California Hospitals Are Rated on Heart Bypass Surgeries

Each year, more than 27,000 Californians are admitted to the hospital for bypass surgery to restore blood flow through their coronary arteries. Yet few of these patients know how their hospital measures up as far as surgical outcomes.

Last week, a state agency and a private coalition of 45 California employers that buy health insurance jointly released the first public accounting of death rates after heart bypass surgery.

The initial report from the California Coronary Artery Bypass Graft Mortality Reporting Program is intended to help hospitals, surgeons, policymakers, insurers and consumers compare how well hospitals are getting patients through the sophisticated and sometimes life-saving operation.

The report, covering 1997 and 1998, is a first step in holding California hospitals accountable, making the surgery safer and helping consumers make better-informed decisions about the procedure.

“The benefit will be that hospitals and surgeons and other caregivers will be able to look at their performance in a very objective way and ... embark on a quality improvement program,” said Dr. Daniel Ullyot, director of cardio-thoracic surgery at Mills-Peninsula Medical Center in Burlingame.

The report on patient deaths after surgery is based on information about 30,814 bypasses collected from 79 hospitals that agreed to participate in the study. Those hospitals--among 118 that offer the procedure--accounted for 70% of the bypasses performed in California in 1997 and 1998. The data showed 802 deaths among patients who received grafts in their coronary arteries--a mortality rate of 2.6%.

“We’re doing well in California,” said Dr. David M. Carlisle, director of the Office of Statewide Health Planning and Development, which prepared the report with the Pacific Business Group on Health, a San Francisco-based alliance of major employers who jointly purchase health insurance for their workers.

But “there’s room for improvement statewide,” said Cheryl Damberg, director of research for the alliance.

The report concluded that 72 of the 79 hospitals performed “as expected” on coronary bypass procedures. That meant that when hospital mortality rates were statistically adjusted to reflect the severity of the patients’ illness, the number of deaths fell within an expected range. Put another way, the study took into account that hospitals, that tend to treat a higher number of very sick patients who would be at greater risk of death, could not be compared directly with hospitals that treat less severely ill patients.

While the vast majority of the hospitals were given the “as expected” rating, there were subtle variations in the data that could influence health insurers’ decisions on which doctors and hospitals to contract with for cardiac services. It also could influence medical groups’ decisions about which hospitals to send patients for bypass procedures.

Four hospitals statewide performed significantly worse than expected, including two in Southern California: Downey Community Hospital in Downey and Presbyterian Intercommunity Hospital in Whittier.

Dr. Bill Kim, Downey Community’s medical director, questioned the study’s methodology. He said that in 2000--a year not included in the study--the hospital’s death rate for bypass surgeries “was well below the national average.” Dr. J.R. Hamilton, vice president of medical affairs at Presbyterian Intercommunity, said the hospital’s mortality rates have improved each of the last three years.

Hoag Memorial Presbyterian Hospital in Newport Beach was among three hospitals that did significantly better than expected.

Differences in mortality rates reflect variations in preoperative care, surgical practices, the skill of surgeons and nurses and care after the operation.

The American College of Cardiology recommended a decade ago that a hospital should perform at least 200 to 300 bypasses a year to assure good results. But 68 California hospitals performed fewer than 200 in 1998, the report said. That, Damberg suggested, should send up a red flag to patients who have a choice of hospitals. The report can help them seek out hospitals that do more bypasses or find the lower-volume hospitals that get excellent results.

With the report, the first in a planned series, California joins New York, Pennsylvania and New Jersey in releasing data on bypass surgery.

Several major California hospitals, including Huntington Memorial in Pasadena and Harbor-UCLA in Torrance, declined to submit bypass results.

Some hospitals that declined to participate questioned the study’s statistical methods or complained that they lacked the staff or technology to collect the information, Damberg said.

Dr. Joseph S. Carey of Torrance said that there was “a lot of suspicion among physicians about public release of data,” because they believed consumers would not be able to interpret it, and that doctors disliked numerical rankings.

The initial results, especially those from hospitals that do not perform a lot of bypass procedures, are “not sufficient for drawing definitive conclusions” about any given hospital, the report said. It will take several years of data to show “whether there is a consistent pattern of performance, either good or bad.”

Patients facing cardiac bypass can get more information by contacting a hospital’s public affairs office or cardiac care unit and asking about the hospital’s performance since 1997-98, Damberg said. They can ask hospitals that didn’t participate in the study why they made that decision and can ask to see information on mortality rates. The report appears on the Web sites of the Pacific Business Group on Health at https://www.pbgh.org and the Office of Statewide Health Planning and Development at https://www.oshpd.state.ca.us.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Bypass Success Rates

A new statewide report on coronary bypass deaths provides results for 1997 and 1998 showing how well hospitals are getting patients through bypass surgery. The scores for Southern California hospitals, shown below, indicate whether the death rates after bypass were higher, lower or what was expected, given how sick the patients were.

