Leapfrog's latest hospital safety grades show wide variation in quality of care persists

The latest Hospital Safety Grade report released Tuesday by the Leapfrog Group again demonstrates the large differences in patient safety between hospitals, even among those in the same state or region.

In the 10th edition of the report, patient safety performance by hospitals in states varied widely. For example, the report showed Connecticut had seven hospitals that received "A" grades, four that got a "B" grade and 13 that received "C" grades.

"We still see a lot of variation," said Leah Binder, CEO of the Leapfrog Group. "Hospitals even in the same system perform completely differently, or even hospitals in the same community."

Not-for-profit Leapfrog advocates for transparency in healthcare. Its hospital safety grades, released every April and October since 2012, are aimed at encouraging patients to pay attention to safety when they choose hospitals.

This fall, Leapfrog scored 2,632 hospitals, of which 832 earned A's, 662 received B's and 964 garnered C's. D's were assigned to 159 hospitals, and 15 hospitals received F's.

The number of hospitals that receive each letter grade is relatively consistent each year, although the latest report showed the smallest number of hospitals that received an F. To get the grades, 27 process measures such as standard of hand hygiene, and patient outcomes, such as pressure ulcers and accidental puncture or laceration, are used. The data are derived from the CMS, Leapfrog's own hospital survey, and secondary data sources such as the American Hospital Association.

The fact that hospitals overall haven't improved performance in the past five years might be because they are inundated with many other kinds of public surveys and reports that also evaluate their performance, said Francois de Brantes, vice president and director of the Center for Payment Innovation at the Altarum Institute.

"It ends up being a strategic decision, 'how much effort do I want to spend on this?' " he said.

Although patient safety should be a top priority for all hospitals, "This ought to be the basic standard of care," de Brantes said. "At the very least, everyone should get an A on patient safety."

Despite the relatively small fluctuations in performance among hospitals overall, Binder said she has noticed consistent performance improvement among hospitals in certain states.

The report called out Oregon, Rhode Island, Hawaii, Wisconsin and Idaho for improvements since the inception of the Hospital Safety Grade five years ago.

Rhode Island ranked first among the states with the most A-rated hospitals. Five of the seven Rhode Island hospitals included in the report received an A. In 2012, the state ranked 50th for its hospitals' grades. Hawaii moved up from 36th in 2012 to third, while Oregon moved up from 48th in 2012 to eighth.

Binder said states with consistently good hospital grades show a state-wide, collaborative commitment to patient safety.

"We are seeing in pockets of the country like Rhode Island that there seems to be a significant effort and achievement to bringing all hospitals to top levels of safety," she said. "Hospitals have come together whether as hospital engagement networks or collaboratives."

For the first time, Maryland was included in the list after it agreed to generate measure results to be included in the Leapfrog report. The state has a program that excludes it from reporting some safety metrics at the federal level. The state had just one hospital that received an A, Howard County General Hospital in Columbia. Seven hospitals received a B and 27 hospitals received a C.

In a statement, the Maryland Hospital Association said, "Each and every hospital in Maryland has programs and initiatives in place to make sure the care their patients receive is safe and compassionate, and while we welcome the Leapfrog report, it is one of several available to consumers seeking care. Our recommendation as always is that consumers work with their doctor to find the hospital that works best for their needs."

The association also said that Maryland's quality improvement program "may not compare as well" to the rest of the nation because it uses 65 measures instead of "just a handful" the CMS uses.

Many of the 15 hospitals that received F's treat a high proportion of low-income patients with complex healthcare needs.

Rita Numerof, president and co-founder of consultancy Numerof & Associates, said, "There should be no correlation between safety rates and socioeconomic status."

De Brantes agreed, saying hospitals can control the processes in place to ensure the care they provide is safe. "Patient safety is patient safety."

Correction: An earlier version of this story misstated the status of Maryland's program. This error has been corrected.