Posts Tagged ‘hospitals’

Hospital-Acquired Infection Report

Posted by medconsumers on July 1, 2009

New York State Releases 2008 Hospital-Acquired Infection Report

June 30, 2009. The long awaited New York State 2008 report on hospital-acquired infections was released today at a press conference held at Roosevelt Hospital. The law requiring the report took effect in mid-2006, but the first report issued in 2007 did not by design provide the names of hospitals. The 2007 report did provide aggregate rates for the state by region and type and size of hospital, thus establishing a baseline for trending purposes. Arthur A. Levin, MPH, Director of the Center for Medical Consumers, was instrumental in writing the law and steering it through the legislative process.

Some important findings from the new report are as follows:

- No one hospital was found to have a high hospital-acquired infection rate across the board.

- Colon surgical-site infection rates decreased significantly in 2008 and were lower than 2006-2007 national rates.

- Coronary Artery Bypass Graft chest infection rates declined from 2007 and were significantly lower than 2006- 2007 national rates.

-Hip replacement surgical-site infections in 2008 were unchanged from the previous year.

-Central line-associated bloodstream infection rates in intensive care units for 2008 were the same or higher than the 2006-2007 national rates. The report breaks down intensive care units into categories, such as surgical, medical, pediatric and newborn.

As a result of including the auditing requirement in the law, New York State likely has the most reliable information of any state hospital infection reporting system. A Department of Health team of infectious disease specialists visited each of the reporting hospitals at least once during the year to review the accuracy of their identification and reporting. The Department of Health teams conducted sample chart reviews as part of their routine audit process. While in 2007, eight hospitals were identified as out of compliance with reporting requirements and eventually cited by the department; by 2008 all hospitals in New York State were in compliance with the law.

Consumers should understand that infection rates alone might not be a sufficient reason to go to or stay away from any one hospital. If the report had found that one or more hospitals with higher rates across all the measures, a prudent consumer would have had reason to avoid that facility. However, that was not the case in 2008. Furthermore, the results are mixed for each hospital.

The department has said it will work with hospitals with higher than average infection rates on one or more measures to find ways to improve patient safety.

Here are some tips on how to best understand the report. The graphical presentation of results starts on page 55 with the results for colon surgical-site infection rates and the other measures follow. On page 26 of the report you will find an explanation of the tables. A summary of all the results for each hospital begins on page 123 (Table XXIII). The absence of any result in any cell (box) of the table means that the hospital does not provide that service (for example only 40 hospitals perform CABG surgery). Where “NA” appears in the cell, the hospital did less than 20 procedures in 2008, a number too small for statistical significance.

Contact Arthur A. Levin at medconsumer@earthlink.net

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Posted in Advocacy, hospital-acquired infection, hospitals | Tagged: Advocacy, hospital-acquired infection, hospital-borne infection, hospitals, infection | Comments Off

Heartburn Drugs Overused In Hospital Patients Not at Risk for Stress Ulcers

Posted by medconsumers on June 1, 2009

Acid-reflux drugs like Nexium and Zantac, which suppress stomach acid, are among the most widely prescribed in the country. Their use has been steadily increasing among hospital patients, often for indications that have no supporting scientific evidence. Between 40% and 70% now receive some version of these acid-suppressive drugs, also known as proton pump inhibitors (PPIs), during a hospital stay. A new study, published last month in the Journal of the American Medical Association, found that they have a higher incidence of pneumonia than hospital patients not given these drugs.

The study was led by Shoshana J. Herzig, MD and colleagues who analyzed the medical records of all patients who where admitted to a large, urban, academic medical center in Boston from 2004 through 2007. To be included in this study, the patients had to be at least 18 years of age and hospitalized for three or more days, but not admitted to the intensive care unit. The study included nearly 64,000 patients, 52% of whom were given one of two classes of acid-suppressive drugs—PPI (e.g., Nexium, Prevacid, Prilosec) and histamine2 receptor antagonist (e.g., Pepcid, Zantac).

Of the hospital patients who received the acid-suppressive drugs, 4.9% developed pneumonia while in the hospital, compared with 2% of the people not given the drugs. PPIs were more likely than H2 receptor antagonists to be prescribed and to cause an increase in pneumonia. After taking into account that the drug-treated people may have been sicker at the time of hospital admission, the researchers estimated that the people given acid-reflux drugs had a 30% increase in their risk of pneumonia compared with those not given the drugs.