Key: = as expected; -lower than expected; +higher than expected

*--*

Hospital Number of surgeries Anaheim Memorial Medical Center, Anaheim 125 Cedars-Sinai Medical Center, Los Angeles 412 Citrus Valley Medical Center-Intercommunity, Covina 225 Community Memorial Hosp. of San Buenaventura, Ventura 192 Daniel Freeman Memorial Hospital, Inglewood 160 Desert Regional Medical Center, Palm Springs 120 Downey Community Hospital, Downey 116 Encino Tarzana Regional Medical Center, Tarzana 183 Glendale Adventist Med Center -Wilson Terrace, Glendale 206 Glendale Memorial Hospital and Health Center, Glendale 192 Granada Hills Community Hospital, Granada Hills 75 Heart Hosptial of the Desert, Rancho Mirage 117 Hoag Memorial Hospital Presbyterian, Newport Beach 269 Kaiser Foundation Hospital -Los Angeles Sunset, Los Angeles 1267 Lancaster Community Hospital, Lancaster 47 Little Company of Mary Hospital, Torrance 165 Long Beach Memorial Medical Center, Long Beach 370 Los Angeles County USC Medical Center, Los Angeles 117 Methodist Hospital of Southern California, Arcadia 210 Northridge Hospital Medical Center, Northridge 131 Pomona Valley Hospital and Medical Center, Pomona 268 Presbyterian Intercommunity Hospital, Whittier 113 Providence Holy Cross Medical Center, Mission Hills 78 Providence St. Joseph Medical Center, Burbank 202 Riverside Community Hospital and Medical Center, Riverside 364 Saddleback Memorial Medical Center, Laguna Hills 173 San Antonio Community Hospital, Upland 143 Santa Barbara Cottage Hospital, Santa Barbara 266 Santa Monica -UCLA Hospital and Medical Center, Santa Monica 44 St. Bernardine Medical Center, San Bernardino 565 St. Francis Medial Center, Lynwood 89 St. John’s Hospital and Health Center, Santa Monica 141 St. John’s Regional Medical Center, Oxnard 198 St. Joseph Hospital -Orange, Orange 292 St. Jude Medical Center, Fullerton 197 St. Mary Medical Center -Long Beach, Long Beach 79 St. Vincent Medical Center, Los Angeles 229 Torrance Memorial Medical Center, Torrance 201 UCLA Medical Center, Los Angeles 180 University of California Irvine Medical Center, Orange 95 USC University Hospital, Los Angeles 72

Hospital Rating Anaheim Memorial Medical Center, Anaheim = Cedars-Sinai Medical Center, Los Angeles = Citrus Valley Medical Center-Intercommunity, Covina = Community Memorial Hosp. of San Buenaventura, Ventura = Daniel Freeman Memorial Hospital, Inglewood = Desert Regional Medical Center, Palm Springs = Downey Community Hospital, Downey + Encino Tarzana Regional Medical Center, Tarzana = Glendale Adventist Med Center -Wilson Terrace, Glendale = Glendale Memorial Hospital and Health Center, Glendale = Granada Hills Community Hospital, Granada Hills = Heart Hosptial of the Desert, Rancho Mirage = Hoag Memorial Hospital Presbyterian, Newport Beach - Kaiser Foundation Hospital -Los Angeles Sunset, Los Angeles = Lancaster Community Hospital, Lancaster = Little Company of Mary Hospital, Torrance = Long Beach Memorial Medical Center, Long Beach = Los Angeles County USC Medical Center, Los Angeles = Methodist Hospital of Southern California, Arcadia = Northridge Hospital Medical Center, Northridge = Pomona Valley Hospital and Medical Center, Pomona = Presbyterian Intercommunity Hospital, Whittier + Providence Holy Cross Medical Center, Mission Hills = Providence St. Joseph Medical Center, Burbank = Riverside Community Hospital and Medical Center, Riverside = Saddleback Memorial Medical Center, Laguna Hills = San Antonio Community Hospital, Upland = Santa Barbara Cottage Hospital, Santa Barbara = Santa Monica -UCLA Hospital and Medical Center, Santa Monica = St. Bernardine Medical Center, San Bernardino = St. Francis Medial Center, Lynwood = St. John’s Hospital and Health Center, Santa Monica = St. John’s Regional Medical Center, Oxnard = St. Joseph Hospital -Orange, Orange = St. Jude Medical Center, Fullerton = St. Mary Medical Center -Long Beach, Long Beach = St. Vincent Medical Center, Los Angeles = Torrance Memorial Medical Center, Torrance = UCLA Medical Center, Los Angeles = University of California Irvine Medical Center, Orange = USC University Hospital, Los Angeles =

*--*

Pacific Business Group on Health; Office of Statewide Planning and Development