U.S. Issues Data About Hospitals’ Death Rates

In what the government termed a major step forward in assuring quality health care, the U.S. Health Care Financing Administration on Thursday released comprehensive information on death rates for Medicare patients at most of the nation’s hospitals.

The statistics reveal which hospitals have unusually high or low overall death rates, as well as high or low death rates for common causes of death in the elderly and disabled, such as heart diseases, lung diseases and strokes.

In California, 13 hospitals with more than 200 Medicare patients had higher than predicted overall mortality rates, and three had low overall values--Century City Hospital in Los Angeles, Green Hospital of Scripps Clinic in La Jolla and UCLA Medical Center.

The seven-volume report is based on a computerized analysis of about 10 million admissions for elderly and disabled patients at nearly 6,000 hospitals during 1986.

Aimed at Improvement

The report’s “first and foremost usage should be by doctors and hospitals to improve what they do for patients,” said the administration’s Dr. William L. Roper, who oversees the Medicare program. “So I expect that all across America there’s going to be a lot of board meetings in hospitals and hospital staff meetings asking pointed questions of doctors that have a high number of their patients die.”

Three California hospitals also had lower than expected death rates for both severe acute and severe chronic heart disease, the most common causes of death in the elderly: Cedars-Sinai Medical Center, Kaiser Foundation Hospital, Los Angeles, and Sequoia Hospital in Redwood City.

The statistics allow each hospital’s actual mortality rates to be compared to the government’s calculations of a range of its predicted death rates, based on the characteristics of its patients, such as age, sex, previous hospitalizations and the additional illnesses from which they suffer.

The performance statistics are not intended to be used to make comparisons among hospitals and are not a direct measure of the quality of medical care. They do not take into account variations in the severity of illness between different patients with similar conditions--an important factor in predicting which patients are most likely to die, despite good medical care.

Because of these limitations, health care experts suggest that the statistics be used as starting points for asking questions when high mortality rates are found, not as hospital report cards.

Roper hailed the data disclosure as one of his most important accomplishments and pledged that his agency would release more meaningful hospital performance data next year.

But the completeness of the data release was significantly curtailed by what Dr. Henry Krakauer, a Health Care Financing medical officer who played a key role in preparing the report, called “political sensitivities.”

The federal agency, for example, chose not to compile any summary statistics, such as national or statewide mortality rates, as is almost always done when such data is published in a medical journal. Such statistics might have facilitated comparisons between hospitals. It did not reveal the actual predicted death rates for hospitals, another standard reporting procedure for health care data.

Calculation Method

The agency also used a calculation method that minimized the number of hospitals whose death rates would have turned out to be higher or lower than their predicted ranges. As a result, there were 146 hospitals, or 2.4% of the total, that exceeded the upper bound of the range of their predicted overall mortality and 180, or 3.0%, which were below the lower bound, according to Health Care Financing.

But if another accepted calculation method had been used, then the number of hospitals with higher than predicted overall mortality would have risen to about 11%, or about 660 hospitals, according to the report’s technical appendix.

In a telephone interview from his Baltimore office, Krakauer defended these decisions. Asked about the choice of the more restrictive statistical technique, he said it is just as important for patients, physicians and hospitals to be concerned about the performance of hospitals near the upper bounds of their predicted mortality rates as the performance of those hospitals that exceeded their bounds.

“The political reason why we are so reluctant to bandy numbers about is that they are likely to be misused,” Krakauer said. “You fall into the fallacy of misplaced concreteness--just because a number can be written down doesn’t mean that it carries a precision. . . . It is a very difficult problem; it has caused us an immense amount of agony.”

Additional Data

The release of mortality information for almost all acute-care hospitals significantly expands on Health Care Financing’s initial data release in March, 1986, which only included some of the hospitals that were found to have high or low death rates.

Another difference is that this time hospitals were given a chance to review their statistics in advance and provide explanations, which were published as part of the report. About 45% of the hospitals prepared such comments.

