Low safety ratings worry area hospitals

Report's information gathering questioned

7/13/2012

Directly next to the University of Toledo Medical Center's main entrance is a large banner proudly announcing the hospital's ranking as number one in the region, according to a U.S. News and World Report from July, 2011.

It's a safe bet there won't be a banner proclaiming the hospital's safety rating in the August, 2012, issue of Consumer Reports: out of 107 ranked Ohio hospitals, UT Medical Center, the former Medical College of Ohio, was last with a score of 28 out of 100.

UT Medical Center wasn't the only well-known hospital to perform poorly -- Cleveland Clinic, one of the most highly regarded institutions in the country, earned a score of 39 out of 100. More than half of the study's rated hospitals -- a total of 1,159 in the United States -- received a score below 50.

CONSUMER REPORTS ARTICLE: How Safe Is Your Hospital?

Officials at UT Medical Center chalk the poor ranking up to what they said are flaws in Consumer Reports' data gathering.

"My guess is that they are rushing into [this field of ranking hospitals] to jump on a bandwagon," said Dr. Lloyd Jacobs, the president of the University of Toledo. "We take this really seriously, but at the same time my impression is that they did a sloppy job of dealing with the data."

While Consumer Reports has been rating hospitals on individual criteria, such as hospital-contracted infections and patient satisfaction since 2008, this is the first year that the magazine, published by the nonprofit Consumers' Union, has come up with composite safety scores for hospitals, said Tildy La Farge, communications counsel at Consumer Reports.

Six categories are included in the composite safety score: surgical-site infections, re-admission rates, overuse of scanning, communication about new medications and discharge, complications, and mortality.

The ratings use a one to five scale that is denoted by Consumer Reports' characteristic colored dots, known as blobs.

Although the report is intended as a means for patients to compare various institutions, officials at UT Medical Center said that the small number of hospitals represented in the rankings make such comparisons difficult -- 80 percent of hospitals in the United States could not be ranked because of a lack of available information. The data upon which rankings were based came from the Centers for Medicare and Medicaid Services, information reported to states from hospitals, and the Leapfrog Group, which provides its own hospital safety scores.

"Unlike what Consumer Reports does for washing machines and automobiles and other things, they have, to use their word, 'scraped' the data from other publicly reported sources," said Dr. Jeffrey Gold, the chancellor, executive vice president for biosciences and health affairs, and dean of the college of medicine and life sciences at the UT Medical Center. "Part of it is self-reported and most of it is not risk-adjusted to the severity of illness … it represents a very limited survey."

Among its concerns with the accuracy of measurements used for the rankings, UT Medical Center cited small sample sizes, which Dr. Gold said denoted trends rather than significant conclusions. He also took issue with the study's re-admission rates, which he said included patients who come back to the hospital for staged procedures, which are common in orthopedics, cancer care, and those suffering from coronary artery disease. "If you don't correct for that, it gets characterized as a hospital re-admission," he said.

Dr. Gold also argued that the report doesn't account for varying levels of complexity in care -- 50 percent or more of the patients seen at UT Medical Center are referred or transferred from other hospitals that "don't want to care for those higher-risk patients."

"The long and short of it is, I don't care what risk-adjusted mortality is compared to a community primary access hospital," he said. "I want to know how we're doing compared to hospitals that provide services of the same complexity we provide."

John Palmer, a spokesman for the Ohio Hospital Association, said that when considering hospital care, patients should be careful not to place too much stake in one ranking system. He pointed to the importance of looking over a variety of available sources instead of relying on one.

Mr. Palmer's view was seconded by those hospitals that ranked more highly in the Consumer Reports study, who said their work in improving patient safety is far from done.

"It's just a very small piece of the pie," said Charla Ulrich, the director of quality at Mercy St. Vincent Medical Center, which was the third highest ranked hospital in Lucas County with a score of 58 out of 100. "[The ranking] should not be taken out of context and looked at as individual decision-maker related to care."

Administrators at ProMedica Hospitals in Lucas County -- Flower, which received a score of 65, and Toledo Hospital, which received a score of 64 -- also found that as a whole, the state of Ohio has a ways to go in improving patient safety.

"None of the hospitals in the state did wonderful," said Kevin Webb, the president of Toledo Hospital. "Until we get to zero patient safety problems we're not where we need to be."

Consumer Reports, which expressed confidence in its first attempt at a composite hospital safety score, acknowledged there are still advances to be made. "We think this is a good start," said Dr. John Santa, the director of the health rating center at Consumer Reports. "There are other things we're hoping to include in our safety analysis, so we think we're going to be able to improve this."

For his part, Dr. Gold doesn't believe that applications to the medical school will decline and remains hopeful that patients won't view the hospital differently as the result of one ranking.

"If this does defer students to other institutions, if this does defer patients to less safe institutions, if this does have a negative impact on this community, it would be the greatest tragedy of all," he said.

Contact Madeline Buxton at: mbuxton@theblade.com or 419-724-6368.