Although hospital patients frequently are given acid-reflux drugs for preventive purposes, Dr. Herzig and colleagues say that the drugs are approved by the FDA only for people at high risk for developing stress ulcers.

This study builds on the results of earlier acid-reflux drug studies that found people on these medicines have a higher incidence of hip fracture, community-acquired pneumonia (i.e., pneumonia that occurred outside of a hospital), and diarrhea associated with Clostridium difficile.

Maryann Napoli, Center for Medical Consumers© June 2009

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Posted in Drugs, hospitals | Tagged: Drugs, heartburn, hospitals | Comments Off

Hospitals Compared

Posted by medconsumers on June 1, 2008

Consumer Reports Provides Comparisons of Aggressive vs. Conservative Hospital Care

The “more is better” approach to American health care has been challenged consistently over the last 15 years by research compiled by two Dartmouth Medical School physicians. As reported in previous issues of HealthFacts, these researchers have studied the care given to Medicare patients in the last two years of life and shown that more tests, more procedures, more specialist care, more days in the hospital do not lead to a longer life or a better quality of life.

Now Consumer Reports has put the Dartmouth findings in a consumer-friendly format that will help Americans determine whether a hospital in their part of the country is likely to deliver aggressive or conservative care. Nearly 3,000 hospitals across the U.S. are included and will be available in the July 2008 issue of Consumer Reports and is freely accessible on the magazine’s Web site. It relies on data from the Medicare claims records of over 4.7 million elderly people treated from 2001 through 2005 for severe illnesses like cancer, congestive heart failure, lung diseases, dementia and coronary heart disease.

The brains behind this research are John E Wennberg, MD, and Elliott S. Fisher, MD, at the Dartmouth Medical School, who have regularly published findings in medical journals as part of a 30-year study of U.S. health care. Entitled the Dartmouth Atlas of Health Care 2008, this research project has also made its findings freely available at its own Web site (www.dartmouthatlas.org).

Contrary to what many Americans believe, aggressive care and consulting many specialists do not improve outcomes or lead to more patient satisfaction. In fact, altogether they slightly increase mortality. The Dartmouth researchers demonstrated years ago that more care often results in more procedures that are painful and unnecessary; more days in the hospital raises the chances of suffering a medication error or getting a fatal hospital-borne infection; and more specialist care leads to uncoordinated care. (Get a good primary care doctor is one of the take-home messages of the Dartmouth researchers.)

At a time when hospitals typically advertise their new high-tech equipment and friendly staff members, Consumer Reports provides an easy way for the public to see just how aggressive their care will be compared to other hospitals in their cities. (Next, we need to know the infection rate of all U.S. hospitals.) It raises a larger question for everyone to consider: Since overly aggressive care is not limited to the elderly, how can people of any age protect themselves when they become hospital patients?

Things aren’t likely to change until consumers make their wishes known and raise questions. Consumer Reports provides many excellent suggestions: Is this treatment likely to extend my life, and if so, for how long? How do its side effects and risks compare with the symptoms and risks of my disease itself? What will happen if I do not have the treatment? Will this test change the way you treat the disease? If not, what is the benefit of doing it? Is this test likely to lead to follow-up tests, biopsies, or other diagnostic procedures? How will this benefit my health?

The Consumer Reports Web site illustrates why New York University Langone Medical Center in Manhattan is #1 in the country in terms of delivering the most aggressive (and expensive) care. The Medicare cost per person in the last two years of life at this hospital was $105,067. This is compared with $44,090 at the country’s #1 hospital in terms of the most conservative care —Scott & White Memorial Hospital in Temple, Texas. (Both are chosen from a subcategory of 93 U.S. hospitals called “integrated medical centers”—that is, hospitals affiliated with medical schools.)

The average patient treated at NYU hospital in the last two years of life spent 54 days in the hospital, 12 days in the ICU, had 34 primary-care visits and 97 specialist visits. The average patient at the Hospital in Temple, Texas spent 16 days in the hospital, four days in the ICU, had 23 primary-care visits and 18 specialist visits. Yet, as Consumer Reports notes, “The Centers for Medicare and Medicaid Services rates care at Scott & White to be at least as good as that at NYU.”

The New York Times reported that the list of New York City hospitals at the Consumer Reports Web site shows a clear division in terms of aggressive care between the private and the public hospitals. As a group, the private hospitals were in the 94th percentile of aggressive care compared with the public hospitals in the 69th percentile. Although the latter is still above the national average, the difference cries out for explanation. The most obvious would be that poor people get inferior (i.e., less) care.

