By MICHAEL RUKAVINA
OBSERVER Assistant News Editor
The comprehensive Niag-ara Health Quality Coal-ition's ninth annual NYS Hospital Report Card has been released and for the first time with two new components America's Safest Hospitals and New York State Hospitals Watch List for 2011.
Local hospitals such as Brooks Memorial, TLC Health Network, Westfield Memorial and Tri-County Hospital did not find themselves on either list but more so in line with the majority of health care providers across the state.
"One way that patients can compare hospital quality is to ask where they have the best chance of surviving, and where they have the best chance of avoiding an infection or a medical error," Bruce Boissonnault, President & CEO of the Coalition said during a conference call with media across the state. "Another way is to assess where patients say they are most satisfied with clinical elements of their care like how clean the rooms are, or how effectively doctors and nurses communicate with patients, or how well hospitals manage patients' pain. In this year's report, patients also can find where hospitals have the lowest readmission rates. This report is the only way for patients, their families, and communities to answer these questions objectively."
The report, which is found on myhealthfinder.com, indicated that Brooks Memorial Hospital and TLC Health Network each ranked at state average for mortality indicators, based on five out of the 14 areas listed.
Only five categories were ranked because they were only ones with a sample size large enough, they included the following areas hip replacement mortality, congestive heart failure, gastrointestinal hemorrhage, hip fracture and pneumonia mortality. Statewide, mortality rates have improved by an average of more than a 50 percent, according to Boissonnault.
The indicators used in the New York State Hospital Report Card are based on federal methodologies. The 2011 report shows that statewide, the risk adjusted mortality rate for nearly all procedures and conditions continued to improve. That means, according to the report, that patients admitted to a hospital are less likely to die than they were before NHQC began disclosing this information publicly.
"Improvements on mortality rates, every single year we see more improvement. Some of that is better coding, some of that is better care, but both of them are being driven by better transparency," Boissonnault said. "The second, is the 14 error rates we measure, 12 of them have improved. The only error rate you can't fix one hospital at a time is the hospital acquired infection."
Westfield Memorial Hospital did not rank in the mortality indicators because of the small sample sizes.
Under patient safety indicators, Brooks Memorial Hospital ranked at state average in 9 out of the 10 areas measured except in postoperative wound dehiscence in abdominopelvic surgical patients. According to the report, this indicator is intended to flag cases of wound dehiscence in patients who have undergone abdominal and pelvic surgery. Dehiscense is defined as a bursting open or splitting along natural or sutured lines; to gape; the separation of a surgical incision or rupture of a wound closure, typically an abdominal incision.
"The ever increase of risk adjustment ... it is very important," Dr. Norbert Goldfield, Chief Medical Officer for 3M Health Information Systems, referring to the report. "Secondly, it is getting better, it's becoming more transparent and better in the sense that the data elements have even more validity in distinguishing differences between patients."
TLC Health Network also listed below average in postoperative wound dehiscence in abdominopelvic surgical patients, and also in the area of iatrogenci pneumothorax (collapsed lung). Many procedures performed in an intensive care or emergency setting can result in an iatrogenic pneumothorax. These procedures include mechanical ventilation therapy, cardiopulmonary resuscitation and neck surgery. Treatment of pneumothorax is generally with a chest tube. This measure is intended to flag cases of pneumothorax caused by medical care. The indicator is used to show complications that can result from interventional treatment in the chest area.
Westfield Memorial only ranked in two of the same 10 categories based on sample size and were state average for each.
Variations in quality between hospitals, and for different services within each of the hospitals, remain high. According to the report, many New York hospitals continue to offer complex procedures infrequently and have worse outcomes because of it.
Brooks Memorial Hospital was the only hospital ranked in the utilization indicators in the categories of cesarean section delivery utilization (state average) and vaginal birth after cesarean utilization (below state average). According to the report, just because a woman has had one Cesarean section (C-section) delivery does not necessarily mean she must deliver future babies by C-section. Many women have normal deliveries even though they had a C-section in the past. The report provides information on the proportion of vaginal births that occurred to mothers who had delivered previously by C-section. This indicator must be viewed with caution, it states, as there is some evidence that standards of care are changing in this complex area. In general, higher percentages are better.
"With health costs continuously rising and the problems we're facing it becomes more important for consumers to be able to identify where they can get the best healthcare for their particular needs," Consumer Advocate for transparency Linda Joseph said. "We think this report is so important to that ability."
In the patient survey indicator, TLC had no information available, Brooks Memorial Hospital ranked at state average for each of the five categories, and Westfield Memorial ranked above state average in three of the five categories. It excelled in the areas of overall hospital rating, hospital cleanliness and physician communication.
Tri-County Hospital in Gowanda did not have a large enough sample size to rank them under the mortality indicators; it ranked at state average in the only two patient safety indicator areas that it qualified for; and received at state average on each of the five patient survey indicators.
"We urge patients and their families to do their homework in selecting a hospital and to discuss this information with their family physician before an emergency arises," Boissonnault said.
Consumers can visit www.myhealthfinder.com to view results of the Hospital Report Card and compare hospital outcomes before they need care. Patients are encouraged to phone NHQC staff at 716-250-6472 Extension 1 between 9 a.m. and 4 p.m. Monday through Friday if they have questions about the reports. NHQC provides assistance to health care consumers at no charge.
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