Mortality/readmission data for US hospitals (infections, depression, smoking, heart)

[susan42]

Compare hospitals on heart attack, heart failure and pneumonia - USATODAY.com
I know that there are many variables that influence mortality and readmission, but thought it was good to see how well CMC does compared to Duke and some of the other providers.Lake Norman regional figures not impressive.
The study was of medicare and medcaid patients and was collected from 2005-2008.

[anifani821]

Susan, I feel posting this type of info w/o other data is somewhat misleading. I know you stated that but . . . just saying.

[susan42]

Originally Posted by anifani821

Susan, I feel posting this type of info w/o other data is somewhat misleading. I know you stated that but . . . just saying.

Here is the link to the original article.



Of course all research has it's limitations and if you wanted to get into the reasons for the differences then you would have to look at demographics, epidemiology,staffing levels ,EMS reponse times etc.

This research will hopefully be food for thought, not only for the hospitals, but also for those involved in health care reform.
As for service users, maybe it will be enough to make people find out a bit more about the hospital closest to them and whether it is a certified heart or stroke center etc.

,

[chicagocubs]

Originally Posted by susan42

Here is the link to the original article.



Of course all research has it's limitations and if you wanted to get into the reasons for the differences then you would have to look at demographics, epidemiology,staffing levels ,EMS reponse times etc.

This research will hopefully be food for thought, not only for the hospitals, but also for those involved in health care reform.
As for service users, maybe it will be enough to make people find out a bit more about the hospital closest to them and whether it is a certified heart or stroke center etc.

,

Actually, Susan, I think that it is a good link. Too many people think that all hospitals are alike and that they are all fantastic regardless. In regards to healthcare reform, that is probably good food for thought as well. As you know, I am all for healthcare reform, although Ani and those that have done research into the present bills before Congress say that they are not so much healthcare reform as insurance reform. Regardless, something needs to be done with the healthcare system in this country.

However, I am afraid that the language and ideals in that link might be above the understanding of the average reader. Perhaps if you broke it down it might be more palatable? I know that Ani understands it...she is in the field. but, others, such as myself might be a bit boggled.

[susan42]

Originally Posted by susan42

Here is the link to the original article.



Of course all research has it's limitations and if you wanted to get into the reasons for the differences then you would have to look at demographics, epidemiology,staffing levels ,EMS reponse times etc.

This research will hopefully be food for thought, not only for the hospitals, but also for those involved in health care reform.
As for service users, maybe it will be enough to make people find out a bit more about the hospital closest to them and whether it is a certified heart or stroke center etc.

,

http://circoutcomes.ahajournals.org/cgi/rapidpdf/CIRCOUTCOMES.109.883256v1.pdf

[Barkingowl]

Those charts only talk about 3 specific ailments. How do the hospitals rate overall?

[susan42]

Originally Posted by chicagocubs

Actually, Susan, I think that it is a good link. Too many people think that all hospitals are alike and that they are all fantastic regardless. In regards to healthcare reform, that is probably good food for thought as well. As you know, I am all for healthcare reform, although Ani and those that have done research into the present bills before Congress say that they are not so much healthcare reform as insurance reform. Regardless, something needs to be done with the healthcare system in this country.

However, I am afraid that the language and ideals in that link might be above the understanding of the average reader. Perhaps if you broke it down it might be more palatable? I know that Ani understands it...she is in the field. but, others, such as myself might be a bit boggled.

Well I am with you 100% re healthcare reform, but coming from a country where we have a "free" (which it is not if you work) healthcare for Uncle Tom Cobbly and all I am a little sceptical and I think some people may think that we have some sort of Nirvana here as regards healthcare in the UK.

I don't work with heart attack patients-stroke is my area of speciality.

I am happy to try to break down the info if it might help people, that's the important thing.


On the first link to the USA today article

To find results for a particular hospital for a particular illness
At the top of the map
To the left select the illness from the drop down
Select an outcome ie death or readmission
The resulsts for each hospital will show you all illnesses and outcomes anyway, so doesn't really matter what you select.
Select a State.

Once you have selected a State-say NC -you get a map with all the hospitals that take medicaid/medicaire patients marked on it.
There is also a list of hospitals in the top right corner.
If you "hover" over the crosses on the map it will tell you the name of the hospital (use the zoom in slider bar to the left of the map to get a clearer view of the hospitals)
Once you find the name of the hospital you are intereated in you can click on it and the results for that hospital will be displayed at the bottom of the map.