Dr. Eric Manheimer, who is the medical director at Bellevue (a public hospital) and on the faculty at NYU medical school, offered a unique perspective to The New York Times of someone who works for both the public and private systems. “The care at public hospitals was less aggressive because most of their doctors—he estimated 75-85%–were salaried physicians with little financial incentive to order tests or other interventions. At private hospitals, he said, supply can creates its own demand. There is often an abundance of beds and an endless list of specialists who can be called.”

Maryann Napoli, Center for Medical Consumers ©
June 2008

Posted in hospitals | Tagged: hospitals, infection, overtreatment | Comments Off

Hospital-Acquired Infection…and What To Do About It

Posted by medconsumers on February 1, 2008

What kills more than five times as many Americans as AIDS? Betsy McCaughey, PhD, chairman and founder of the Committee to Reduce Infection Deaths (RID) wants you to know that it is hospital infections, specifically a bacterium called methicillin-resistant Staphylococcus aureus. MRSA infections are far more difficult to treat than ordinary Staph infections because they are resistant to most types of antibiotics.

Dr. McCaughey, former lieutenant governor of New York State, has made it her mission to get hospitals and especially the Centers for Disease Control and Prevention (CDC) to make prevention a high priority. In a recent Wall Street Journal op-ed article, she notes, “These infections are caused largely by unclean hands, inadequately cleaned equipment, and contaminated clothing that allow bacteria to spread from patient to patient. At one time, hospitals routinely tested surfaces for bacteria, but in 1970, the CDC and the American Hospital Association advised them to stop, saying testing was unnecessary. Astoundingly, the CDC still adheres to that position despite a 32-fold increase in MRSA infections.”

Dr. McCaughey is interviewed by Maryann Napoli, Center for Medical Consumers.

MN: The statistic that you use—100,000 deaths due to hospital infections annually in the U.S.—comes from the CDC, doesn’t it?

BM: The CDC is only one source. Their more recent statistic is: One out of every 10 to 20 people contracts an infection [while in the hospital]. The CDC puts the number of deaths at 99,000, but other sources say that is a severe undercount. So I usually say, “At least 100,000 deaths.” In fact it’s probably quite a bit more.

MN: What is your basis for saying that?

BM: Last October the Journal of the American Medical Association published a study about the extent of the MSRA infections in U.S. hospitals that nearly doubled what the CDC had been estimating. The reason is the methodology used. Instead of relying on what hospitals report or tell patients’ families, these new data are based on laboratory results which cannot be diminished or modified.

MN: Explain that.

BM: When the hospitals send all their tests to the labs, the laboratories simply count, “How many MSRA infections do we have here?” This was the first nationwide study using this methodology on the extent of MSRA—85% of which occurred in hospitals. The CDC realized that the extent of MSRA infections is far larger than what hospitals had been reporting. And if that’s true for MSRA infections, then it’s likely true for other types of bacteria. So the previous CDC guesstimates need to be reevaluated, based on this October 17 study in JAMA. It revealed the truth gap in the previous methodology.

MN: Denmark, Finland and the Netherlands reduced their soaring rates of MRSA infections to near eradication with multiple preventive measures (see “15 steps” at Dr. McCaughey’s Web Site). You are very critical of the CDC for not encouraging similar actions.

BM: For 25 years, the CDC has tracked the rapid rise in drug-resistant infections. They have consistently understated the extent and cost of the problem. And they have done too little to prevent it.

MN: How do you explain the CDC inaction?

BM: I can only imagine, but having been in government, I know that often agencies that are created to oversee an industry become co-opted by the industry. They spend so much time with hospital administrators rather than with grieving families and ill patients that they begin to share the hospitals’ concerns about the difficulties of changing procedures, the difficulties of more effective cleaning.

MN: You’ve been known to take cleaning matters into your own hands when friends or relatives are hospitalized.

BM: I’ve often gone into the hospital to visit a patient with a bag of cleaning supplies, including gloves, and cleaned the bed rails, the over-the-bed table, the TV monitor. I do it myself, knowing that otherwise it would not be clean.

MN: What do you use?

BM: Something like Windex [ammonia] because it has to stay on the surface for three minutes to kill the germs. It’s not a quick spray and wipe; it’s a drench and wait. Spray it on, wait three minutes to kill the germs and then wipe it off. The only one that Windex won’t kill is Clostridium difficile [bacterium that attacks the colon]—there you need something with bleach in it generally.

