care Cost Containment Council report.
“We are always looking at performance improvement,” said Linda Wedge, vice president for clinical services.
“We look at patients’ safety very seriously.”
This year, Memorial Medical Center is facing a similar challenge with six higher-than-expected mortality black marks.
“It’s very difficult to use (the information) in the form that it is presented,” Chief Medical Officer Dr. David Carlson said.
“These reports have made us pay attention to continually improving processes and care. We drive improvements on the transparency issues.”
Windber had higher-than-expected mortality rates in 2008 for these conditions: Non-hemorrhagic stroke, diabetes with medical management, chronic obstructive pulmonary disease, infectious pneumonia, respiratory failure without mechanical ventilation and congestive heart failure.
This year, all those mortality rates were “not significantly different than expected” at Windber, the 2009 report said.
Memorial’s 2009 black marks referred to patients with abnormal heartbeat, congestive heart failure, diabetes with medical management, acute kidney failure, stomach and intestinal bleeding and non-hemorrhagic stroke.
Memorial received no high mortality ratings in the major categories last year.
Somerset Hospital had only one black mark in two years. The high mortality rate last year for laparoscopic gall bladder surgery patients was actually a case of improper reporting, a Somerset Hospital official said.
“We have done a lot of work with the medical staff to promote adequate documentation,” said Craig Saylor, vice president for quality control.
Saylor said consumers can use the report to compare small and large hospitals because it adjusts the expected mortality rate expectations based on the severity of patient condition.
“This is a piece of it,” Saylor said. “The PHC4 report is very valuable, knowing that the playing field is level because risk adjustment is used.”
‘The patient’s choice’
Patients with terminal illness elevated death rates for both Windber’s and Memorial’s recent negative reports, leaders said.
“With our hospice, it is basically home care provided to keep the patient at home as long as possible,” Wedge said.
“A lot of patients do request to come to the (palliative care unit) to die.”
That was especially true during the 12-month period covered in last year’s report, she said.
“This year, more patients decided to stay at home to die,” Wedge said. “It is the patient’s choice.”
Memorial’s elevated mortality rates also illustrate some end-of-life issues, Carlson said. The figures include patients who gave the doctors “do not resuscitate” orders.
“I don’t think PHC4 does a very good job of understanding,” Carlson said. “If someone who is expected to die – and who wishes to die – they are not taken out of the data.”
In addition, Memorial’s role as the region’s tertiary-care hospital and its charity mission boosted its numbers.
“We are a community medical center and we take all comers,” Carlson said. “We don’t always have the ability to transfer. In our market, we are the place people come when they are very, very sick.”
Memorial’s black marks came in areas with a large number of patients, but typically few deaths.
One or two additional deaths can create a bad rating, even if the death was caused by an unrelated medical condition, Carlson pointed out.
Hospitals use the state report and other reviews as a gauge to direct planning and improvements, the local leaders said.
Both suggested the federal Hospital Compare Web site – www.hospitalcompare.hhs.gov, maintained by Medicare – is a more useful tool for consumers.
“It is creating an environment where we can’t be cavalier about it,” Carlson said. “We value the transparency of the Hospital Compare Web site and other databases that help us monitor our performance. It always points us back to how we can get better.”
‘Improve our outcomes’
Hospitals have extensive review procedures for all cases, the leaders said.
“We evaluate regularly, individual by individual,” Carlson said. “We have multiple processes to help us improve our outcomes.”
“We look at each and every chart,” Wedge said.
Patients should use the reports as one tool in selecting a health-care provider, Wedge said.
“This concept of rating health-care providers and hospitals is a very early and imperfect science,” Carlson said. “Most people should decide based on their physician’s recommendation. Physicians do what is best for their patients.”
Memorial is still a quality hospital, he said.
“Most people want to get health care in their community,” Carlson said. “Johnstown is one lucky community. They have a great institution to take care of the health care with a great medical staff. Many doctors are trained here.”
Results of another report show Windber’s quality, Wedge said. The Centers for Medicare and Medicaid Services requires patient surveys for all hospitals.
“Our patient satisfaction scores are always high,” Wedge said. “We are highest in the state for the number of patients who would definitely recommend the hospital.”
