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COVER STORY : Experts advise looking at data, asking questions and getting opinions from friends and physicians.

March 26, 1993|BARBARA BRONSON GRAY | SPECIAL TO THE TIMES; Barbara Bronson Gray is a regular contributor to Valley Life

When Laura Callaway was pregnant and trying to pick the hospital where she would deliver her baby last July, she didn't look for hospital statistics or for well-advertised amenities like champagne dinners or video machines in the labor rooms. She talked to her friends.

"It's funny; there's just sort of an underground grapevine. I had heard such good things about the hospital, I didn't do much research," says the 37-year-old feature film coordinator for Fox Studios.

But Callaway admits that beyond reputation alone, she was swayed by the fact that St. Joseph Medical Center in Burbank had a neonatal intensive care unit--"just in case something went wrong," she says--and a parent education program that included a range of classes on childbirth preparation, infant CPR and "You and Me" classes for parents and their newborns. As it turns out, she didn't need the neonatal unit, but she did take advantage of the parenting classes.

Physicians, nurses and hospital administrators say that while there are a range of factors worth knowing before choosing a particular hospital for any type of medical procedure, the best way to make a decision is to talk to as many people as possible. In the San Fernando Valley, there are a dizzying array of choices, with more than two dozen to choose from.

For the Record
Los Angeles Times Friday April 2, 1993 Valley Edition Valley Life Page 19 Zones Desk 1 inches; 31 words Type of Material: Correction
Wrong Name: The name of the chief of cardiovascular surgery at Encino Hospital was misspelled in a story about hospitals and their specialties in the March 26 issue of Valley Life. The surgeon's name is Dr. Mohammad Gharavi.

Hard data--such as the hospital mortality statistics that are reported to the Health Care Financing Administration by hospitals to qualify for Medicare payment for services--is good to know, they say, but is affected by a wide range of variables, making the information hard to interpret.

For some procedures, experts say the number of cases a hospital handles every year seems highly correlated to success. But for others, the skill and experience of the particular physicians and nurses involved in the case can be the most crucial factor.

Unless consumers know what questions to ask and where to seek the data, the statistics can be hard to come by. What's easier for patients to find, however, are the hospitals' marketing tools--ads that highlight the glitz but sometimes gloss over the realities of hospital programs and capabilities. No firms specialize in matching patients to hospitals--yet.

But health-care providers recognize that consumers should do some shopping and fact-hunting before they decide on a particular facility. "There's a change in the way medicine is practiced now compared to when I was a child," says Dr. Avrum Bluming, a professor of medicine at USC and chief of staff at Tarzana Regional Medical Center. "There was a deification of medicine then, but people now are partners in their health care.

"Of all the members of the health-care team, the patient, after all, has the greatest investment in the outcome. And the way you empower patients is with information," he says.

Yet Bluming, a medical oncologist, concedes that much of the data is confusing at best. The hospital mortality statistics can make hospitals that tackle the more complicated cases look less successful than others, or can make an institution that carefully chooses only the lowest-risk patients look good. "It's next to impossible to get an absolutely clean answer from the data," he says.

Dr. Gerald Green, also a professor of medicine at USC and a gastroenterologist, agrees. "To some degree we can use the statistics--but one has to understand that the published data is a very mixed bag of information. The ultimate method will require doing your own research, talking to others who have been to the hospital, and visiting the unit and evaluating the ambience," he says.

Dr. Rich Johnson, associate chief of the Division of Family Medicine at UCLA Medical Center, also downplays the value of all but the most exceptional data. "The information is helpful on the extreme end," he says, suggesting that patients avoid hospitals with the highest mortality rates and look closely at the ones with the best data.

As for ambience, Johnson says it's mostly irrelevant. "Too many people make their decisions based on a hotel mentality because they don't appreciate that hospitals are bad places to be in," Johnson says. People should really be more concerned by the 2% to 5% chance that something unexpected could happen, he says, and should pick their facility with an eye to how the hospital can handle emergencies.

"Whether you have a VCR or get a bedpan quickly isn't as important as whether you survive congestive heart failure," Johnson says. Ten years ago, he explains, hospitals were beefing up their guest-relations efforts, trying to emulate the ambience of fine hotels. That carpeted-hall feeling is history, he says, as the hospitals now are filled with technology--cardiac monitors, respirators--in virtually every unit.

Johnson likes teaching hospitals. "They are very overstaffed, and while they are less user-friendly, they are better equipped to deal with the unexpected problems," he explains. There are more people with advanced levels of preparation and training around in the off-hours, he says.

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