MN: We’ve been told that, when hospitalized, we should tell the hospital staff to wash their hands before touching us, but that’s difficult when you’re the one in the bed.

BM: Generally it’s the families [that should do it] because patients are usually too sick, too scared, too old, or in too much pain to act on their own behalf. Families should not be worried about being too aggressive when their loved one’s life is at stake.

For more information:

See 15 steps you can take to reduce your risk of a hospital-acquired infection at the Web site of Dr. McCaughey’s Committee to Reduce Hospital Infection Deaths (www.hospitalinfection.org).

Consumers Union (www.consumersunion.org/campaigns/stophospitalinfections/learn.html) for ways to take action and articles on the topic.

The Leapfrog Group (www.leapfroggroup.org) is aimed at reducing medical mistakes, including hospital infections. See whether the hospitals in your area have instituted 30 safe practices of which five are related to healthcare associated infections. The hospitals collect and submit their own data. The Leapfrog Group does not independently verify the data.

Maryann Napoli, Center for Medical Consumers ©
February 2008

Posted in hospital-acquired infection, hospitals | Tagged: CDC and hospital infections, hospital-acquired infection, hospital-borne infection, hospitals, infection, interviews | Comments Off

Yogurt Drink Prevents Antibiotic-Induced Diarrhea

Posted by medconsumers on July 8, 2007

A yogurt drink sold in many supermarkets has been shown to reduce the risk of severe diarrhea that can occur after taking antibiotics. The study, published last month in the British Medical Journal Online First, was conducted at several hospitals, a setting where people are most likely to be exposed to drug-resistant strains of bacteria.

Of particular concern in most industrialized countries is the emergence of Clostridium difficile, an increasingly common, sometimes fatal, complication of antibiotic treatment, which occurs in about 5-25% of all hospitalized patients, usually two or three weeks after finishing antibiotic treatment.

Eating yogurt is now a standard way for people to protect themselves while on antibiotics. And to serve this expanding market, more and more yogurt products now feature the word probiotics on the label, claiming that they contain live cultures. Probiotics are defined as “live micro-organisms which when administered in adequate amounts confer a health benefit on the host.” Most probiotic products contain bacteria that help to balance the hundreds of different species of bacteria found in the human body.

Probiotics are gaining some research attention because of the overuse of antibiotics and the resulting increase in drug resistance. Probiotic-containing foods and capsules are consumed to overcome the tendency of antibiotics to kill the normal as well as the harmful bacteria. The problem with products claiming to contain probiotics or “live active cultures” is that they are unregulated, so it’s impossible to know whether they actually contain adequate amounts of live bacteria and the right strains of live bacteria.

British Hospital Study

The probiotic drink used in the newly published British hospital study was Actimel, sold as DanActive in the U.S. This study was partly funded by Danone, a French company that makes both products, which contain Lactobacillus casei, L bulgaricus and Streptococcus thermophilus. All three strains had already been evaluated for the prevention or treatment of diarrhea associated with antibiotic use and found to be safe, according to the British researchers led by Mary Hickson, Imperial College, London, England.

The researchers recruited patients from three London hospitals. All were asked to participate within 48 hours of taking their first dose of antibiotics prescribed for a variety of infections unrelated to any gastrointestinal ailments. The 113 patients (mean age, 74 years) who decided to participate were randomly assigned to drink either four ounces of Actimel or a placebo drink (milkshake).

All agreed beforehand to take the assigned drink twice a day during the course of antibiotics and for one week after completing the regimen. Neither the patients nor the hospital staff knew who was in the probiotics group and who was in the placebo (milkshake) group. When participants developed diarrhea, stool samples were analyzed for the potentially fatal Clostridium difficile toxin.

The hospital patients in the probiotics group fared much better than those in the placebo group. Hickson and colleagues concluded, “Consumption of a probiotic drink containing L casei, L bulgaricus and S thermophilus can reduce the incidence of antibiotic-associated diarrhea and C difficile-associated diarrhea. This has the potential to decrease morbidity, heath care costs, and mortality if used routinely in patients over age 50.”

Here are the results of the study: 12% of the hospital patients in the probiotic group developed diarrhea associated with antibiotic use, compared with 34% of the patients in the placebo group. No one in the probiotics group developed C difficile, but 9% of the patients in the placebo group developed this serious complication.

Cost Effective, Too

Hickson and colleagues provided this estimate of the cost savings in U.S. dollars. The average cost of the probiotics regimen in this study was $20 per patient. The cost of preventing one case of C difficile-associated diarrhea with probiotics was estimated to be $120, excluding dispensing and nursing costs. This is due to that fact that six patients were treated with probiotics for each case of C difficile prevented.