The administration also modified and improved its calculation methods, after soliciting the advice of academic experts, hospital organizations and consumer groups.

“It is an incredibly positive thing that (Roper) sees it as one of his primary missions to release information other than on cost and efficiency,” said Robert H. Brook of RAND Corp. in Santa Monica, an authority on monitoring the quality of care in the Medicare program and one of the project’s advisers.

Airing Dirty Linen

Brook added: “(This will) begin to focus American medicine again on what it is about, to have people live longer, comfortably and to increase their function. . . . The only way to do it is to get the public on our side and air some of our dirty linen.”

This view was sharply disputed by Carol McCarthy, president of the Chicago-based American Hospital Assn. and another project adviser. “Dr. Roper is incorrect in saying that this kind of release is necessary to stimulate the review of care which is given in hospitals,” McCarthy said in a telephone interview. “To simply publish mortality statistics like this (is) of no use to the public.”

In California, eight of the 22 Kaiser Foundation Hospitals had lower than predicted death rates for acute heart disease patients and five had low death rates for stroke patients. Dr. Mark S. Blumberg, Kaiser’s director of special studies and another project adviser, cautioned that the data, while vastly improved, was “probably of very limited value.”

Under the federal Freedom of Information Act, Kaiser asked for additional data so that it could better evaluate the statistics for its hospitals. But Health Care Financing denied the request.

Treating Elderly Patients

For the five disease categories reviewed in detail by The Times, one California hospital, AMI Medical Center of North Hollywood, had four instances of higher than predicted death rates--overall mortality, stroke, severe acute heart disease and pulmonary disease. When asked about the high death rates, Jim Bennie, the hospital’s vice president for marketing, said “an in-depth analysis” is in process. He said many of the patients who died were in their 80s and were critically ill upon arrival at the hospital.

The seven volume report, “Medicare Hospital Mortality Information--1986” is available from the U.S. Government Printing Office in Washington for $69. Copies are also being mailed to some libraries, state and local hospital associations and medical societies, regional offices of the American Assn. of Retired Persons and peer review organizations, such as California Medical Review in San Francisco.

Robert Steinbrook reported from Los Angeles and Robert A. Rosenblatt reported from Washington. Times researcher Tracy Thomas in Los Angeles assisted in preparing the story.

MORTALITY RATES IN CALIFORNIA HOSPITALS These California hospitals show statistically significant high or low death rates for elderly and disabled people, according to mortality data released by the federal Health Care Financing Administration. The statistics were compiled from a computer data bank containing information on about 10 million hospital admissions of Medicare patients during 1986 to nearly 6,000 hospitals across the country.

The data reflect the percentage of the hospital’s Medicare patients who died within 30 days of being admitted to the hospital, whether as hospital patients or after discharge, as well as a range of predicted mortality for each hospital. The predicted mortality takes into account characteristics of individual patients, such as age, sex, previous hospital admissions and other major medical illnesses, as well as the number of patients treated at each hospital. It does not account for variations in severity of illness. There is a less than 5% probability that a hospital would be listed as having either a high or a low mortality rate because of chance, according to HCFA. If a patient was hospitalized several times during 1986, only the last hospitalization was included. For overall mortality, only hospitals with 200 or more patients are listed.

Range of Predicted Total Deaths Deaths Hospital Patients By % By % OVERALL High Mortality Rates AMI Med. Center of No. Hollywood* 919 18 10-17 AMI Valley Med. Ctr., El Cajon* 1,344 19 11-18 Canoga Park Hospital* 449 21 9-18 Greater El Monte Community Hospital 581 21 11-19 West Hollywood Hospital 224 26 11-23 Humana Hospital, Westminister* 1,041 18 9-16 Ontario Community Hospital* 476 20 9-18 Pico Rivera Community Hospital 428 23 12-22 Riverside General Hospital* 785 19 8-15 Santa Ana Hospital Medical Center 545 19 9-17 Santa Teresita Hospital, Duarte 643 19 10-18 Van Nuys Community Hospital* 294 25 11-21 Ventura County Medical Center* 584 16 7-15

