Reaction to State Comparison of 395 Hospitals Is Mixed

A first-ever comparison of California hospitals to determine how well they treat heart attack victims and perform back surgeries will name a handful of top performers when it is released today.

Only 14 hospitals of the 395 surveyed statewide were considered to have exceptionally good records in their handling of heart attacks in the landmark report by the Office of Statewide Health Planning and Development. None are in Orange County. Hospitals with the worst records were not identified.

There were more high marks for back surgeries. Twenty-six of the 330 hospitals studied for back surgeries around the state got top marks, including three in Orange County. These are Pacifica in Huntington Beach and Chapman General and St. Joseph, both in Orange.

No hospital got top marks in both categories.

The findings were released without comment on what the numbers said about the quality of health care in California hospitals or how this state’s hospitals might stack up against those of other states.

Hospitals not included in the list of best performers--and some who were--reacted with highly vocal criticism of the survey.

Even before release of the report, state health planners circulated findings to individual hospitals. They got enough critical letters to fill almost an entire volume of the three-volume report.

David Langness, a spokesman for the Hospital Council of Southern California, contended that the health planners simply took hospitals at the top of the grading curve and gave them top marks. He called this a disservice to other hospitals because it was based on numerical values.

“This study is almost useless in determining quality,” Langness said.

State officials conceded that the survey had shortcomings. One of the biggest potential problems is that the report is the first and has no base line of quality against which to compare the findings. Sponsors of the report said the possibility of statistical error was one of the reasons they did not want to identify hospitals with the worst records.

Qualifying the findings, the authors said in an executive summary: “This report is only a first step. In future years, additional data will become available and our confidence about our ability to measure outcomes will increase.”

Ed Foley, regional vice president of the Hospital Council of Southern California in Orange County, said he and administrators of Orange County’s 34 acute care hospitals were still waiting Wednesday for a copy of the state findings.

Foley said he does not believe a foolproof way of measuring the medical risks associated with individual patients has been found so as to create a level playing field on which all hospitals can fairly compete.

“Hospitals recognize the fact the public and government agencies and the media want information on the quality of care at hospitals so they will have something to compare, and hospitals aren’t resisting that,” Foley said. “We are just nervous, because we are concerned that it accurately reflect the performance of hospitals.”

Noting that the report is the state’s first such attempt at compiling a report card on health care providers, Foley predicted that “they will get better at it.”

Sponsors of the report hope that it eventually will become a useful tool for consumers in choosing a hospital or health care provider. President Clinton’s national health care reform proposal calls for development of similar kinds of report card-type studies.

Assemblyman Burt Margolin (D-Los Angeles), chairman of the Assembly Health Committee, said: “It’s not a perfect report. It does not do all we had hoped for, but it is a major breakthrough.”

Nevertheless, the survey falls far short of the relatively detailed report card that was anticipated when legislation calling for the study was enacted in 1991.

At the time, the Legislature wanted the Office of Statewide Health Planning and Development to study three medical procedures: heart attacks, back surgeries and deliveries by Cesarean section. But health planners said they could not amass enough data on the obstetric procedure.

The Legislature also wanted hospitals ranked on a scale of five outcomes--average, above average, much higher than average, below average and much lower than average.

The authors of the report, acknowledging heavy pressure from hospitals, decided that for the first year they would simply list the hospitals with exceptional records.

Times staff writer Leslie Berkman contributed to this report.