The $120 was then compared with the $3,669 it would cost in the U.S. to provide the standard medical treatment for one person with C difficile. The high cost is mainly due to the increased length of hospital stay required for people with C difficile and the use of a costly intravenous antibiotic called vancomycin, according to Hickson and colleagues.

Vaginal Infections

Something important to women was not addressed in the British study. Many eat yogurt while on antibiotics in order to avert another nasty side effect—vaginal infections. Will the yogurt drink used in this study have any preventive benefit for this infection? The answer is no, according to a leading probiotics expert not associated with the British study: Gregor Reid, PhD, Canadian Research and Development Centre for Probiotics in London, Ontario. “The product [Actimel/DanActive] is designed for intestinal benefits and not for the type of bacteria strains needed to promotevaginal health.”

There is, however, another product proven to reduce the risk of vaginal infections, called Fem-Dophilus (www.jarrowprobiotics.com), said Dr. Reid, who owns patents to the strains present in these capsules. As for the probiotic claims on numerous products sold in supermarkets and pharmacies: “It’s only a probiotic if the product formulation has been clinically tested. Many of them have not. At least, if they have the strains of probiotic in a suitable viable count as found in studies with other formulations, it is promising, but the real test is a human study with the formulation.”

Maryann Napoli, Center for Medical Consumers ©
July 2007

Posted in Alternative Medicine, Drugs, hospital-acquired infection, hospitals, Women's Health | Tagged: Alternative Medicine, antibiotics, hospital-acquired infection, hospitals, probiotics, probiotics and hospital-acquired infections, yogurt and antibiotics | Comments Off

Patient Safety Crises in New York State

Posted by medconsumers on December 31, 2006

Center for Medical Consumers
New York Public Interest Research Group

NEWS RELEASE
For immediate release: For more information:
Monday, December 22, 2003 Arthur Levin 212 674-7105
Center for Medical Consumers
Blair Horner 518 436-0876
NYPIRG

REPORT: STATE HEALTH DEPARTMENT FAILS TO PROTECT PATIENTS FROM DANGEROUS DOCS

GROUPS URGE HEVESI TO AUDIT HEALTH DEPARTMENT

PATIENT RIGHTS AND CONSUMER GROUPS URGE REFORMS TO BOOST OVERSIGHT AND IMPROVE DISCLOSURE OF HEALTH CARE INFORMATION

The New York State Health Department is failing to protect patients from dangerous doctors charged patient rights and consumer groups today. The groups documented their concerns in a report that found that the Health Department is taking fewer actions against physicians despite increased resources. The groups urged New York State Comptroller Alan Hevesi to launch an investigation of the Health Department by auditing its unit that oversees physicians.

The key findings of the groups’ report, Failing To Act: New York State’s Department of Health and the Patient Safety Crisis , were:

New York State is taking fewer actions against physicians and physicians’ assistants (PAs), despite a doubling of resources, legal reforms and its stated goal of reducing medical injuries.
Of that shrinking percentage, few physicians and PAs are disciplined for reasons having to do with their competency to deliver safe and quality medical care.
A substantial proportion of OPMC sanctions are based the results of discipline meted out in other jurisdictions. The percentage of sanctions based on investigations originally initiated by OPMC in New York is declining.
A large percentage of sanctions imposed by OPMC permit physicians and PAs to continue to practice without interruption in New York State and without notification to their patients.

In addition to calling on Comptroller Hevesi to audit the OPMC, the groups recommended that the state should:

Disclose more information to the public about hospitals’ and physicians’ comparative safety and quality performance.
Require physicians to routinely demonstrate their medical skills and knowledge as a condition of continued licensure.
Mandate that OPMC proactively review physicians’ malpractice experience and initiate investigations as appropriate.
Codify the ethical requirement that health care providers and professionals inform patients or patient’s family or friends when a medical errors causing harm has occurred.
Require that serious patient harm occurring as a result of office-based surgery be reported to the Health Department.
Create an OPMC consumer assistance office to help consumers understand when a complaint is appropriate for OPMC, if not where else to seek redress, and to shepherd them through the process, including advising them about the progress of the complaint.
Open up The Board of Professional Medical Conduct to increased public membership, include public members in leadership positions, and permit hearing and appeals panels in some cases, to consist of a majority of public members.
Punish physicians and providers who don’t report observed medical misconduct as is required by law.

