Heart Attack Report Dings 2 O.C. Centers

When you’re having a heart attack, one hospital is not as good as another, according to the most comprehensive study to date of hospital outcomes in California.

In a state study of mortality rates released today, researchers found heart attack patients fared pretty much as expected in most of California’s hospitals, but they died significantly more often than predicted at 10 institutions--nine of them in Southern California. Six were in Orange and Los Angeles counties.

In Orange County, the bad grades went to Friendly Hills Regional Medical Center in La Habra and Garden Grove Hospital and Medical Center, according to the analyses of mortality rates among heart attack victims. Alhambra, Bay Harbor, Huntington East Valley and Gardena Memorial hospitals in Los Angeles County received black marks. The heart attack “report card,” however, comes as a very late post-mortem. Because collecting and analyzing data is so time-consuming, the report on 418 hospitals covers only 1991-1993. The deaths counted occurred within 30 days of admission.

The death rate study “is inherently a limited perspective on quality of service of an institution,” acknowledged Dr. Patrick S. Romano of UC Davis, one of the principal investigators. But, he said, “I think we can reasonably argue that limited measures are better than no measure.”

Thirteen hospitals statewide--including Cedars-Sinai, Glendale Adventist and Long Beach Memorial Medical Centers--got the equivalent of gold stars. Each posted much lower than expected death rates, given the patient mix. Orange County, where hospital heart attack death rates climbed slightly across the board, had no standout performers.

Researchers said some findings may be due to chance, but the study is thought to be the most thorough done by the state because it stretches over three years, it is validated through intensive sampling, it adjusts findings for various risks and the outcome measured--death--is unambiguous.

Heart attacks were selected as a focus because they are “important, common and deadly,” according to the report. Every year, 40,000 heart-attack patients are admitted to hospitals in California; more than 5,000 die.

The study, the third of its kind coordinated by the Office of Statewide Health Planning and Development, is in response to a 1991 state law that required selected outcome measurements. It is based on medical and death records.

The researchers, from UC Davis and UC San Francisco, said the findings could be used by hospitals as an incentive for improvements or as a confirmation of good practices. To employers, managed care contractors and consumers, it may serve as one rough measure of quality, they said.

The report also may point to the most promising avenues for treatment. In another study last year, researchers determined that the hospitals with the lowest death rates were more likely to be aggressive in their use of aspirin, clot-busting agents, angiography (X-rays of blood vessels), and angioplasty (repairing damaged blood vessels).

Hospitals with poor ratings said the study was flawed. Foremost among the complaints was that the data are 4 to 6 years old and no longer relevant. Some hospitals changed ownership during or after the study period.

“It was only our hospital for a short period of time” before the study period ended, said Dr. Henry Johnson, vice president of health systems improvement for ScrippsHealth. His company owns Scripps Hospital-East County in San Diego County, which rated poorly. Under new ownership, he said, “all policies and procedures were changed. The place was overhauled.”

Hospitals also said certain factors that put their patients at high risk for poor outcomes were not accounted for. For example, Friendly Hills argued that the state did not take into account the high number of patients on “do not resuscitate” orders, which precluded heroic measures and life-sustaining treatment. Friendly Hills, Kaiser and others also said their own coding, as reported to the state, may not have captured important risk factors.

A spokeswoman for Garden Grove Hospital and Medical Center said it is “misleading” to use the old data to rank the hospitals’ care today.

“Treatment modalities have changed in the last six years,” spokeswoman Donna Wolf said. “Care of cardiac patients at Garden Grove Hospital is our utmost concern.”

Some hospitals protested inclusion of patients who died up to 30 days after admission. They said the outcomes may reflect deficiencies in outpatient care or patients’ noncompliance with therapy, rather than hospital performance.

The study demonstrates the difficulty of grading medical performance--an area of increasing focus under managed care. The researchers themselves acknowledged that they are uncertain of the best approaches--so much so that they published two sets of data, each based on different statistical models.

Some hospitals did fine under one model and poorly under another. Researchers say they are most confident of findings that held true across both models.

These showed 13 hospitals performing better than expected and 10 worse.

In general, consumer advocates complain there isn’t much information available for patients to make informed choices. Federal health officials used to publish mortality data on hospitals serving large numbers of Medicare patients, but stopped after 1992 amid protests from institutions that the ratings did not account for illness severity. Other data are either too complex or of questionable quality, advocates said.

“Patients who need to go to the hospital, who have urgent care issues, don’t have the time to go online [on the Internet] and weed through the maze of technical information that’s out there. It’s confusing and limited,” said Jamie Court, director of Consumers for Quality Care, a Santa Monica-based health watchdog group.

Consumer-friendly data aren’t there because “hospitals don’t like to be compared,” he said. “They’d rather compete on holding down costs than . . . on outcomes.”