Heart Attack Patients Faring Better at California Hospitals
Hospitals in California are doing a better job of keeping heart attack patients alive, according to a state report. The number of heart attack patients who died within a month of being admitted to a California hospital declined from 15.1% in 1991 to 12.1% in 1998, the most recent year for which data is available.
The report is the latest in a series of state-mandated studies on hospital care begun in 1991. Known as the California Hospital Outcomes Project, the studies are intended to encourage hospitals to improve patient care and to make comparative information available.
From 1996 to 1998, about 5,000 of the state’s 40,000 heart attack patients died within 30 days of reaching the hospital. Data for the 1998-to-2000 period should be available before the end of this year, said David Carlisle, director of the state’s Office of Statewide Health Planning and Development.
The report found that 304 hospitals statewide in the study, or 76.4%, had the expected rate of heart attack deaths. The data is “risk-adjusted,” meaning that the authors take into account the fact that some hospitals--academic centers, for example--tend to care for sicker patients than others.
The report’s value, said Carlisle, lies in identifying those hospitals that are outliers. The report found that 32 hospitals, or 8%, did better than expected, with fewer deaths. And 42 hospitals, or 10.6%, did worse than expected, with more deaths than expected.
Even though the latest data are several years old, the reports, when taken together, help track how well hospitals handle heart attacks.
“Some hospitals have been doing well consistently for several years,” Carlisle said. “Some have been doing the opposite.”
Among hospitals with superior performance in the last three reports were several in Los Angeles County: Cedars-Sinai Medical Center, Long Beach Memorial Medical Center, St. John’s Health Center, Temple Community Center and UCLA Medical Center; and one in San Diego County, Kaiser Foundation Hospital.
Louise White, vice president of the Heart Institute at Long Beach Memorial, attributed her hospital’s highly rated heart care to having ER nurses dedicated exclusively to cardiac patients, having cardiologists ready to care for them, and having lab, operating rooms and intensive care units at the same location. In addition, she said, nearly all heart attack patients quickly undergo angioplasty to open blocked vessels.
Hospitals that performed worse than expected in the last three reports include Kern Medical Center in Bakersfield in Kern County; Memorial Hospital of Gardena in Los Angeles County; Chino Valley Medical Center and San Antonio Community Hospital in San Bernardino County; and Scripps Memorial Hospital-East County in El Cajon, San Diego County.
Dr. Royce Johnson, chairman of the department of medicine at Kern Medical Center, described heart attack deaths there as “extremely rare,” saying he’d seen “only a couple in the last couple of years.”
He said the hospital might have scored badly in the reports because of two factors other than the quality of care it provides. Although some heart attack patients may only pass through its emergency room before being sent to other hospitals that can offer specialized cardiac care such as angioplasties, the deaths are still tallied as part of Kern Medical Center’s total. Second, he said, his hospital often is the last stop for very sick nursing-home patients who can’t be resuscitated. Report authors acknowledged that their data did not account for the higher death rate at hospitals that treat more do-not-resuscitate patients than others.
Carlisle said the study has two key messages for consumers: that not all hospitals are the same, with similar technology or surgical proficiency, and that patients with heart disease, or people with risk factors might want to closely examine which hospital their doctors or health plans have relationships with in their geographic area.
