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COVER STORY : Experts advise looking at data, asking questions and getting opinions from friends and physicians.

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SPECIAL TO THE TIMES; Barbara Bronson Gray is a regular contributor to Valley Life

When Laura Callaway was pregnant and trying to pick the hospital where she would deliver her baby last July, she didn’t look for hospital statistics or for well-advertised amenities like champagne dinners or video machines in the labor rooms. She talked to her friends.

“It’s funny; there’s just sort of an underground grapevine. I had heard such good things about the hospital, I didn’t do much research,” says the 37-year-old feature film coordinator for Fox Studios.

For the record:

12:00 a.m. April 2, 1993 For the Record
Los Angeles Times Friday April 2, 1993 Valley Edition Valley Life Page 19 Zones Desk 1 inches; 31 words Type of Material: Correction
Wrong Name: The name of the chief of cardiovascular surgery at Encino Hospital was misspelled in a story about hospitals and their specialties in the March 26 issue of Valley Life. The surgeon’s name is Dr. Mohammad Gharavi.

But Callaway admits that beyond reputation alone, she was swayed by the fact that St. Joseph Medical Center in Burbank had a neonatal intensive care unit--”just in case something went wrong,” she says--and a parent education program that included a range of classes on childbirth preparation, infant CPR and “You and Me” classes for parents and their newborns. As it turns out, she didn’t need the neonatal unit, but she did take advantage of the parenting classes.

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Physicians, nurses and hospital administrators say that while there are a range of factors worth knowing before choosing a particular hospital for any type of medical procedure, the best way to make a decision is to talk to as many people as possible. In the San Fernando Valley, there are a dizzying array of choices, with more than two dozen to choose from.

Hard data--such as the hospital mortality statistics that are reported to the Health Care Financing Administration by hospitals to qualify for Medicare payment for services--is good to know, they say, but is affected by a wide range of variables, making the information hard to interpret.

For some procedures, experts say the number of cases a hospital handles every year seems highly correlated to success. But for others, the skill and experience of the particular physicians and nurses involved in the case can be the most crucial factor.

Unless consumers know what questions to ask and where to seek the data, the statistics can be hard to come by. What’s easier for patients to find, however, are the hospitals’ marketing tools--ads that highlight the glitz but sometimes gloss over the realities of hospital programs and capabilities. No firms specialize in matching patients to hospitals--yet.

But health-care providers recognize that consumers should do some shopping and fact-hunting before they decide on a particular facility. “There’s a change in the way medicine is practiced now compared to when I was a child,” says Dr. Avrum Bluming, a professor of medicine at USC and chief of staff at Tarzana Regional Medical Center. “There was a deification of medicine then, but people now are partners in their health care.

“Of all the members of the health-care team, the patient, after all, has the greatest investment in the outcome. And the way you empower patients is with information,” he says.

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Yet Bluming, a medical oncologist, concedes that much of the data is confusing at best. The hospital mortality statistics can make hospitals that tackle the more complicated cases look less successful than others, or can make an institution that carefully chooses only the lowest-risk patients look good. “It’s next to impossible to get an absolutely clean answer from the data,” he says.

Dr. Gerald Green, also a professor of medicine at USC and a gastroenterologist, agrees. “To some degree we can use the statistics--but one has to understand that the published data is a very mixed bag of information. The ultimate method will require doing your own research, talking to others who have been to the hospital, and visiting the unit and evaluating the ambience,” he says.

Dr. Rich Johnson, associate chief of the Division of Family Medicine at UCLA Medical Center, also downplays the value of all but the most exceptional data. “The information is helpful on the extreme end,” he says, suggesting that patients avoid hospitals with the highest mortality rates and look closely at the ones with the best data.

As for ambience, Johnson says it’s mostly irrelevant. “Too many people make their decisions based on a hotel mentality because they don’t appreciate that hospitals are bad places to be in,” Johnson says. People should really be more concerned by the 2% to 5% chance that something unexpected could happen, he says, and should pick their facility with an eye to how the hospital can handle emergencies.

“Whether you have a VCR or get a bedpan quickly isn’t as important as whether you survive congestive heart failure,” Johnson says. Ten years ago, he explains, hospitals were beefing up their guest-relations efforts, trying to emulate the ambience of fine hotels. That carpeted-hall feeling is history, he says, as the hospitals now are filled with technology--cardiac monitors, respirators--in virtually every unit.

Johnson likes teaching hospitals. “They are very overstaffed, and while they are less user-friendly, they are better equipped to deal with the unexpected problems,” he explains. There are more people with advanced levels of preparation and training around in the off-hours, he says.

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Bluming says he encounters some patients who are not only afraid of straying away from teaching hospitals, but fear San Fernando Valley-based health care in general.

“Patients have told me their throats tighten up at the crest of the 405 freeway as they realize they are going to the San Fernando Valley for treatment. It’s a well-established bias. Many people believe if you’re any good, you practice on the Westside,” he says.

But Bluming, who has taught medicine at Tufts, Columbia and Johns Hopkins medical schools, says health care provided in the Valley is on a par with what he has found anywhere he has worked.

Bluming prefers community medical centers to teaching institutions because the medical staff tends to live in the same area served by the hospital, and thus has a vested interest in the quality of care the facility provides. “In a community hospital, we’re not just the health-care deliverers, we’re the consumers, too,” he says.

Of all the information-gathering a patient can do, Green suggests patients rely most heavily on the feedback they get from physicians and nurses. “A patient may like the physical layout of a facility, but when it comes to the standards of care, ask nurses, physicians and other patients,” he suggests.

Green recommends patients ask their physicians how they feel about particular hospitals, and why. He also advises patients to ask how frequently the physician has performed a procedure, and how often the surgery or treatment is done at the hospital being considered.

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According to the “Consumer’s Guide to Hospitals,” (Center for the Study of Services, 1992, $12), Medicare death rate data shows the importance of case volume as a predictor of success in some types of surgeries. Coronary artery bypass graft surgery, for example, showed an average death rate of 8.4% for hospitals doing only 25 to 49 procedures in a three-year period, but a rate of 5.8% for hospitals doing 600 or more of the surgeries in the same time frame.

Hal Wurtzel, vice president of corporate development at Valley Presbyterian Hospital in Van Nuys, predicts that the far-reaching restructuring of the health care system expected under the Clinton Administration will only increase consumers’ demand for information.

“The focus on hospitals is to be very cost-effective in a managed-care environment, with a strong emphasis on quality care and quality outcomes,” he says.

Wurtzel doesn’t think it will be long before people will be able to call an 800 number to get detailed hospital and physician data to help them make choices between competing providers.

Until then--or perhaps even then--most experts advocate a combination of data and word of mouth. “As far as I’m concerned, patients can never ask too many questions,” says Joan Strohm, a registered nurse and manager of the oncology unit at St. Joseph Medical Center. “The more opinions you seek out, the better off you are.”

WHERE TO GO

What: A copy of the 221-page “Consumer’s Guide to Hospitals,” published by the Center for the Study of Services, a nonprofit organization founded in 1974 with funding from Consumers Union and the U. S. Office of Consumer Affairs.

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Contents: Guide reports actual death rates, risk-adjusted death rates and trends in Medicare cases in each of the almost 6,000 short-term, acute-care hospitals in the United States. It also details information on acute myocardial infarction, congestive heart failure, pneumonia/influenza, chronic obstructive pulmonary disease and other conditions and procedures.

Price: Send $12 (includes shipping and handling) to Center for the Study of Services, 806 15th St. N.W., Suite 925, Washington, D.C. 20005.

Call: (800) 475-7283.

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