For complete text of report click here.

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Assessing Physician Performance

Posted by medconsumers on December 1, 2006

Despite the fact that seven years have passed since the Institute of Medicine’s landmark report on the epidemic of medical mistakes plaguing U.S. hospitals, experts continue to decry the lack of substantial progress in reducing substandard doctor performance. According to one renowned safety expert and co-author of the errors report, Lucian Leape, MD, Harvard School of Public Health, “Performance failures of one type or another are not uncommon among physicians, posing substantial threats to patient welfare and safety.”

In the Annals of Internal Medicine earlier this year, Dr. Leape estimated, “At least one third of all physicians will experience, at some time in their career, a period during which they have a condition that impairs their ability to practice medicine safely.” If that’s not frightening enough, he also warns that hospitals fail to routinely monitor physician performance and identify these problem doctors.

Unfortunately, hospital credentialing has largely been ineffective in making patients safer. A major problem, according to Leape, is that “Independence is so highly valued that physicians are loath to evaluate or confront a colleague who they perceive is having a problem.” Hospitals are not rushing to confront problem doctors either. Doctors denied admitting privileges or facing limitations in their hospital practice often drag the offending institution into court seeking to appeal the credentialing decision or be paid monetary damages.

A hospital’s inherent economic conflict of interest may also get in the way of disciplining a problem doctor if she or he admits many patients and contributes positively to the facility’s bottom line. Hospitals have a fiduciary as well as ethical responsibility to do everything possible to protect patients from preventable harm. Their continued failure to weed out substandard doctors violates that responsibility.

Simulation Technology
What to do? To improve the credentialing process, hospitals should be required to use simulation technology to routinely evaluate the performance of every doctor on staff so as to make better credentialing decisions. Pilots are trained to fly in flight simulators, which provide an exact replica of an airline’s cockpit. Physicians could be similarly trained, for example, to insert a breathing tube on a life-size dummy which would “breathe, bleed, and express pain” as a sick person would under real-life circumstances.

It makes sense to employ simulation technology train people who will perform risky tasks in order to evaluate the safety of their job performance, including unanticipated emergencies. As it stands now, unsuspecting hospitalized patients often become training fodder with their safety possibly compromised.

Pilots, as a condition of licensure, are required once or twice a year to go to a flight simulation center for an evaluation of their abilities. By contrast, doctors are licensed in virtual perpetuity and are not required to routinely demonstrate their competence.

Although relatively new to health care, simulation technology could do for hospitals and patient safety what it has done for pilots and the safety of flying – provide a way to both train and routinely evaluate a doctor’s competency, weed out substandard performers, and keep the public out of harm’s way in the process. But until that happens, a doctor’s hospital affiliation, no matter how prestigious, does little to assure a patient’s safety.

Posted in hospitals | Tagged: hospitals, medical errors, physicians | Comments Off

America’s Best Hospitals – Many Others are Just as Good

Posted by medconsumers on September 1, 2006

America’s Best Hospitals. Who among us does not like lists that direct us to the best hospitals, the best doctors, the best colleges? For 16 years the weekly news magazine U.S. News & World Report has published an annual list of the top 50 hospitals in the country by area of specialty. Its popularity continues to grow despite some major gaps in the information sources used in its ranking system, which is based in large part on perception rather than hard evidence.

It has been eight years since we reported anything about this topic. The impetus for that article was a devastating critique of the methodology used by USN&WR, which was published in 1997 in the Journal of the American Medical Association. Its lead author Jesse Green, PhD, New York University, told HealthFacts: “For the consumer, what’s offered by USN&WR is less than what they claim it to be, and that is the major problem. They’ve patched together data from a number of fairly unreliable sources, and with a magic formula, they come up with a score. None of it’s worth the paper it’s printed on, frankly.”

In 1999, the New England Journal of Medicine published a study by J. Chen, MD, and colleagues at Yale. It was the first to look at the question of whether Medicare enrollees treated at the top-ranked hospitals on the USN&WR list were more likely to survive a heart attack than those admitted to other hospitals. The answer was yes, with the lion’s share of the credit going to greater adherence to evidence-based guidelines that recommend the use of aspirin and beta-blockers (see next page).

Little else had been done to validate the purportedly superior performance of “America’s Best Hospitals” until last month. A new study has found the “best” cardiac hospitals ranked by USN&WR had provided appropriate care—most of the time—for people admitted for a heart attack or heart failure. But it also found that these hospitals were often outperformed or equally matched by many hospitals that never made the list.