What the results mean
If I look at the results for Carolinas Northeast in Concord

The first graph is for heart attack.

The first bar on the graph shows that out of all the patients admitted to Northeast with a heart attack, under medicaire/medicaid,approx 15 out of every 100 (14.8%) patients had died within 30 days.
The second bar shows that out of all the patients admitted to Northeast with a heart attack, under medicaire/medicaid,approx 19 out of every 100 (18.7%) patients were readmitted within 30 days.
Of course there will be some patients who were both re admitted and died within 30 days (probably quite a few) but it doesn't tell us that unfortunately.

You can then go through the results for Pneumonia and heart failure in the same way.

Re admission rates are often used (either rightly or wrongly) as a quality outcome measure-one of the rationale being that if you had to be readmitted then maybe you were sent home too soon in the first place, or did not receive recommended/appropriate investigations treatment.

I don't know if it would be more likely that pts on medicaire/medicaid might not get the right investigations/interventions, compared to someone with private insurance.

On the second link that goes to the original journal article, it is easier to see the results geographically across the USA. Lighter color is better-from white to dark blue.

Fators that might affect the results

1. severity of heart disease in people in the area surrounding the hospital
2. Urban or rural area
3. Knowledge of heart attack symptoms
4. time taken for people to respond to symptoms
5. How they respond ie phone a relative,911,nothing
6. EMS response times ie how quickly they get to the patient and get them to hospital
7. EMS policy regarding which hospital they take patient to ie nearest or certified heart center which may be in another county.
8. Hospital ED triage times
9. Hospital protocols ie set plans that are followed in the case of heart attack
10. Staffing levels and type of staff ie registered nurses, Licensed practical nurses,Nurse Practitioners and the number on duty at any one time in ED/Cardiolgy unit and wards.

Also need to consider whether people are more or less likely to adhere to their treatment plan post discharge ie behaviour change (aagh)-eg smoking in the case of pneumonia, and medication concordance ie taking prescribed tablets.

Important thing it doesn't tell us is whether the death was related to the condition eg in the case of heart attack was it something to do with the heart attack , or was it something else such as a hospital acquired infection, pneumonia, a fall etc.

there will be more factors, these are just some that came to mind.

Hope this helps.

[anifani821]

Unfortunately, the legislation now b/f our Congress is not universal h/c a la Canada/UK, and it appears many folks across the nation think it is. Not gonna argue the pros or cons of that system . . . but it is discouraging to me that our leaders would rather add a layer (several layers, actually) of bureaucracy and insurance mandates rather than get down to the nitty gritty of repairing our system . . .

Yes, this is essentially an insurance mandate bill, but the pork thrown in it is outrageous. Billions of dollars for advertisements, for example.

Doing some simple things such as prohibiting insurance companies from denying coverage based on pre-existing conditions would be immensely helpful to our citizens, but that does not take hundreds of pages of legislation to enact.

As for rating hospitals . . . there is no way this type of article can accurately rate care. Joint Commission accreditation helps distinguish the overall operations . . . but mortality figures are dependent on demography.

For example, some hospitals may historically have higher end-of-life admissions, may receive many admissions from nursing homes, etc.

Infections rates tell me more, frankly . . .or at least are as revealing (or can point to a problem).

[susan42]

Originally Posted by Barkingowl

Those charts only talk about 3 specific ailments. How do the hospitals rate overall?

Yes and the research only looked at those and only in medicaid/medicaire patients. I think they probably looked at illnesses that had the highest immediate risk of death following admission, or maybe the most common in medicaid/medicaire patients.
I don't know how they rate for other specific diseases, but would hope that a hospital that is level 1 trauma would be better for trauma than one that was level 2 or 3.

The joint commission on accreditation for healthcare organisations (JCAHO)
sets standards of care for many diseases.Hospitals and other providers can become accredited by demonstrating that they are meeting these standards.
Heart attack, heart failure and pneumonia are included in the conditions that hospitals can become accredited for.There are many more including breast cancer, diabetes ,depression etc.
http://www.jointcommission.org/CertificationPrograms/Disease-SpecificCare/dsc_facts.htm

It would be interesting to look and see if there is a positive correlation between certification and outcome ie if the hospital is certified for heart attack,then patients have less chance of dying-one would hope so!

[anifani821]

Actually, I just read a study this week that concluded that there is very little difference in outcome b/n Level I trauma centers and other hospitals w/o that designation. Surprised the heck outta me. If I can find that again (didn't DL it - just read the abstract) I will post a link.