A study released this week by Thomson Reuters (New York), ranking hospital performance, shows the Midwest region as having significant improvement above all other regions in the U.S. California, along with New York, did not fare as well.

"When we started this study back in 1993 the West Coast had the highest performance, and in 1996 it shifted to the South, in Florida and in Texas," Jean Chenoweth, senior vice president for performance improvement and "100 Top Hospitals" programs at Thomson Reuters, told Medical Device Daily. "The rate of improvement has changed pretty radically. What this means is that we're probably ready for another shift in performance."

Although Chenoweth did not give specifics as to why the Midwest had the best level of service, the region has garnered attention lately as to having a significant amount of financings and interest in the healthcare sector, specifically in the medical device arena, which could have some impact on its success.

Just last year healthcare investments topped the $1 billion mark for the region (MDD, Feb. 28, 2008).

Overall, U.S. hospitals struggled to improve their performance from 2002 to 2006, the period covered by the study, but the winning hospitals illustrate that rapid, across-the-board improvement is attainable.

The study — Thomson Reuters 100 Top Hospitals Performance Improvement Leaders, 5th Edition — examined the performance of more than 2,800 U.S. hospitals on a variety of clinical, financial, operational and patient safety criteria to identify the 100 top performers.

"What this study does is give the boards of these hospitals an idea of the CEOs and the staff who're making these hospitals better," Chenoweth said. "This is unique because there is no long-term data to evaluate performance in other fields ... but that's not the case in healthcare."

The hospital assessment project, which dates back to 1993, was formerly called the Solucient 100 Top Hospitals program. Thomson acquired Solucient in 2006. It acquired Reuters earlier this year to form Thomson Reuters.

The study rated hospitals on eight factors — patient mortality, medical complications, patient safety, length of stay, expenses, profitability, cash-to-debt ratio and use of evidence-based medicine. Researchers evaluated 2,867 short-term, acute-care, non-federal hospitals grouped into five categories: major teaching hospitals, other teaching hospitals, large community hospitals, medium-sized community hospitals, and small community hospitals.

"All of this information is from publicly available data, so anyone can see how we did this," she said. "We try to make this as transparent as we possibly can."

The study analyzed publicly available Medicare cost reports, Medicare Provider Analysis and Review data, and the Centers for Medicare and Medicaid Services' Hospital Compare data set. It found that the 100 performance improvement leaders:

Went from having more patient deaths and adverse safety events than expected to fewer than expected.

Increased expenses only 2.5% during the five-year study period, on average, compared with a 17.4% increase among their peer hospitals.

Increased profit margin from less than 1% to 6.9%.

Reduced average length of stay by nearly a day, despite greater severity of illness.

The vast majority of peer hospitals, however, showed appreciable improvement in only three categories — mortality, length of stay, and patient safety. More than half of the hospitals studied had improved survival rates (lower mortality indices), and one-third decreased their average patient stay. Nearly 14% of all hospitals showed significant improvement on the majority of patient safety measures studied.

For the remainder of the measures, the majority of peer hospitals had no statistically significant change in performance. Financially, most hospitals were treading water – 84% showed no marked change in profitability and 77% showed no change in cash position. Two-thirds of the hospitals did not significantly decrease their expense per adjusted discharge, and the other third saw an increase in expense per discharge.

"Given these findings, it is clear that healthcare executives are facing great challenges in aligning their organizations for continuous performance improvement," Chenoweth said. "The hospitals that accomplish this feat are well deserving of this award."

The Healthcare business of Thomson Reuters produces insights, information, benchmarks and analysis that enable organizations to manage costs, improve performance and enhance the quality of healthcare.

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