In aggregate, hospitals are improving their quality of care, but the best hospitals are improving more quickly and are pulling away from subpar hospitals on quality, according to an annual study of hospital performance.
HealthGrades, a clinical quality measurement and public reporting firm based in Golden, Colo., analyzed 37 million Medicare patient records for hospitalizations between 2002 and 2004 at more than 5,000 nonfederal hospitals.
The encouraging news, according to Samantha Collier, M.D., a hospitalist and the primary author of the 39-page report released last week, is that risk-adjusted hospital mortality rates have improved on average by more than 12% over the study period for 18 selected procedures and diagnoses.
"With all the attention being paid to quality, I would have just gotten out of the business if I hadn't seen improvement," Collier said. Hospitals in the top tier of the survey improved 21% more than the national average and 45% more than the bottom tier hospitals, according to the report. "There are some hospitals that are just improving more and faster," Collier said. "Everyone is generally getting better at an aggregate level, but there are just these big gaps."
HealthGrades used data from the annual survey to assign rankings to individual hospitals, with the poorest performers -- roughly the lowest 15% -- receiving a one-star rating and the top performers in the upper 15% receiving a five-star rating. If all hospitals had performed during the three-year study period as well as the five-star hospitals, more than 273,000 lives potentially would have been saved, according to the study.
The widest gap between top and bottom facilities was for patients with the diagnosis of diabetic acidosis and coma, which Collier described as "a tricky, tricky acute critical illness" best treated in intensive-care units at hospitals with intensivist programs. Patients with this diagnosis were about 82% less likely to die in a five-star hospital than in a hospital performing at the national average and almost 93% less likely to die than in a one-star hospital, the study showed.
Combining data for acidosis and coma patients with Leapfrog Group survey results on intensivist programs, the study concluded that five-star hospitals were five times more likely to have intensivist programs in their intensive-care units than one-star hospitals.
This story originally appeared in the Oct. 17 issue of Modern Healthcare.