774 Hospitals in the Study

The new study, published in the American Heart Association’s journal Circulation, was conducted by Scott C. Williams, PsyD, and colleagues at the Joint Commission on Accreditation of Healthcare Organizations. The JCAHO researchers set out to determine how often the top-ranking cardiac hospitals on the USN&WR list were delivering quality care to their patients with heart attack or heart failure. For comparison purposes, 774 hospitals were included in this study with 41 of them in the top 50 cardiac hospitals on the USN&WR list. (Nine of the 50 hospitals failed to supply complete data on their patients treated for heart attack or heart failure.)

The JCAHO researchers applied the following performance measures of quality care, which were established years ago by the American College of Cardiology and the American Heart Association. Note how simple and low-tech virtually all are:

For Both Heart Attack and Heart Failure Patients

Aspirin given within 24 hours of arrival
Beta blocker given within 24 hours of arrival (Beta-blockers are a class of drugs that decrease the heart’s need for blood and oxygen by reducing its workload. They are sold under numerous different brand and generic names.)
aspirin therapy and beta-blocker therapy prescribed at discharge
Angiotensin-converting enzyme (ACE) inhibitor therapy prescribed at discharge to patients with left ventricular systolic dysfunction (ACE inhibitors belong to the class of high blood pressure drugs sold under multiple brand and generic names.)
Smoking cessation advice/counseling

Additional Measures for Heart Failure Patients

Assessment of left ventricular function (with echocardiography or radionuclide ventriculography)
Instructions at discharge about drugs, diet, weight, symptoms worsening, follow-up, and physical activity

These performance measures are all based on published evidence that clearly demonstrates effectiveness. For example, numerous studies have shown that giving aspirin as early as possible to someone having a heart attack not only reduces adverse “events” but also mortality. All 774 hospitals in this study were accredited by the JCAHO; all had supplied relevant information in 2004 as part of the accrediting process.

Drawing from administrative and discharge information supplied by the hospitals, the JCAHO researchers found that the 41 top-ranked USN&WR cardiac hospitals “provided care that was consistent with evidence-based practice guidelines 86% of the time, on average… In comparison, the other 733 hospitals in the study provided care that was consistent with practice guidelines 83% of the time.”

But the superiority of the USN&WR list was challenged by these findings: 13 hospitals not on this list did better than any of the 41 top-ranked hospitals. And 313 non-ranked hospitals did better than half of those on the USN&WR list. “The fact that so many hospitals did as well or better than those ranked at the top by USN&WR is good news for many Americans who may not have access to those highly rated institutions,” concluded Dr. Williams and colleagues at the JCAHO.

Asked for the take-home message from his study, “We’re not knocking any hospitals on the USN&WR list. Hospital quality assessment is a complex issue,” answered Dr. Williams in a telephone interview. (His study does not identify any hospitals by name.) “For the first time, there are data available [to the public] for how hospitals comply with evidence-based measures for cardiac care.”

Sources of information about U.S. hospitals

For the longest time the USN&WR was the only game in town for anyone who wanted independent information about hospitals. Of the following Web sites only the Leap Frog Group provides information in a consumer friendly format.

JCAHO Web site (www.qualitycheck.org);
the Leapfrog Group (www.leapfroggroup.org);
and the U.S. Health and Human Services (www.hospitalcompare.hhs.gov/hospital/home2.asp).

*Nine out of the 50 hospitals failed to supply complete data on their patients treated for heart attack or heart failure.

Posted in hospitals | Tagged: hospitals | Comments Off

Hospital Errors Still Out of Control

Posted by medconsumers on August 1, 2006

Every day patients spend in a hospital bed, they risk harm from at least one preventable medication error. This disturbing finding is cited in a recent report on medication errors undertaken by the Institute of Medicine (IOM) at the behest of Congress. While many such errors cause only minor problems, a significant number result in permanent injury or death.

The IOM estimates that a total of 1.5 million preventable injuries occur each year as a result of lapses in medication safety. Almost half of these befall residents of nursing homes or other long-term care facilities, about 400,000 afflict hospital patients, and the rest occur in outpatient settings. Injuries to hospital patients alone are said by IOM to generate $3.5 billion in extra medical costs. Given that many drug-related injuries go undetected and/or unreported, the report concedes that the estimate of 1.5 million injuries is likely too low.

