Report Points Out Hospital Death Rates

Thirty-one of the California hospitals with more than 250 Medicare patients in 1987 had higher-than-predicted mortality rates, and 10 had low overall values, according to a federal report released Thursday.

In what the government called “another significant step forward” in improving health care, the U.S. Health Care Financing Administration released its second annual report on death rates for Medicare patients at the nation’s hospitals.

The 1987 statistics indicate which institutions had unusually high and 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 disease, lung disease and strokes.

Lower Rates

Three hospitals--French Hospital in Los Angeles, Green Hospital of Scripps Clinic in La Jolla and UCLA Medical Center--had lower-than-predicted death rates for both 1986 and 1987.

Ten hospitals had higher-than-predicted death rates for both years. These facilities included Martin Luther King Jr./Drew Medical Center in Los Angeles, Highland General Hospital in Oakland, Riverside General Hospital and San Bernardino County Medical Center.

The report “is a valid tool for improving the quality of the American health care system,” Dr. William L. Roper, the HCFA administrator, said at a press conference in Washington.

Roper directed peer review organizations, private groups that monitor the quality of care for Medicare patients under contract to HCFA, to scrutinize all the hospitals with high mortality rates and prepare reports stating whether problems exist and what is being done to correct them.

The HCFA administrator defended the agency’s annual public data disclosure against criticisms from consumer groups, who say that the statistics are inadequate, and some hospital officials, who do not want the statistics released at all.

“I am confident that it has had a profound impact on focusing attention on the actual care that is delivered in hospitals,” Roper said. “I believe information is power and information drives change. The more of this kind of information, appropriate information, we can publish the better informed the decisions will be that are being made.”

This view was disputed by Carol McCarthy, president of the Chicago-based American Hospital Assn. While acknowledging that such data could help hospitals and physicians improve care, McCarthy said that public release was “not useful” and served to “misinform, not inform” patients.

The 14-volume report is based on a computerized analysis of about 10.5 million admissions for elderly and disabled patients at nearly 6,000 hospitals during 1987. Comparable statistics for 1986 are included in the report, as well as summary statistical information on each hospital’s services and staffing, such as the percentage of the physicians who are certified in a medical specialty.

Explanations Offered

Hospitals were given a chance to review their statistics in advance and provide explanations, which were published as part of the report. About 1,900 hospitals, or 32% of the total, prepared such comments, compared to about 45% of the hospitals last year. Almost all of those with high mortality rates defended their quality of care; some cited discrepancies in the data, others said they cared for a disproportionate number of nursing home and severely ill patients.

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. For example, they only partially take into account variations in the severity of sickness between different patients with similar conditions--an important factor in predicting which patients are most likely to die despite good medical care.

“These statistics are screening tools,” HCFA officials said in a prepared statement. “Hospitals with mortality rates exceeding the predicted range are more likely to have quality problems than other hospitals. But not all hospitals with mortality rates exceeding the predicted range do in fact have problems. Some may be fine institutions that treat unusually sick patients.”

Because of these limitations, the government and other health care experts suggest that the statistics be used by patients as well as physicians and administrators as a starting point for asking questions, not as a score card on individual institutions.

For the three disease categories reviewed in detail by The Times, there were no instances where one California hospital had lower- or higher-than-predicted death rates in more than two categories.

Strikingly, the vast majority of the hospitals with high or low death rates for stroke, severe acute heart disease or pulmonary disease in 1987 did not have such high or low death rates in 1986. And most of the hospitals that had been outside their predicted mortality ranges in 1986 were within their predicted ranges in 1987.

The Washington-based Public Citizen Hospital Research Group, a strong advocate of greater hospital data disclosure, said the HCFA information is “an important improvement over last year’s” report. But the group’s leader, Dr. Sidney M. Wolfe, said he still objected strongly “to their not giving out more specific information,” such as the death rate for Medicare patients who have suffered heart attacks and those who undergo coronary artery bypass surgery.

There were 188 hospitals nationwide, or 3.2% of the total, that exceeded the upper bound of the range of their predicted overall mortality, and 363, or 6.2%, that were below the lower bound, according to the report. In last year’s report, by comparison, 2.4% of the hospitals exceed the upper bound of the range of their predicted overall mortality and 3.0% were below the lower bound.

Calculation Method

The apparent doubling of the number of hospitals with low mortality rates reflected the change in the calculation method, not an improvement in quality of care, according to HCFA officials.

In a related development, HCFA said that hospitals can now purchase a computer program developed by the government to help them interpret their death rates for patients with stroke, pneumonia, acute myocardial infarction and congestive heart failure. These conditions account for one-third of hospital-associated deaths among Medicare beneficiaries. The “Medicare Mortality Predictor System” allows hospitals to use information contained in medical records--but not in HCFA’s computer data bank--to help adjust for variations in the severity of illness of their patients.

The 14-volume report, “Medicare Hospital Mortality Information--1987,” is available from the U.S. Government Printing Office in Washington. Copies are also being provided to state hospital associations, state health departments and other organizations.

Times staff writer Laurie Duncan contributed to this story 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 persons, 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 10.5 million hospital admissions of Medicare patients during 1987 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. If a patient was hospitalized several times during 1987, only the last hospitalization was included in the analysis. For overall mortality, only hospitals with 250 or more cases are listed.