Low Mortality Rates Century City Hospital, Los Angeles 784 6 8-15 Green Hosp. of Scripps Clinic, La Jolla* 1,695 5 6-12 UCLA Medical Center, Los Angeles* 2,870 7 8-14

The Health Care Financing Administration also released information on patient deaths within 16 individual diagnostic categories. These are the California hospitals with statistically significant high or low death rates in four of these categories--stroke, severe acute heart disease, severe chronic heart disease and pulmonary disease--which together account for about 40% of all deaths within 30 days of hospital admission in the elderly. Only hospitals that treated 30 or more Medicare patients in each category are listed.

Range of Predicted Total Deaths Deaths Hospital Patients By % By % SEVERE ACUTE HEART DISEASE High Mortality Rates Alhambra Community Hospital 36 56 23-55 AMI Medical Center of North Hollywood* 46 63 28-57 Charter Suburban Hospital, Paramount* 31 58 22-55 Downey Community Hospital* 79 51 26-49 Greater El Monte Community Hospital 31 58 22-56 Hi-Desert Medical Center, Joshua Tree* 39 59 27-58 Hollywood Presbyterian Medical Center* 88 56 30-52 Humana Hospital, West Anaheim* 31 74 23-58 Paradise Valley Hospital, National City* 38 61 27-58 Queen Of The Valley Hospital, Napa* 57 61 28-54 Redbud Community Hospital, Clearlake 36 58 25-57 South Bay Hospital, Redondo Beach* 38 58 24-55 St. Rose Hospital, Hayward* 59 58 28-54 UC Davis Medical Center, Sacramento 43 58 24-53

Low Mortality Rates Cedars-Sinai Med. Center, Los Angeles* 301 25 35-49 Eisenhower Mem. Hosp., R. Mirage 83 24 26-48 Kaiser Foundation Hospital, Anaheim* 56 16 24-50 Kaiser Foundation Hospital, Bellflower* 99 20 27-47 Kaiser Foundation Hospital, Fontana* 185 24 28-44 Kaiser Foundation Hospital, Hayward* 63 22 23-47 Kaiser Found. Hosp., W. Los Angeles* 77 17 27-49 Kaiser Foundation Hosp., Panorama City* 143 20 27-45 Kaiser Foundation Hospital, Santa Clara* 92 21 26-47 Kaiser Found. Hosp., Woodland Hills* 40 18 21-51 Providence Hospital, Oakland 69 28 29-53 Sequoia Hospital, Redwood City* 105 24 26-46 Sutter Memorial Hospital, Sacramento 110 18 29-49 UC San Diego Medical Center* 37 19 21-51

* Hospitals that submitted specific comments explaining their mortality rates to the Health Care Financing Administration.

Range of Predicted Total Deaths Deaths Hospital Patients By % By % SEVERE CHRONIC HEART DISEASE High Mortality Rates Greater Bakersfield Memorial Hospital 61 36 13-34 Humana Hospital, West Anaheim* 59 39 15-37 Sierra Community Hospital, Fresno* 36 39 11-38 St. Mary Desert Vy. Hosp., Apple Valley 59 37 13-34

Low Mortality Rates California Medical Center, Los Angeles* 133 12 16-31 Cedars-Sinai Med. Ctr., Los Angeles* 405 14 20-30 Chinese Hospital, San Francisco 33 12 14-45 Doctors Hospital of Pinole* 55 11 14-37 French Hospital of Los Angeles* 51 6 14-37 French Hospital, San Francisco* 53 11 14-38 Holy Cross Hospital, Mission Hills 80 9 15-34 Kaiser Foundation Hosp., Los Angeles* 163 17 18-32 Los Alamitos Medical Center* 142 17 18-33 L. A. County-USC Med. Center* 67 10 11-31 Marshall Hospital, Placerville 61 10 14-35 Mission Comty. Hosp., Mission Viejo 44 9 14-40 Monterey Park Hospital* 42 5 12-37 Mt. Zion Hosp. & Med. Ctr., S. Francisco* 81 14 16-36 Ridgecrest Community Hospital 33 6 12-42 Roseville Community Hospital 89 11 15-34 Sequoia Hospital, Redwood City* 133 13 16-31 St. John’s Hosp. & Hlth. Ctr., S. Monica* 134 13 18-33

