Hospitals in the central San Joaquin Valley had higher death rates than statewide averages for several procedures and conditions, according to a state report released Monday on hospital quality.
Three Valley hospitals received "worse" than average marks for three procedures or conditions. They were among five hospitals statewide to receive three bad marks. Two Valley hospitals rated worse for two categories.
Saint Agnes Medical Center in northeast Fresno and Kaweah Delta Medical Center in Visalia had higher death rates for acute stroke, hip fracture and pneumonia. Sierra View District Hospital in Porterville had higher rates for heart failure, intestinal bleeding and pneumonia.
The only other "three-strike" hospitals in the state were Twin Cities Community Hospital in San Luis Obispo County (heart attack, heart failure and stroke) and Sharp Memorial Hospital in San Diego County (angioplasty, stroke and heart failure). One hospital -- Los Angeles County/University of Southern California Medical Center -- rated worse on five indicators.
Two Fresno hospitals -- Saint Agnes and Community Regional Medical Center -- received "better" than average marks for besting state averages in a couple of procedures. Statewide, 65 hospitals were rated "better" than the statewide rate on at least one category, state officials said.
The report by the California Office of Statewide Health Planning and Development looked at death rates at 331 hospitals in 2011 and compared them to the average statewide death rates for 12 procedures ranging from brain surgery and heart attack to hip surgery and pneumonia.
The worse ratings mean there were significantly more deaths than expected for the procedure or treatment. For example, the statewide average mortality rate for acute stroke was 9.4% in 2011. Saint Agnes' was 13.1% and Kaweah Delta's rate was 17.6%.
Valley hospital officials said they take the ratings seriously, but some questioned whether two-year-old data accurately reflect today's practices.
"Any time there is a critique of patient safety or patient outcomes at Kaweah Delta we will always investigate," said Dr. Mark Garfield, chief medical officer.
Garfield said the state report, however, differs from other ratings the hospital has received, which showed mortality for stroke and pneumonia within expected ranges. "We're trying to figure out why there is this discrepancy," he said.
Saint Agnes officials said the hospital was certified as an Advanced Primary Stroke Center in 2011 by the Joint Commission, which accredits hospitals. The hospital's goal is to fast-track stroke patients in the emergency department and begin lifesaving treatment for eligible patients within one hour.
The hospital also began expediting hip patients to surgery in the past year, Saint Agnes officials said in a written statement. And it is focusing on early management of pneumonia patients.
At Sierra View in Porterville, the hospital has improved access to immunization for pneumonia and has improved patient compliance and control of congestive heart failure by improving follow-up at home after discharge.
The hospital is confident those efforts "will be successful in bringing a noticeable change in these ratings," Dr. Harpreet Sandhu, chief of staff, said in a written statement.
For smaller hospitals, a few cases can skew results, such as Tulare Regional's 16.2% death rate for heart attack, said Carol Furgal, vice president for quality. The hospital treated 30 patients and had six deaths in 2011. Tulare does not do invasive heart procedures, she said. Patients who need heart surgery are sent to other hospitals.
However, the hospital's pneumonia death rate of 12.4% is of concern, Furgal said. All hospitals in the county have had higher-than-average rates, she said.
"That right there tells us we have some unique things happening in our county as to air quality, patient population that make pneumonia a very complicated illness and disease for us to treat."
Tulare will be doing a medical review of cases to see if anything could have been done differently or better, Furgal said. "Because we're not happy with the results."
Off the norm
The categories in which central San Joaquin Valley hospitals have higher-than-average death rates:
- Adventist Medical Center in Hanford, pneumonia, 7.8% (statewide, 4.1%)
- Community Regional Medical Center, stroke, 11.2% (9.4%)
- Kaweah Delta Medical Center, stroke, 17.6%; hip fracture, 6.3% (2.3%); pneumonia, 5.9%
- Madera Community Hospital, stroke, 28%; heart failure, 11.6% (3%)
- Saint Agnes Medical Center, stroke, 13.1%; hip fracture, 4.5%; pneumonia, 6.9%
- Sierra View District Hospital, heart failure, 9.4%; intestinal bleeding, 9.7% (2.2%); pneumonia, 12.8%
- Tulare Regional Medical Center, heart attack, 16.2% (6.5%); pneumonia, 12.6% (4.1%)
The categories in which central San Joaquin Valley hospitals have lower-than-average death rates:
- Saint Agnes Medical Center, craniotomy (a brain surgery), 0% (statewide, 6.8%)
- Community Regional Medical Center, intestinal bleeding, 0.6% (statewide, 2.2%)
Source: Office of Statewide Health Planning and Development, oshpd.ca.gov
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