Odds are good that one won't read a chamber of commerce advertisement promoting its city as "a great place to be admitted to the hospital." But, it is a fact that some hospitals are simply better rated than others. When dealing with patient mortality, a recent hospital quality study should warrant some attention.

Patients have on average a 70% lower chance of dying at the nation's top-rated hospitals compared with the lowest-rated hospitals across 17 procedures and conditions analyzed in the 11th annual HealthGrades Hospital Quality in America Study, issued by HealthGrades (Golden, Colorado), an independent healthcare ratings organization.

While overall death rates declined from 2005 to 2007, the nation's best-performing hospitals were able to reduce their death rates at a much faster rate than poorly performing hospitals, resulting in large state, regional and hospital-to-hospital variations in the quality of patient care, the study found.

HealthGrades Hospital Quality in America Study also found that if all hospitals performed at the level of five-star rated hospitals, 237,420 Medicare deaths could potentially have been prevented over the three years studied. More than half of those deaths were associated with four conditions: sepsis (a life-threatening illness caused by systemic response to infection), pneumonia, heart failure and respiratory failure.

Rick May, MD, senior physician consultant for HealthGrades, and an orthopedic surgeon, explained to Medical Device Daily the criteria for the different hospital ratings. "It's really not the quality of the physicians or staff, not the location of the hospital, not the equipment. The real key to distinguishing between the different hospitals has to do with two major factors: from the board of directors on down to the staff there has to be a clear dedication to quality improvements. Secondly, there have to be systems of care in place at the hospital that that guarantee that every patient gets the best evidence-based treatment on a consistent basis."

The HealthGrades study of patient outcomes at the nation's approximately 5,000 hospitals is the most comprehensive annual study of its kind, analyzing more than 41 million Medicare hospitalization records from 2005 to 2007. The study examines procedures and conditions ranging from heart valve-replacement surgery to heart attack to pneumonia.

Full reports on death rate trends in each of the 50 states and the District of Columbia are available in the study. And, for the first time, HealthGrades has released hospital death rates for the nation's 15 largest metropolitan statistical areas: New York, Los Angeles, Chicago, Dallas, Philadelphia, Houston, Miami, Washington, Atlanta, Boston, Detroit, San Francisco, Phoenix, Riverside-Inland Empire (California) and Seattle. Large variations exist between these areas.

The study's major findings are:

The nation's inhospital risk-adjusted mortality rate improved, on average, by 14% from 2005 to 2007, but the degree of improvement varied widely by procedure and diagnosis studied. Five-star hospitals' mortality rates continue to improve at a faster rate (13.18%) than 1- or 3-star hospitals (12.3% and 13.14%, respectively).

Large gaps persist between the "best" and the "worst" hospitals across all procedures and diagnoses studied. Five-star hospitals had significantly lower risk-adjusted mortality across all three years studied. Across all procedures and diagnoses studied, there was an approximate 70% lower chance of dying in a 5-star hospital compared to a 1-star hospital. Across all procedures and diagnoses studied, there was an approximate 50% lower chance of dying in a 5-star hospital compared to the U.S. hospital average.

If all hospitals performed at the level of a 5-star hospital across the 17 procedures and diagnoses studied, 237,420 Medicare lives could have potentially been saved from 2005 to 2007.

Fifty-four percent (128,749) of the potentially preventable deaths were associated with just four diagnoses: Sepsis, heart failure, pneumonia and respiratory failure.

May told MDD that Medicare patients were used because the standard patient information is required in every hospital and could be surveyed on a consistent basis.

In the study's analysis of hospital death rates, the following 17 procedures and conditions were analyzed: bowel obstruction, chronic obstructive pulmonary disease, coronary bypass surgery, coronary interventional procedures (angioplasty/stent), diabetic acidosis and coma, gastrointestinal bleed, gastrointestinal surgeries and procedures, heart attack, heart failure, pancreatitis, pneumonia, pulmonary embolism, resection/replacement of the abdominal aorta, respiratory failure, sepsis, stroke, and valve replacement surgery.

"Geography should not be a major factor in patients' outcomes. If our nation's hospitals are to close the quality gap and guarantee an equally high level of medical care for every patient, no matter where he or she lives, it will require a commitment by our nation and its communities to demand more from quality improvement," said Samantha Collier, MD, HealthGrades' chief medical officer and a study author. "Until then, it is imperative that anyone seeking medical care at a hospital do their homework and know the hospital's quality ratings before they check in."

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