Overall, the top hospitals did significantly better on mortality rates and lengths of stay. When compared with their peers, they had 23.8% fewer patient deaths from heart attack, 19.2% fewer deaths from heart failure, 36.2% fewer deaths among patients undergoing coronary artery-bypass graft surgery and 31.3% fewer deaths among coronary-angioplasty patients. In addition, length of stay was shorter by 15.6% and 10.5% for heart attack and heart failure patients, respectively, at top hospitals, and 10.9% and 16.3% shorter for bypass grafting and angioplasty procedures, when compared with the peer group. “There's a fair amount of room for improvement for the peer group in these areas,” Young said.
However, long-established clinical-process measures (eight are in the study) had no significant impact on performance. “Most of these core measures have been used for years,” Young said. These included, for example, giving heart-attack patients angioplasty within 90 minutes of arrival at the hospital; providing discharge instructions to heart-failure patients; keeping blood glucose for heart-surgery patients under control after surgery; and giving heart-attack patients with elevated cholesterol levels a statin prescription at discharge. “Hospitals have focused efforts on improving them and tend to be compliant close to 100% of the time,” she said.
As cardiovascular hospitals aim to meet quality and safety benchmarks, Chenoweth said one frequent barrier is the ability to provide consistency across systems. “That is a big challenge, but we are starting to see an impact,” she said. A total of six health systems had more than one facility make the list, she noted. HCA had five hospitals represented. Banner Health, Phoenix; CareGroup Healthcare System, Boston; the Mayo Foundation, Rochester, Minn.; and Providence Health & Services, Renton, Wash., each had two on the list. Two hospitals from Tenet Healthcare Corp. that were formerly part of Vanguard Health Systems also made this list.
“We see consistency in airlines, hotels and restaurant chains,” Chenoweth said. Having more than one hospital represented in a system means that “it is possible to raise the bar” on standardization in healthcare.
Among the facilities on this year's list, Scott & White Memorial Hospital in Temple, Texas, a teaching hospital with a cardiovascular residency program, has been recognized the most frequently. Since Truven began the recognition in 1999, that hospital has been among the top performers 12 times. Scott & White became a part of the Baylor Health Care System during an October 2013 merger, and Dr. Greg Dehmer, chief of cardiology at Baylor Scott & White Health, said the integration has presented new opportunities for collaboration.
“We're able to take the best practices of both organizations and blend them,” he said. “It's very easy for us to institute common order sets and adapt new therapy models.”