Inland Hospitals Rank Low

Hospitals serving the Inland Empire overall ranked worst in the country last year in their treatment of patients with heart attacks and pneumonia, according to a new study.

A team of Boston researchers found that the 21 hospitals covering most of San Bernardino and Riverside counties were least likely to meet national medical standards proven to increase patients’ chances of survival.

The research, published last week in the New England Journal of Medicine, also looked at patients with congestive heart failure, finding that care provided by the Inland Empire market ranked 34th among the 40 largest hospital markets in the nation.

The study, among the first to compare hospital quality across regions, raised questions about the care in other California hospitals too.

It found that those serving the San Diego area ranked in the bottom five for their treatment of congestive heart failure and pneumonia, and Los Angeles was next to last for its pneumonia care.

No region in the state ranked among the top five in treating any of the three medical conditions studied.

“These are all really relatively simple things,” said Dr. Ashish K. Jha, the study’s lead researcher and an assistant professor of health policy and management at the Harvard School of Public Health. “These are things that every hospital should be able to do and ... that every hospital should be able to do consistently.”

The standards include, for instance, giving aspirin and other medications on time to heart attack patients, as well as giving pneumonia patients appropriate vaccines, checking oxygen levels in their blood and ensuring they receive antibiotics promptly.

“It’s an anomaly that we haven’t been able to dissect or explain,” said Jim Lott, executive vice president of the Hospital Assn. of Southern California, of the poor showing among the region’s hospitals.

He said he was particularly stumped by the findings in the Inland Empire market.

“These people are trained the same places everybody else is trained,” he said, referring to the medical staffs. “I don’t want to say the data is wrong. I just don’t know.”

Jha and his colleagues analyzed data submitted to the federal government by more than 3,500 hospitals. The information, intended to help patients make better decisions about where to seek treatment, has been posted online at www.hospitalcompare.hhs.gov. since April.

Lea Brooks, a spokeswoman for the California Department of Health Services, said she could not say whether the data had been reviewed by anyone in her agency, which inspects hospitals statewide. The department itself keeps no data comparing hospitals or regions to one another.

In the Inland Empire, there was considerable variation among -- and even within -- hospitals, according to the federal website.

Loma Linda University Medical Center in San Bernardino County, for example, scored high for its treatment of heart attack patients, but below average for some pneumonia care.

Spokesman Preston Smith said the hospital only received resources in recent years to focus on improving care for patients with heart attacks and congestive heart failure. Last month, he said, Loma Linda implemented new standards for treating pneumonia and expects its numbers to improve.

Hemet Valley Medical Center in Riverside County consistently ranked near the bottom. Only 32% of its 197 heart attack patients were given aspirin at discharge in the first half of 2004, according to data the hospital submitted to the federal government. That compares to an average of 86% nationally and 88% in Southern California.

The hospital also fared poorly in terms of giving pneumococcal vaccinations to its pneumonia patients -- inoculating only 1% of its 210 patients, compared with a national average of 43%.

Hemet Valley officials said their problems resulted from poor documentation, not poor care, and that their figures have improved in the last year. Internal indicators, such as the percentage of patients readmitted to the hospital within a week of discharge, show that the care is proper, they said.

“This is a wake-up call, there’s no question about it,” said Rick Skillman, the hospital’s administrator. “Whether it’s a documentation problem or a quality problem, we take this very seriously.”

Skillman said his hospital has improved training for nurses and created new forms that make it easier to document the drugs and treatment given patients.

Experts say hospitals have known since at least 2002 which information would be collected and publicly reported, and they should have taken action earlier.

“It seems like hospitals have had ample opportunities to fix those problems,” said Dr. Patrick S. Romano, a professor of medicine and pediatrics at UC Davis. “I’m puzzled and a little bit concerned about what’s going on in some of these communities.”

Jha found that, in general, nonprofit hospitals performed significantly better than for-profits, and that hospitals in the Midwest and Northeast outscored those in the West and South.

Boston hospitals ranked highest for care of heart attacks and congestive heart failure, and Oklahoma City did best for pneumonia.

Romano and others said that public release of this data ultimately could force hospitals to improve.

“We don’t expect individual patients to go into the hospital and say, ‘Where’s my aspirin? Where’s my beta blockers?’ But the community as a whole needs to expect and demand better care.”

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Variations in care

Researchers ranked local hospital markets on how well they treated three common medical conditions: heart attack, congestive heart failure and pneumonia.* A sampling of the rankings, from best to worst:

Heart attack

1. Boston

2. Minneapolis

3. Kansas City, Mo.

4. Albany, N.Y.

5. Indianapolis

15. Orange County

19. Los Angeles

31. San Diego

36. Little Rock, Ark.

37. Orlando, Fla.

38. Miami

39. Memphis, Tenn.

40. San Bernardino

Congestive heart failure

1. Boston

2. Detroit

3. Baltimore

4. Camden, N.J.

5. Cleveland

13. Orange County

30. Los Angeles

34. San Bernardino

36. San Diego

37. Nashville

38. Orlando, Fla.

39. Little Rock, Ark.

40. Lexington, Ky.

Pneumonia

1. Oklahoma City

2. Indianapolis

3. Kansas City, Mo.

4. Camden, N.J.

5. Knoxville, Tenn.

23. Orange County

36. Miami

37. Chicago

38. San Diego

39. Los Angeles

40. San Bernardino

Source: Dr. Ashish K. Jha, Harvard School of Public Health

Los Angeles Times

*The hospital markets are not strictly defined by city or county boundaries. In fact, San Bernardino refers to the market serving most of the Inland Empire, including much of San Bernardino and Riverside counties.