A first-ever comparison of California hospitals to determine how well they treat heart attack victims and perform back surgeries will name a handful of top performers when it is released today.
Only 14 hospitals of the 395 surveyed statewide were considered to have exceptionally good records in their handling of heart attacks in the landmark report by the Office of Statewide Health Planning and Development. Eight of the hospitals with the top marks for treating heart attacks are in Los Angeles County. Hospitals with the worst records were not identified.
There were more high marks for back surgeries. Twenty-six of the 330 hospitals studied for back surgeries around the state got top marks, five in Los Angeles County.
No hospital got top marks in both categories.
The findings were released without comment on what the numbers said about the quality of health care in California hospitals or how this state's hospitals might stack up against those of other states.
Hospitals not included in the list of best performers--and some who were--reacted with highly vocal criticism of the survey.
Even before release of the report, state health planners circulated findings to individual hospitals. They got enough critical letters to fill almost an entire volume of the three-volume report.
David Langness, a spokesman for the Hospital Council of Southern California, contended that the health planners simply took hospitals at the top of the grading curve and gave them top marks. He called this a disservice to other hospitals because it was based on numerical values.
"This study is almost useless in determining quality," Langness said.
State officials conceded that the survey had shortcomings. One of the biggest potential problems is that the report is the first and has no base line of quality against which to compare the findings. Sponsors of the report said the possibility of statistical error was one of the reasons they did not want to identify hospitals with the worst records.
Qualifying the findings, the authors said in an executive summary: "This report is only a first step. In future years, additional data will become available and our confidence about our ability to measure outcomes will increase."
Sponsors of the report, the first such attempt at compiling a report card on health care providers, hope that it eventually will become a useful tool for consumers in choosing a hospital or health care provider. President Clinton's national health care reform proposal calls for development of similar kinds of report card-type studies.
Assemblyman Burt Margolin (D-Los Angeles), chairman of the Assembly Health Committee, said: "It's not a perfect report. It does not do all we had hoped for, but it is a major breakthrough." Margolin also said much of the criticism was expected. "Hospitals, like any other industry, are going to be resistant to being held up to this kind of scrutiny."
Nevertheless, the survey falls far short of the relatively detailed report card that was anticipated when legislation calling for the study was enacted in 1991.
At the time, the Legislature wanted the Office of Statewide Health Planning and Development to study three medical procedures: heart attacks and back surgeries and deliveries by Cesarean section. But health planners said they could not amass enough data on the obstetric procedure.
The Legislature also wanted hospitals ranked on a scale of five outcomes--average, above average, much higher than average, below average and much lower than average.
The authors of the report, acknowledging heavy pressure from hospitals, decided that for the first year they would simply list the hospitals with exceptional records.
Even so, the hospitals are not happy.
Long Beach Memorial Hospital, which got a top mark for its handling of heart attack patients, was not ranked near the top in its handling of back surgeries.
"We feel that on the basis of the (back surgery) study, it is seriously flawed and not worthy of consideration. We'd like them to review the way they conducted the survey," said Ron Yukelson, a spokesman for the hospital.
Dorel Harms of the California Assn. of Hospitals and Health Systems said she did not believe the survey would provide useful data to consumers. "There were so many problems with this data that we don't think anyone could make a decision on which hospital to go to based on this data at this time," she said.
The survey was based on official hospital records sent to Sacramento. But hospitals complained that each hospital reported data differently.
State and hospital officials concede that some hospitals apparently got bad marks because over the years they had consistently reported higher than usual complication rates from surgeries in order to receive higher reimbursements under the state Medi-Cal and federal Medicare programs. Reimbursements under the programs go up with each complication.
A study by the California Office of Statewide Planning and Development has rated the best area hospitals on their track records in treating heart attack victims and performing spinal disk surgeries. The top performers are:
HEART SPINAL DISK ATTACK SURGERIES LOS ANGELES COUNTY Cervical* Lumbar** Cedars-Sinai + Cigna Hospital of L.A. + Holy Cross + Kaiser, Panorama City + Kaiser, Bellflower + Rancho Los Amigos + Long Beach Memorial + Medical Center of Tarzana + Northridge Hospital + Pomona Valley Hospital + + Saint John's Hospital + St. Vincent + UCLA Medical Center + ORANGE COUNTY Chapman General Hospital + Pacifica Community + St. Joseph, Orange + VENTURA COUNTY Community Memorial +
* Surgeries in neck area (upper spine) ** Lumbar refers to lower back
NOTE: The ratings on heart attack victims were developed over a 10-month period in 1990 and 1991. The evaluations on back surgeries were based on hospital experiences from 1988 through 1990.