State Ranks Hospitals by Cardiac Bypass Death Rates
For the first time, state officials on Tuesday released information on death rates for all California hospitals that perform cardiac bypass surgery, a sign of the increasing pressure on medical centers to be accountable to patients.
The data, which cover the 2003 calendar year, show that three of the four hospitals with the worst records are in Southern California.
All four were owned at the time by healthcare giant Tenet Healthcare Corp., although one has since been sold.
Two of the hospitals -- Alvarado Hospital Medical Center in San Diego and Desert Regional Medical Center in Palm Springs -- have been flagged by the state for poor performance in the past.
The other low-performing hospitals in 2003 were Centinela Hospital Medical Center in Inglewood and Doctors Medical Center of Modesto.
Tuesday’s report, released by the California Office of Statewide Health Planning and Development, marks the first time all 121 California hospitals with bypass programs have been forced to release their data publicly.
The lag in reporting is due to the time required to collect data, verify it and adjust it for various patient characteristics.
The programs with the best survival rates in the state were St. Vincent Medical Center in Los Angeles, St. John’s Regional Medical Center in Oxnard, UC Davis Medical Center in Sacramento and Salinas Valley Memorial Hospital in Salinas.
The report is a prelude to a groundbreaking review expected later this year that will compare the performance of individual surgeons who perform heart bypass surgery.
It is part of a broader push at the state and federal level to provide comparative information on hospitals so that consumers can make informed decisions about where to seek care.
The state health planning office is working on reports comparing all hospitals’ death rates for patients admitted for heart attacks, pneumonia and hip replacement surgery. In addition, it will release data on complications experienced by women during childbirth.
Other accountability measures are pending. Separately from the state effort, a coalition supported by the California HealthCare Foundation is working on a report card that will compare the performance of hospitals on 59 measures. That is expected this fall.
“There’s a huge, huge effort -- I think of it sometimes as a quality juggernaut,” said Joseph P. Parker, director of the Healthcare Outcomes Center at the state health planning agency. “There’s an insatiable need for this kind of healthcare information.”
Tuesday’s report looked only at patients who received cardiac bypass surgery alone, not with any other procedures. Among the findings:
* The number of bypass surgeries statewide declined 23% between 2000 and 2003 as the number of other cardiac procedures, including angioplasty and stent insertion, increased 15%.
* There was no clear association between the number of bypass surgeries a hospital performed and its death rate, a finding that rebuts earlier research suggesting a link between volumes and outcomes.
* Overall, 2.91% of the 21,272 patients who received stand-alone heart bypass surgery in 2003 died within 30 days of the procedure.
That’s higher than the 2.4% reported nationally, although the significance of the difference was not made clear.
* Eight hospitals reported no deaths: French Hospital Medical Center in San Luis Obispo, Fresno Heart Hospital, Granada Hills Community Hospital, Irvine Regional Hospital and Medical Center, Little Company of Mary Hospital in Torrance, St. John’s Hospital and Health Center in Santa Monica, Sutter Medical Center of Santa Rosa and UC Davis. These hospitals performed between 25 and 136 procedures that year.
Dr. Joseph S. Carey, executive director of the California Society of Thoracic Surgeons, said his group was studying what makes cardiac bypass programs perform well or not. Centers that don’t improve won’t survive long, he said.
“Once the public finds out that these places are not doing a good job” the programs will close, Carey said.
About a quarter of the state’s more than 430 hospitals perform cardiac bypass surgeries. Such operations long have been considered useful measures of quality because they are expensive and frequently performed.
Representatives of the poor-performing hospitals said Tuesday that their facilities have improved markedly since 2003.
Officials at Centinela, which is no longer owned by Tenet and now is known as Centinela Freeman Regional Medical Center, said they had hired new cardiothoracic surgeons, brought on a new medical director for the team, and provided additional staff training, among other things.
“The one thing we do know is that we had a higher mortality rate, and that’s just not acceptable,” said Deborah Ettinger, vice president of business development for Centinela Freeman Health System. But she said the hospital’s rate now is “clearly better.”
A spokesman for Tenet, which still owns the other three hospitals with subpar bypass survival, said the chain had beefed up its quality improvement program and fixed the way it codes patient information to ensure that their conditions are accurately reflected in the data provided to the state.
“You will see in 2004 and 2005, when those reports come out, that almost all of the Tenet hospitals will be on the very good list,” spokesman David Langness said.
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Cardiac bypass survivors
Below are data from California hospitals where the survival rates for cardiac bypass surgeries in 2003 were significantly better or worse than expected.
Better than expected
*--* Expected Hospital Surgeries Deaths deaths* Salina Valley 219 1 6 Memorial Hospital St. John’s Regional 176 1 7 Medical Center, Oxnard St. Vincent Medical 207 1 7 Center Los Angeles UC Davis Medical 136 0 4 Center, Sacramento
Worse than expected
*--* Expected Hospital Surgeries Deaths deaths* Alvarado Hospital 83 6 2 Medical Center San Diego Centinela Hospital 105 7 3 Medical Center, Inglewood Desert Regional 146 9 4 Medical Center, Palm Springs Doctors Medical 426 16 9 Center of Modesto
*Based on patient characteristics, including age, sex and health conditions
Source: California Office of Statewide Health Planning and Development (www.oshpd.ca.gov)
The report can be accessed online at www.oshpd.ca.gov.