The California Office of Statewide Health Planning and Development has released its second outcomes report on California hospitals, providing risk-adjusted information on mortality following heart attacks.
Based on their acute myocardial infarction outcomes, the hospitals were classified as "significantly better than expected," "not significantly different than expected" and "significantly worse than expected."
Most of the hospitals' outcomes were "not significantly different than expected."
The report "should help patients in choosing a hospital and will help insurance carriers and HMOs in contracting with hospitals," said David Werdegar, M.D., OSHPD director, in a written statement. "Perhaps most importantly, the hospitals and their medical and nursing staff find this information useful in their ongoing efforts to improve the quality of care."
But the California Healthcare Association isn't impressed with the report, which is based on data from 1990 to 1992.
"Things change rapidly in healthcare," said Dorel Harms, CHA vice president of professional services.
"One of our other concerns is that risk-adjustment methodology is a very new science. Hopefully, down the road we'll be able to have some true risk-adjusted statistics that are valid, but we're not there yet," she said.
Harms said a big deficiency in OSHPD's research methods is that the agency didn't have access to information such as orders not to resuscitate. Patients who had asked not to be resuscitated and later died were still included in a hospital's mortality statistics, she said.
"We've been working very closely with OSHPD over the past few years to make sure the report's perfected. We do commend them for taking the step to get comparable standardized data. It's a first step that needs a lot of refinement before it can be reliable," she said. OSHPD plans to issue additional reports in the future.
The report covers all California hospitals except Department of Veterans Affairs and Department of Defense facilities. Studies on the outcomes of care in California's acute-care hospitals were mandated by legislation signed by Gov. Pete Wilson in 1991.
The legislation "responded to needs expressed by healthcare purchasers, providers and consumers to have publicly available information that objectively compares hospitals on factors other than price," OSHPD's Werdegar said.
Hospitals were shown a draft of the report, and their comments appear in the final report. They said additional risk factors should have been included in the risk-adjustment process. They also said hospital coding practices are different and may affect the validity of outcomes as a measure of quality.
Several hospitals said that in the case of patient transfers some outcomes were attributed to the wrong facilities. Many hospitals said they underreported other clinical risk factors, which would have skewed outcomes for this report.
The hospitals also complained that the study compares very different kinds of hospitals. Low-volume hospitals said they were unlikely to be classified as significantly better than expected because of the scant number of cases they treated.