Hospital care quality differs markedly by state: annual HealthGrades study

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LAKEWOOD, Colo. (September 22, 2003) – The quality of care at the nation's hospitals varies substantially from state to state, according to the sixth annual HealthGrades Hospital Quality in America Study, released today. Results of the study, which rates each of the nation's nearly 5,000 hospitals in 26 procedures and diagnoses, were made available today on HealthGrades.com to assist individuals in finding high-quality hospitals in their local areas.

The HealthGrades study, which ranked the states in hospital quality, found that better-performing hospitals were concentrated in northern and less populous states, while worse-performing hospitals were concentrated in southern states. Many of the states that exhibited the highest hospital quality, such as Florida, Colorado, Ohio, Pennsylvania and Michigan, ranked among the best consistently across the procedures and diagnoses studied. Similarly, many of the worst states, such as Arkansas, Alabama, Oklahoma, Tennessee and Mississippi, were ranked among the worst consistently across all procedures and diagnoses studied. While there are five-star hospitals in these states, patients, on average, get better care in the higher-ranking states.

"On average, you have a 54.9% increased chance of dying if you have an angioplasty or other percutaneous coronary intervention in Texas rather than New York," said Samantha Collier, MD, HealthGrades' vice president of medical affairs. "In Mississippi, your chance of dying from a heart attack is 49.4% higher, on average, than if you were treated in Colorado. The quality chasm at American hospitals is real, and it is very alarming and concerning – despite evidence of process improvements."

Ranking of States by 5 Key Quality Outcome Measurements

To compile the state rankings, 5 procedures and diagnoses – of the 26 HealthGrades rates at hospitals nationwide – were chosen to represent various aspects of quality at the state level: Coronary Artery Bypass Graft surgery (CABG), Percutaneous Coronary Interventions (PCI), Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF) and Community Acquired Pneumonia (CAP).

The greatest difference in outcomes at the state level was found with PCIs, which includes angioplasty, stent, and atherectomy. More than 500,000 PCIs are performed each year, according to the American Heart Association. For these procedures, New York was the best performing state and Alaska was the worst. Along with Alaska, states such as Texas and Tennessee had an above-average level of PCI mortality, which resulted in hundreds of unnecessary deaths between 2000 and 2002. Hospitals in states such as New York, New Jersey and Florida had lower-than-expected mortality rates, which resulted in hundreds of lives being saved in those states during the same period.

State-Level Hospital Quality for Percutaneous Coronary Interventions (PCI), Including Angioplasty, Stent and Atherectomy

* Puerto Rico, Guam, Virgin Islands were analyzed, but results were not included in this table.

Attention to improvement at the state level does seem to be having an impact, the study found. States with well-known and publicized Centers of Medicare & Medicaid Services' Quality Improvement Organization efforts, or with hospital- and physician-specific public profiling of CABG outcomes, are ranked among the best states for performance of CABG surgery. These include New Jersey, New York, Pennsylvania, Michigan, Massachusetts and Virginia. The study also found that for all cardiac procedures and diagnoses, there was a positive trend between performance and hospital volume, a finding consistent with previous studies.

Hospital Ratings Methodology

The quality ratings of 26 procedures and diagnoses at nearly 5,000 hospitals just released by HealthGrades are available at HealthGrades.com. They cover cardiac care, orthopedics, vascular surgery, neurosciences and pulmonary medicine. New categories added this year include atrial fibrillation, gastrointestinal bleed, sepsis, prostatectomy, cholecystectomy and bowel obstruction.

A five-star rating in a given category reflects performance statistically better than expected, a three-star rating reflects care at an expected or average level, while a one-star rating reflects care significantly worse than expected. HealthGrades updates the hospital ratings annually and analyzes the most recent three-year period for which national data of this type is available. This currently includes the years 2000-2002.

HealthGrades' ratings are compiled using advanced statistical techniques and raw data taken from Medicare files licensed from the Center for Medicare and Medicaid Services (CMS). HealthGrades risk-adjusts the hospital data, taking into account patient characteristics such as age, gender and pre-existing medical conditions of patients treated at different hospitals, in order to make accurate and fair comparisons. HealthGrades compares the actual and the predicted mortality or complication rates for specific procedures and diagnoses to assign a one-, three-, or five-star rating. The full methodology is available at www.healthgrades.com.

About HealthGrades

Health Grades, Inc. (OTCBB: HGRD) is the leading independent healthcare quality company, providing ratings, information and advisory services to healthcare providers, employers, health plans and insurance companies. HealthGrades also provides consumers access to information about health care providers and practitioners through its Web site. At http://www.healthgrades.com, consumers access profiles of more than 620,000 physicians, 5,000 hospitals, 16,000 nursing homes, 10,000 mammography clinics, 300 fertility clinics, 60,000 chiropractors, 6,000 home health agencies, 75 birth centers and 3,000 hospice care facilities. HealthGrades is also working closely with the Leapfrog Group to disseminate information on hospital patient safety activities to consumers, payers and employers.

Editor's Note: The full HealthGrades Hospital Quality in America Study can be found at http://www.healthgrades.com.

A PDF of the report is available at http://www.eurekalert.org/images/release_graphics/SixthAnnualFinal091903.pdf.