Rangeof Predicted Total Deaths Deaths Hospital Patients By% By% OVERALL High Mortality Rates AMI Valley Medical Center, El Cajon* 1,179 19 12-17 American River Hosp, Carmichael* 2,069 15 9-14 Bellwood General Hospital, Bellflower 917 20 13-19 Charter Community Hosp, Hawaiian Gardens 1,624 14 7-12 County--MLK Drew Med Cent, L.A.* 327 26 10-20 Delta Memorial Hospital, Antioch 703 18 10-17 Fresno Community Hospital 4,656 15 10-14 Greater Bakersfield Mem Hospital 1,864 17 11-16 Highland General Hospital, Oakland* 470 16 8-15 Humana Hospital Westminister* 855 18 10-16 Kaiser Foundation Hosp, Oakland* 2,013 15 10-14 Kaiser Foundation Hosp, Walnut Creek 1,431 16 10-15 Kern Medical Center, Bakersfield 592 21 9-17 Medical Center of Garden Grove 1,183 19 13-18 Medical Center of La Mirada 332 23 10-20 N.M. Holderman Hosp, Yountville 321 23 13-22 Northbay Medical Center, Fairfield 876 17 10-16 Norwalk Community Hospital 310 20 9-18 Pacifica Community Hosp, Huntington Beach 657 18 10-17 Pacifica Hosp of the Valley, Sun Valley 810 18 10-16 Pico Rivera Community Hospital* 446 24 12-21 Pioneer Hospital, Artesia 597 17 9-16 Queen of the Valley Hosp, West Covina 1,629 17 12-16 Riverside General Hospital* 727 17 8-14 Robert F. Kennedy Med Cent, Hawthorne 1,120 18 12-17 San Bernardino County Med Cent* 553 16 7-14 San Francisco General Hospital 1,159 15 9-14 Santa Clara Valley Med Cent, San Jose 1,173 15 9-14 Valley Medical Center, Fresno* 1,089 19 11-16 Villa View Community Hospital, San Diego 443 18 9-17 Whittier Hospital 899 18 11-17 Low Mortality Rates Encino Hospital 1,034 9 10-14 French Hospital, Los Angeles** 612 11 12-18 Green Hosp of Scripps Clinic, La Jolla** 1,785 6 7-11 Kaisier Foundation Hosp, Anaheim 1,246 10 11-15 Scripps Memorial Hosp, La Jolla 3,026 9 10-14 St Francis Hosp, Santa Barbara 1,098 8 9-13 St John’s Hospital, Santa Monica 3,575 8 9-12 St Mary’s Hosp Med Cent, San Francisco 2,505 10 11-15 Sutter Memorial Hosp, Sacramento 2,346 10 11-15 UCLA Medical Center, Los Angeles** 2,947 7 9-13 SEVERE ACUTE HEART DISEASE High Mortality Rates Doctors Hospital of Lakewood 91 55 29-51 Humana Hospital Westminster 46 63 27-56 Kaiser Foundation Hosp, Walnut Creek 64 53 26-52 Kaweah Delta Dist Hosp, Visalia 66 53 26-52 Long Beach Community Hospital 83 51 27-50 Queen of the Valley Hospital, West Covina 74 55 28-53 Salinas Valley Memorial Hospital 47 66 28-57 Scripps Memorial Hosp, Chula Vista 57 61 26-53 Verdugo Hills Hospital, Glendale 46 59 26-55 Low Mortality Rates Alta Bates Hospital, Berkeley 81 28 31-53 Cedars-Sinai Med Center, Los Angeles** 348 29 36-50 Daniel Freeman Mem Hosp, Inglewood 107 26 28-47 John Muir Med Cent, Walnut Creek 124 26 29-47 Kaiser Foundation Hosp, Harbor City 57 16 25-47 Kaiser Foundation Hosp, Hayward 54 19 25-48 Kaiser Foundation Hosp, West Los Angeles** 77 26 29-51 Kaiser Foundation Hosp, Panorama City** 96 25 29-49 Kaiser Foundation Hosp, San Diego 74 22 24-45 Mount Zion Hosp Med Cent, San Francisco** 105 28 31-51 Peninsula Hosp Med Cent, Burlingame 95 24 26-45 Saint Helena Hospital, Deer Park** 99 26 28-48 St Joseph Medical Center, Burbank** 189 27 29-45 St Jude Hosp & Rehab Cent, Fullerton 64 19 26-47 St Mary’s Hosp Med Cent, San Francisco 84 30 32-54 Samuel Merritt Hosp, Oakland** 98 27 29-49 Sharp Memorial Hospital, San Diego 96 22 27-46 Sierra Nevada Mem Hosp, Grass Valley 72 22 27-48 Sutter Memorial Hospital, Sacramento** 107 23 25-44 PULMONARY DISEASE High Mortality Rates Brookside Hospital, San Pablo 87 45 17-40 Covina Valley Comm Hosp, West Covina 71 46 19-44 Delta Memorial Hospital, Antioch 55 44 13-41 Greater Bakersfield Memorial Hosp 157 39 19-37 Kaiser Foundation Hosp, Martinez 59 44 15-42 Physicians Comm Hosp, San Leandro 56 46 17-44 Robert F. Kennedy Med Cent, Hawthorne 72 53 16-41 Santa Clara Valley Med Cent, San Jose 82 48 16-40 Saint Francis Medical Center, Lynwood 137 39 18-38 Verdugo Hills Hospital, Glendale 90 42 14-37 Westside Hospital, Los Angeles 48 52 20-50 Low Mortality Rates Barstow Community Hospital 58 12 14-35 Henry Mayo Newhall Mem Hosp, Valencia 59 8 15-34 Santa Teresa Comm Hosp, San Jose 58 12 13-33 Tulare District Hospital 47 11 16-37

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 two of these categories--severe acute heart disease and pulmonary disease--which are common causes of death in the elderly. Only hospitals that had 45 or more Medicare cases in each category are listed.

* Hospital that also had a high mortality rate for this category in 1986

** Hospital that also had a low mortality rate for this category in 1986