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HEALTH CARE: A CONSUMER GUIDE

Not Every Hospital Is Created Equal

Patients: With research suggesting that a facility's level of experience impacts patient survival rates, it pays to investigate the options.

September 25, 2000|LINDA MARSA | TIMES HEALTH WRITER

Paul Maurice momentarily lost consciousness while biking on a trail early one morning near his home in Whittier. Paramedics rushed him to the closest hospital, a small community facility that didn't have a trauma unit. He seemed dazed and confused to his wife, Phyllis, who arrived shortly after he was admitted. There was no MRI at the hospital, so doctors didn't perform a brain scan to see what had triggered the blackout.

That evening, Maurice, 60, suffered a massive cerebral hemorrhage, and three days later he was dead. "Other doctors have since told me that Paul should have been given an MRI," insists his widow, Phyllis. "If he had been taken to a hospital that was better equipped to deal with emergencies, he would still be alive today."

Can a hospital make such a difference? You bet, say experts. In fact, the American College of Surgeons strongly urges dispatching trauma victims like Maurice to regional trauma centers--typically major hospitals such as Cedars-Sinai Medical Center in Los Angeles or Huntington Memorial Hospital in Pasadena--that have the high-tech tools and expertise to handle critical injuries. And it's not only accident cases in which the experience of the hospital can make the difference between life and death.

Busier Hospitals Have Lower Mortality Rates

Studies show that mortality rates are as much as 64% lower at busier hospitals for a number of complicated procedures, ranging from heart and other organ transplants, coronary bypass surgery, pancreatic and esophageal cancer surgery, and angioplasty to the management of chronic conditions like asthma, diabetes and HIV-AIDS. Patients fare better overall, too, and have fewer complications, bleeding problems and infections.

Yet few consumers, while deciding which health plan or doctor to choose for medical coverage, consider the track record of the hospitals where, if necessary, their doctors would send them. When patients select a primary care doctor, they often fail to notice that the medical group to which the doctor belongs is affiliated with one or two particular hospitals. At Kaiser Permanente, the nation's biggest HMO, members generally are required to receive treatment only at Kaiser hospitals.

But this oversight can have serious consequences, particularly for those with chronic conditions, like heart disease, or a family history of ills such as breast or colon cancer.

"Surgeons are viewed as the captain of the ship, and patients are always concerned about their doctor's credentials," says Dr. John D. Birkmeyer, a surgeon at Dartmouth College in Hanover, N.H., and a senior research associate with the U.S. Department of Veterans Affairs. "But the fact is that where your surgery is done or your disease is treated is even more crucial."

During the last 25 years, in fact, more than 100 studies have shown that patients do better at hospitals where procedures are performed more frequently. This intuitively makes sense, but it's not just that practice makes perfect.

"Hospital volumes are a proxy for other things," says Dr. Arnold Milstein, medical director of the Pacific Business Group on Health, an employers' coalition in San Francisco. Busier hospitals normally have a better overall package: more sophisticated intensive care units staffed by seasoned doctors and nurses who know how to cope with emergencies, well-stocked blood banks that can support a major bleed if a patient starts to hemorrhage, state-of-the-art equipment like MRIs, and standardized systems for dealing with unstable and critically ill patients.

The numbers tell the story. A 1999 study published in the Journal of the American Medical Assn. identified 11 risky medical procedures and conditions where the experience of a hospital is critical. The researchers found that patients undergoing repairs of weak spots or tears in their aorta artery had a 64% higher death rate than those operated on at hospitals with sufficient experience. Similarly, heart transplant patients were twice as likely to die at centers doing eight or fewer transplants annually, as compared with hospitals where the procedures were done more frequently. And children undergoing heart surgery at hospitals performing fewer than 100 of these procedures each year were 42% more likely to die.

The researchers came to a disturbing conclusion: Of the 120,000 California patients studied, more than 600 people died simply because they had been treated at hospitals with limited experience. That translates to more than 4,000 avoidable deaths a year in the United States--a figure about equal to the number of passengers on a dozen jumbo jets.

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