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Quality rankings disagree on Oklahoma City hospitals

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Integris Health Edmond [The Oklahoman archives]
Integris Health Edmond [The Oklahoman archives]

Oklahoma City — Say you've got a knee replacement coming up. You're pretty healthy, so you're not expecting any trouble, but you want to pick the hospital that will give you the best care. So, which one is that?

It's a harder question to answer than you might think.

Hospital rankings can produce significantly different results. Three major sources only agreed in rating one of 10 hospitals in the Oklahoma City area — Integris Health Edmond, which all deemed about average.

In most other cases, two rating lists placed a hospital on about the same level, with the third placing it higher or lower. In the case of one, Integris Canadian Valley Hospital, none of the rating lists agreed whether it was better, worse, or roughly equal to the national average.

Part of the confusion is because the three rating systems all have slightly different ways of determining which hospital provides the best care.

Leapfrog Group

The nonprofit Leapfrog Group releases report cards on hospital safety twice annually, grading them from A to F, depending on how they compare to other hospitals across the country. Its most recent report card, released in April, gave three As, one B, three Cs and three Ds to hospitals in the Oklahoma City area.

Leapfrog bases its grade on not only publicly available data about infections and mortality rates, but also how hospitals answer its survey about their practices, like how well staff work together and whether nurses consistently wash their hands.

If hospitals answer truthfully, the extra Leapfrog data is valuable — after all, nurses who wash their hands frequently are less likely to spread infections from one patient to another.

The problem, according to a 2017 study from a University of Michigan research team, is that the survey can't verify if hospitals are reporting their procedures accurately, and that they have an incentive to make themselves look better and attract patients.

Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services ranks hospitals from one to five stars based on data about their patients with public insurance. It gave one Oklahoma City-area hospital a one-star rating, and three hospitals each received two, three or four stars.

CMS' rankings include much of the same information Leapfrog uses about complications and deaths, as well as some extra data about whether patients got timely care. It differs in how it interprets that information, though. Leapfrog tends to draw distinctions between hospitals based on smaller differences in performance, while CMS lumps them together as about the same as the national average.

CMS also factors in whether a hospital overuses imaging tests and whether the federal agency considers the hospital a good value for the money Medicare pays, however — pieces that may not be so important to patients, particularly if they have a different form of insurance.

Consumer Reports

Consumer Reports ranked nine of the 10 Oklahoma City-area hospitals as average, and one as below average. It looked at six categories, including rates of two common infections, readmissions and overall patient experience.

Two of the categories, however, are rates of Caesarean deliveries and performance on heart bypass surgery — measures that only matter if you're pregnant or expect to need heart surgery.

All three rankings also suffer from some of the same limitations. They don't reveal whether some hospitals tend to receive sicker patients, who are more prone to complications, or impoverished patients who can't afford follow-up care after they leave. Because of that weakness, it's difficult to tell how likely you are to have a complication at a certain hospital.

LaWanna Halstead, vice president of quality and clinical initiatives at the Oklahoma Hospital Association, said it's important to use multiple resources when choosing where to receive health care, but there's no substitute for being an engaged patient.

“They should ask questions about the medications and treatments they are receiving,” she said. “They should question the caregiver, including physicians, if they don't see them wash or sanitize their hands when they enter the room. They should write down information and it is always good for a patient to have a family member or friend with them to listen to treatment plans as an additional set of ears and eyes.”

Above average

While no hospital was deemed above average in all rankings, Mercy Hospital came out ahead in two of the three.

Terri-Anne Bone, vice president of performance improvement at Mercy, said one of the most important pieces of improving patient safety is to engage the staff who provide direct care or keep the facility clean.

“The people who make that walk and talk are the front-line staff,” she said.

Improving quality is a long-term project, and it's easier to make changes than maintain them, said Dr. Chad Smith, vice president of medical affairs at Mercy. New staff have to be trained, and even long-term employees need reminders about why routine tasks are important.

Some specific changes that help reduce infection rates include putting a greater emphasis on hand-washing and removing devices like catheters as soon as the patient no longer needs them, to reduce the odds of infection through the device, Bone said.

The hand-washing initiative — which requires staff to clean up before and after putting on gloves, and before and after entering a patient's room — has been going on for eight years, with “secret shoppers” reporting their observations of staff from time to time, she said.

“I don't think we're ever done,” she said.

Below average

Three hospitals scored below average on two of three lists: AllianceHealth Deaconess, AllianceHealth Midwest and University of Oklahoma Medical Center.

AllianceHealth Oklahoma spokeswoman Emily Kezbers said the hospitals “take every opportunity” to improve patient care.

“We have a continuous focus on tracking quality data, process improvement, and collaboration between our employees and the medical staff that supports the delivery of quality care,” she said. “When choosing where to receive medical care, we encourage consumers to consider a variety of factors such as speaking with their physician about their individual care plan.”

Chuck Spicer, chief executive officer of OU Medicine, said the medical center cares for many patients with complex needs and uninsured patients — both groups with higher risks of complications. For example, some local hospitals don't take trauma patients who are in immediate danger of dying, he said.

“We don't get the straightforward patients, and are proud of that, actually,” he said.

Linda Salinas, chief quality officer at OU Medicine, said the campuses in Oklahoma City and Edmond have been transparent about reporting infections and other complications, which allows them to improve care. They have made significant progress, she said — for example, OU Edmond completed 2017 without any urinary tract infections linked to catheter use.

“That's the whole point of patient safety. We want to know if they're there.”

Each unit has identified three or four safety priorities for their patients, such as ventilator-associated pneumonia in the neonatal intensive care unit and falls in the geriatric psychiatry unit, Spicer said. Overall, infection rates have declined about 40 percent over the last year.

“We're not trying to get a better score, we're trying to improve care,” he said. “We monitor (infections) on a daily, hourly basis.”

Leapfrog Group rankings (F to A)

 

Alliance Health Deaconess: D

Alliance Health Midwest: D

Integris Baptist Medical Center: C

Integris Canadian Valley Hospital: B

Integris Health Edmond: C

Integris Southwest Medical Center: C

Mercy Hospital Oklahoma City: A

Norman Regional Health Center: A

OU Medical Center: C

St. Anthony Hospital: A

 

Centers for Medicare and Medicaid Services rankings (one to five stars)

 

Alliance Health Deaconess: 2

Alliance Health Midwest: 2

Integris Baptist Medical Center: 4

Integris Canadian Valley Hospital: 2

Integris Health Edmond: 3

Integris Southwest Medical Center: 4

Mercy Hospital Oklahoma City: 4

Norman Regional Health Center: 3

OU Medical Center: 1

St. Anthony Hospital: 3

 

Consumer Reports rankings (Below to above average)

 

Alliance Health Deaconess: Average

Alliance Health Midwest: Average

Integris Baptist Medical Center: Average

Integris Canadian Valley Hospital: Average

Integris Health Edmond: Average

Integris Southwest Medical Center: Average

Mercy Hospital Oklahoma City: Average

Norman Regional Health Center: Average

OU Medical Center: Below average

St. Anthony Hospital: Average

Meg Wingerter

Meg Wingerter has covered health at The Oklahoman since July 2017. Previously, she lived in Topeka, Kansas, and worked at Kansas News Service and The Topeka Capital-Journal, where she earned awards... Read more ›

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