While listening to the press conference announcing the report’s release last month, I was reminded of Yogi Berra’s famous line—“it’s like déjà vu all over again.” As a co-author of the 1999 IOM report on medical errors, “To Err is Human,” I found that much of what this latest report had to say was not new. In fact, I became angry at what I was hearing during the press conference—namely that preventable medication errors were still out of control, despite the urgent warnings we had sounded six years earlier.

The 1999 report concluded, “…there is reasonable agreement about useful approaches” to prevent medication errors. Six years ago we thought that our recommendations for tackling the prevention of medication related errors would be put into practice relatively quickly. In fact the 1996 report challenged the health care system to reduce all varieties of medical mistakes by 50% within five years. But while stories of individual efforts to improve medication safety may abound, the new IOM report suggests that systemwide, the risks remain serious and widespread.

The 1999 report recommended use of computers to prescribe and dispense medicines in all hospitals. The new report recommends that medication prescribing and dispensing should be done electronically by 2010 in all settings, yet, at most, one out of five hospitals and a much smaller proportion of clinics and doctor’s offices now have that capability.

The new report’s number one recommendation for safer prescribing, dispensing and use of medications is that health care providers engage consumers in “activities and behaviors that promote their health, well-being and safety.” More specifically, it recommends that patients become better informed, ask more questions about their medications and keep an up-to-date list of the drugs they take. (For more: www.iom.edu/CMS/3809/22526/35939/35945.aspx)

Similar advice has been handed out to consumers for at least several decades, but considering the continuing epidemic of medication error-related harm detailed by IOM, I question how effective this has been has been as a prevention strategy.

I don’t disagree that becoming your own first line of defense makes good common sense, given the high risk of being hurt due to the slow pace of safety improvements in prescribing and dispensing edications. But I worry that placing too much responsibility for error prevention on patients excuses providers from accountability for the safety of care they render. We don’t approach airline safety by advising passengers to inspect the airplane for air worthiness before they board or to bring a list of questions to ask pilots about their flight plan – passengers expect flying to be safe. I suggest that medication users should someday have the same expectation—that medication use is safe—and we should hold providers accountable for meeting that standard.

For now, the best advice I can give readers is to favor health care providers who demonstrate they are serious about improving medication safety. Ask if a hospital is using computerized physician order entry; ask whether an outpatient clinic or doctor’s office can electronically prescribe and transmit prescriptions; and ask whether a pharmacy can receive electronically transmitted prescriptions from your health care provider.

Posted in hospitals | Tagged: hospitals, medical errors, prevention | Comments Off

Choosing Where to have High-Risk Elective Surgery

Posted by medconsumers on November 1, 2005

You’re facing non-emergency surgery, so there is time to weigh and consider the choice of a surgeon and hospital. Ideally, the choice would be based on the surgeon and the hospital with the best records. An increasing number of state health departments, consumer advocacy groups, and coalitions of employers and insurers can help by providing what is called “performance data” on hospitals and surgeons.

But a new survey found that few elderly Americans who had recently undergone non-emergency surgery looked for performance data. Most relied on the opinions of their referring physician, family members and friends in choosing where to have surgery. The telephone survey was conducted in the U.S. and was published recently in the BMJ, the British medical journal. The 510 randomly chosen respondents had undergone high-risk elective procedures, such as heart valve replacement or cancer surgery involving the bladder, lung or stomach. All were Medicare beneficiaries, so a choice of hospital and surgeon was possible.

The survey’s authors led by Lisa M. Schwartz, MD, Dartmouth Medical School did not see their results as a sign of the ineffectiveness of public reporting of performance data. It was well known—before this survey—that public reporting of this type of information does not have seem to affect people’s choice of hospital or doctor. Instead, Schwartz and colleagues say that the problem lies in assuming that the public is the primary target for surgical performance data. They think that the target audience should be referring physicians and purchasers of health services.

A good example of the latter, say Schwartz and colleagues, is the Leapfrog Group, a coalition of employers and insurers that buy health care. The Group encourages its employer members to use the purchasing power of their health plans to reward doctors and hospitals for improving the quality, safety, and affordability of health care. (To see ratings of hospitals in your area, go to www.leapfroggroup.org and click “For Consumers.”)

Still, the referring physician’s opinions loomed large in this new survey. Schwartz and colleagues acknowledged the fact that more work has to be done to ensure that referring physicians appreciate the importance of performance data. The information must be easily understandable, and doctors may need help in finding the best ways to communicate performance data to their patients.

Posted in hospitals, surgery | Tagged: hospitals, surgery | Comments Off

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