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Medical-Errors Gap Widens Between Best - Worst
Hospitals
Three-Year Study by HealthGrades Covers 37 Million
Hospitalizations
Cost to Medicare of Patient Safety Incidents: $3
Billion Annually
May 2, 2005 - Patient safety incidents at America's
hospitals increased slightly, but the nation's safest hospitals grew
even safer, resulting in a wider gap in patient safety incident rates
among the nation's best and worst hospitals, according to a new study of
37 million patient records released today by HealthGrades, an
organization that evaluates the quality of hospitals, physicians and
nursing homes for consumers, corporations, hospitals and health plans.
The second annual HealthGrades Patient Safety in
American Hospitals Study finds that 1.18 million patient safety
incidents occurred among Medicare hospitalizations in the years 2001,
2002 and 2003, with the cost to Medicare approaching $3 billion
annually. That compares with 1.14 million incidents in the three years
beginning with 2000.
The study also finds that hospital-acquired
infections grew by 20% and accounted for 30% of the costs of patient
safety incidents.
"The reason we see the hospitals with the lowest
incident rates improving the fastest is that they have what I call a
'culture of safety'," said HealthGrades Vice President of Medical
Affairs Samantha Collier, M.D., who authored the study.
"A 'culture of safety' requires rapid
identification of errors and root causes and the successful
implementation of improvement strategies, which can only be achieved
with strong leadership, critical thinking, and commitment to excellence.
For patients, it's important to know which hospitals meet this standard,
as they are nearly 50% less likely to have an incident at hospitals in
the top 10%, according to the HealthGrades study."
The study, which applies 13 patient safety
indicators (PSIs) identified by the Agency for Healthcare Research and
Quality (AHRQ) to Medicare hospitalizations, produced the following
findings:
-
There were wide, highly significant gaps in
individual PSI and overall performance between the top10% and the
bottom 10% ranked hospitals.
-
Top 10% hospitals generally had lower incident
rates across all PSIs in 2001, but also generally improved at a
greater rate than the bottom 10% hospitals between 2001 and 2003.
-
Overall, from 2001 through 2003, the
best-performing hospitals as a group (hospitals that had the lowest
overall PSI incident rates of all hospitals studied, defined as the
top 10% of all hospitals studied) had 267,151 fewer patient safety
incidents and 48,417 fewer deaths resulting in a lower cost of $2.3
billion associated with Medicare beneficiaries as compared to the
bottom 10% of all hospitals studied.
-
Patients in the top 10% hospitals had, on
average, on average 50 percent lower occurrence of experiencing one
or more PSIs compared to patients at the bottom 10% hospitals.
Important and frequent contributors to this notable difference were
significantly lower rates of hospital-acquired infections and
post-operative metabolic derangements.
-
If the bottom 10% hospitals improved only their
hospital-acquired infection rates to the level of top 10% hospitals,
2,734 deaths associated with $792 million could have been avoided
from 2001 through 2003.
-
The rates of six key quality improvement focus
areas (metabolic derangements, post-operative respiratory failure,
decubitus ulcer, post-operative pulmonary embolus (PE) or deep vein
thrombosis (DVT), and hospital-acquired infections) worsened on
average by 20 percent or more over four years (2000 through 2003),
while another six PSIs (death in low mortality DRGs, failure to
rescue, iatrogenic pneumothorax, post-operative hip fracture,
post-operative hemorrhage or hematoma, and post-operative wound
dehiscence) improved on average by less than 10 percent.
-
Of the total of 302,541 deaths among patients
who developed one or more PSIs during 2001 through 2003, 81 percent
(245,008) of these deaths were attributable to the patient safety
incidents.
-
Hospital-acquired infections correlated most
highly with overall performance and performance on the other 12 PSIs,
suggesting that hospital-acquired infection rates could be possibly
used as a proxy of overall hospital patient safety.
-
Hospital-acquired infections rates worsened by
approximately 20 percent from 2000 to 2003 and accounted for 9,552
deaths and $2.60 billion, almost 30 percent of the total excess cost
related to the patient safety incidents.
-
The 16 PSIs studied accounted for $8.73 billion
in excess inpatient cost to the Medicare system over the three years
studied, or roughly $2.91 billion annually.
"We found that that highest incidence rates were in
the categories of Failure to Rescue, Decubitus Ulcer and Post-Operative
Sepsis," continued Dr. Collier. "Since HealthGrades' first Patient
Safety study in 2004, which identified Failure to Rescue as a major
source of patient safety issues, we were gratified to see the Institute
for Healthcare Improvement advocate for -- and providers begin to adopt
-- protocols for minimizing these events."
Distinguished Hospital Awards and Findings
Based on the study, HealthGrades identified 135
hospitals falling into the top 10% in the nation in terms of patient
safety, qualifying them to receive the HealthGrades Distinguished
Hospital Award for Patient SafetyTM. The award was designed to highlight
hospitals with the best records of patient safety in the nation and to
encourage consumers to research their local hospitals' patient-safety
records before undergoing a procedure.
Methodology
The study is based on 13 of AHRQ's patient safety
indicators, applied to the most recent MedPar file of Medicare
admissions at nearly 5,000 hospitals covering 2001, 2002 and 2003.
Teaching hospitals and non-teaching hospitals were evaluated separately,
based on a recommendation from AHRQ that hospitals be compared to their
peer group. All data was risk adjusted, so that hospitals with sicker
patient populations could be compared equally with others.
The 13 AHRQ indicators are:
-
Death in low mortality Diagnostic Related
Groupings (DRGs)
-
Decubitus ulcer
-
Failure to rescue
-
Foreign body left during procedure
-
Iatrogenic pneumothorax
-
Selected infections due to medical care
-
Post-operative hip fracture
-
Post-operative hemorrhage or hematoma
-
Post-operative physiologic and metabolic
derangements
-
Post-operative respiratory failure
-
Post-operative pulmonary embolism or deep vein
thrombosis
-
Post-operative sepsis
-
Post-operative wound dehiscence
The complete study and methodology can be found at
http://www.healthgrades.com.
View a pdf of the study
here.
About HealthGrades
Health Grades, Inc. (OTCBB: HGRD) evaluates the
quality of hospitals, physicians and nursing homes for millions of
consumers and hundreds of the nation's largest hospitals, health plans,
insurance companies and employers. Through its Web site, HealthGrades
provides its award-winning ratings and profiles of healthcare providers
to more than 2.3 million consumers each month. More information about
the company can be found at
www.healthgrades.com.
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