Range of Predicted Total Deaths Deaths Hospital Patients By % By % STROKE High Mortality Rate AMI Med. Ctr. of No. Hollywood* 30 57 15-47 Community Hosp., Monterey Peninsula* 110 44 19-37 Doctors Medical Center, Modesto* 72 42 18-39 Granada Hills Community Hospital* 35 46 15-45 Greater El Monte Community Hospital 34 53 15-45 Hemet Valley District Hospital 157 41 21-37 Hollywood Presbyterian Medical Center* 74 47 19-40 Humana Hospital, Westminister* 56 43 18-42 Parkview Community Hosp., Riverside* 38 50 17-47 Queen of the Valley Hosp., W. Covina* 78 41 19-40 Rideout Memorial Hospital, Marysville 72 43 18-40 Valley Medical Center of Fresno* 41 49 17-45 Watsonville Community Hospital* 43 44 15-41

Low Mortality Rates Chinese Hospital, San Francisco 32 9 14-45 Valley Medical Center, San Gabriel 80 18 19-40 Eisenhower Mem. Hosp., R. Mirage 92 17 19-39 Huntington Memorial Hospital, Pasadena 131 20 21-37 Kaiser Foundation Hosp., Los Angeles* 138 15 19-35 Kaiser Found. Hosp., W. Los Angeles* 66 14 15-37 Kaiser Found. Hosp., Panorama City 91 13 17-36 Kaiser Found. Hosp., Redwood City* 74 14 17-38 Kaiser Foundation Hosp., San Rafael* 48 15 16-41 Los Robles Reg. Med. Ctr.,Thous.Oaks* 33 9 14-44 Ralph K. Davies Med. Ctr., S. Francisco* 65 15 19-42 St. Joseph Medical Center 183 16 21-36

Range of Predicted Total Deaths Deaths Hospital Patients By % By % PULMONARY DISEASE High Mortality Rates Alameda Hospital* 135 35 15-31 American River Hospital, Carmichael* 262 29 14-26 AMI Medical Center of North Hollywood* 117 38 16-34 AMI Valley Medical Center, El Cajon* 216 34 15-29 West Hollywood Hospital 46 39 12-36 Medical Center of Garden Grove* 156 33 16-31 N M Holderman Hosp., Yountville* 54 35 11-34 Redlands Community Hospital* 133 35 15-31 Riverside General Hospital* 75 37 13-33 Santa Ana Hospital Medical Center 105 39 15-33 Santa Clara Valley Med. Ctr., San Jose* 103 31 12-29 St. Francis Medical Center, Lynwood 252 29 14-27 Torrance Memorial Hosp. Med. Ctr.* 159 34 16-31 Valley Hospital Med. Ctr., Van Nuys* 126 36 15-32 Valley Medical Center of Fresno* 131 32 14-30 Van Nuys Community Hospital* 71 39 15-36 Western Medical Center, Santa Ana* 129 31 14-30

Low Mortality Rates Century City Hospital, Los Angeles 65 11 12-33 East Los Angeles Doctors Hospital 39 10 11-39 Eisenhower Mem. Hosp., R. Mirage 179 10 12-25 Fremont Medical Center, Yuba City 112 4 11-28 Kern Valley Dist. Hosp., Lake Isabella 70 10 11-31 Northern Inyo Hospital, Bishop 60 8 11-33 Riverside Community Hospital* 191 12 13-26 Green Hospital of Scripps Clinic, La Jolla* 120 7 10-26 Scripps Memorial Hospital, Chula Vista* 167 11 13-27 Sonora Community Hospital* 87 9 11-29