Cardiovascular disease kills 1 million Americans annually and accounts for an estimated $298 billion in healthcare costs. Most of the nation's hospitals, a new study has found, could reduce that mortality rate and save some of that money if they operated as effectively as the top 100 cardiovascular hospitals.
That's the finding of a study released exclusively to Modern Healthcare last week by the research arm of Evanston, Ill.-based Solucient, a provider of strategic healthcare information. Solucient's third annual study of cardiovascular hospitals names the top 100 facilities based on mortality rates, lengths of stay and cost factors.
Perhaps the best news to come out of the study is that mortality rates for heart attacks (myocardial infarctions) are declining across the board, says Jean Chenoweth, executive director of the Solucient Institute, the company's research group. "What has been achieved is more consistency in outcomes for managing acute myocardial infarction (patients) across the country," she says.
According to Solucient, deaths from cardiovascular procedures would drop 23% and postoperative mortality rates would drop 30% if all hospitals studied performed as well as the top-tier facilities. Nonwinning hospitals could cut their average cost per cardiovascular case by $2,000 for Medicare patients alone, which would result in annual savings of $1.35 million per hospital, Solucient concluded.
One of the winning hospitals, Duke University Medical Center in Durham, N.C., attributes the success of its cardiovascular program to ongoing research efforts, including the use of genomics to identify genes that impact the risk of developing heart disease.
"The great developments and advances in the treatment and prevention of cardiovascular diseases over the next decade will largely come from a human genomics approach to the problem," says Thomas Ryan, M.D., a professor of medicine at Duke and director of the Duke Heart Center, which employs about 100 cardiologists and has about 7,900 cardiac-related inpatient visits per year.
Ryan also points to Duke's increasing use of stents-tiny medical cylinders inserted during an angioplasty procedure to reduce the risk of further arterial blockage-which can keep cardiac patients from returning to the hospital.
To complement its clinical improvement programs, Duke is actively working to reduce medical errors, Ryan says. One way it's doing that is by using handheld computing devices and clinical databases "to make sure that right at the point of care physicians and all providers are aware of the broad availability of knowledge that allows people to make the right choices with respect to things like medication," Ryan says.
Loma Linda (Calif.) University Medical Center, another of Solucient's top hospitals, has reduced costs associated with cardiovascular care by 50% in the past seven years and reduced average length of stay during that time to four days from 10. At the same time, it has increased clinical effectiveness.
Driving its success is a program Loma Linda instituted in 1994 through which cardiovascular department staffers meet once a month to identify areas that need improvement.
"Our mortality rates as we become more efficient have actually plummeted," says Steven Gundry, M.D., a Loma Linda University professor and chief of the hospital's cardiothoracic surgery department, which has 4.5 surgeons on staff and performs approximately 1,000 operations per year.
Hospitals included in Solucient's study were nonfederal, acute-care facilities with at least 100 reported cases of acute myocardial infarction among Medicare patients in 1998 and 1999. Qualifying hospitals also were required to have treated at least 125 cases of percutaneous transluminal coronary angioplasty and performed at least 125 coronary artery bypass surgeries in each of those two years. A total of 412 hospitals were considered.
"What is important is that there are differences in treatment and differences in best practices in hospitals-even among the high-volume hospitals-that make a difference in patient outcomes," Chenoweth says. "This study is a call for action-the industry needs to provide consumers with a broader group of measures for describing best practices in all hospitals."
The winning hospitals are throughout the country, with California, Florida, Michigan, Minnesota, New York and Ohio representing a total of 35 winners. Chenoweth says she was pleasantly surprised that "there's such a nice distribution of top performing institutions around the country."