HealthGrades: Death rate drops, but gap widens between best and worst hospitals

Patients treated at the top-rated hospitals had a 72 percent lower risk of dying when compared with patients at the lowest-rated hospitals—an enormous gap that has held steady over the past years even as overall mortality rates have improved, according to a HealthGrades study, released Oct. 20, on patient outcomes at U.S. hospitals.

Hospital mortality rates, on average, declined by nearly 8 percent during the three-year period studied, from 2007 to 2009. Of the 17 mortality-based diagnoses and procedures analyzed, only two showed increasing mortality rates—gastrointestinal surgeries and coronary intervention procedures, the study showed.

HealthGrades rated individual hospitals with a one-star, three-star or five-star rating in each of 26 procedures and diagnoses ranging from bypass surgery to total knee replacement. A one-star rating means a hospital performed below average to a statistically significant degree when compared with the other 5,000 hospitals. A three-star rating means the hospital’s performance was average, and a five-star rating means the hospital outperformed the national average to a statistically significant degree.

Five-star-rated hospitals had significantly lower risk-adjusted mortality across the three years studied, according to HealthGrades. A typical patient would have a 72.47 percent lower risk of dying in a five-star-rated hospital compared with a one-star-rated hospital, and a 53.36 percent lower risk of dying by going to five-star-rated hospital compared with the U.S. hospital average.

“We are encouraged by the steady improvement in mortality rates among America’s hospitals, but there’s an unacceptably wide gap that has persisted between the top-performing hospitals and all others in terms of patient outcomes,” said study author Rick May, MD, vice president with HealthGrades, an independent healthcare ratings organization.

“For hospital leaders as well as potential patients, it is essential that they understand – and act upon – these findings.”

The study also showed:

• U.S. hospitals’ unadjusted mortality improved on average 7.98 percent from 2007 through 2009 across the 17 diagnoses and procedures studied.
• Gastrointestinal surgeries and procedures and coronary interventional procedures were associated with an increase in unadjusted mortality of 8.76 percent and 9.26 percent, respectively.
• The highest unadjusted mortality rates are among sepsis, respiratory failure and gastrointestinal surgeries and procedures (20.59 percent, 19.45 percent and 10.29 percent, respectively).
• The greatest improvement in unadjusted mortality was seen in chronic obstructive pulmonary disease (18.73 percent), bowel obstruction (14.72 percent), heart attack (13.68 percent) and stroke (13.50 percent).
• If all hospitals performed at the level of a five-star rated hospital, 232,442 Medicare lives could potentially have been saved from 2007 through 2009.
• Approximately 55.91 percent (129,949) of the potentially preventable deaths were associated with just four diagnoses: sepsis (48,809); pneumonia (29,017); respiratory failure (26,361); and heart failure (25,762).
• On average, one in nine patients developed a hospital-acquired condition, across the nine procedures evaluated for inhospital complications, from 2007 to 2009.

The 13th Annual HealthGrades Hospital Quality in America study analyzed objective mortality and complication rates at all 5,000 U.S. nonfederal hospitals using 40 million hospitalization records obtained from the Centers for Medicare & Medicaid Services. Mortality and complication rates are risk-adjusted, taking into account differing levels of severity of patient illness at different hospitals.

The annual study identifies national and state-level trends in hospital care quality and establishes quality ratings for each hospital. More information is available at www.healthgrades.com.