3 North County hospitals lag in pneumonia report

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3 North County hospitals lag in pneumonia report

Mortality rates are worse than average

San Diego Union Tribune*

By Cheryl

UNION-TRIBUNE STAFF WRITER

July 2, 2008

http://www.signonsandiego.com/news/northcounty/20080702-9999-

1m2pneumo.html

Pneumonia patients admitted to three North County hospitals –

Palomar Medical Center, Pomerado Hospital and Tri-City Medical

Center – had significantly worse chances of survival than patients

at more than 260 other California hospitals, according to a new

state report.

" This is especially important because more than 70,000 patients in

the state are admitted to hospitals with community-acquired

pneumonia each year, " said Joe , director of health care

outcomes for the Office of Statewide Health Planning and

Development. Twelve percent die.

hopes the report, which covers data from 2003 through 2005,

will prompt employers and patients who buy health insurance " to

require hospitals to explain the steps they've taken to assure

they're providing good quality of care. "

Pneumonia is caused by bacterial, viral or fungal infections in the

lungs that result in 2 million to 4 million people being admitted to

hospitals each year in the United States. In an effort to reduce

deaths, Medicare and other health experts want hospitals to adopt

specific measures such as speedy administration of antibiotics, to

cut down on deaths.

But not all hospitals consistently implement such procedures.

and his team reviewed data hospitals submitted about every

admitted pneumonia patient and tracked the outcome of their care for

30 days, even if the patients were discharged to other facilities.

The auditors adjusted for age and other illnesses to account for

patients with a higher chance of death.

The hospital with the lowest mortality rate statewide was St.

Medical Center in Los Angeles, where more than 1 in 20

pneumonia patients died. The facility with the highest statewide was

Pacifica Hospital of the Valley in Los Angeles, where more than 1 in

5 pneumonia patients died.

Palomar and Pomerado were listed as having significantly worse than

average mortality in two prior reports, one covering 1999, 2000 and

2001 and another covering 2002, 2003 and 2004. About nine hospitals

in other counties also performed worse than expected in all three

reports.

Paradise Valley, Sharp Chula Vista and Scripps Encinitas repeated

their better-than-expected mortality rates in the two prior reports.

Advertisement Dawkins, Tri-City's pneumonia expert, criticized

the report, saying it is outdated and does not reflect the fact that

many ill patients request they not be resuscitated in the event of

cardiac or respiratory arrest. Those patients are more likely to die

within 30 days, Dawkins said.

The associate chief medical quality officer at Palomar Pomerado

Health, Dr. Jerry Kolins, said the state report is inaccurate

because doctors failed to note patients' many conditions in their

charts.

When the state calculated that information, the patients were

thought to be healthier, with a lower risk of dying, Kolins said.

" What we learned from this is that other hospitals hire clinical

documentation specialists who check the doctor's charts. Now, PPH

has hired them, too, and when they notice the patient is anemic,

they remind the physician to write that down, " Kolins said.

said Palomar Pomerado officials recognized their

documentation problem long ago after a state report and corrected

it.

" I don't think coding issues could explain these results now if they

fixed that problem, " he said.

Kolins also said his hospitals provide better care because they

excel in adopting performance measures, such as assuring that

patients receive appropriate antibiotics and oxygen quickly.

noted that a separate review by state health officials found

that hospitals with lower mortality rates were quicker at testing

blood and administering antibiotics than hospitals with higher

mortality.

" With pneumonia, morbidity and mortality increase with long wait

times in the emergency room and delays in getting X-rays, " said Dr.

Joe Scherger, San Diego County Medical Society communications

chief. " Things should just happen quickly. "

Dr. LaBelle, medical director of emergency services at Scripps

Encinitas, which had lower-than-average mortality, doesn't think

routine use of quality measures should take all the credit for lower

mortality.

" We think that to a great degree it's choosing the correct

antibiotics, aggressive resuscitation efforts and the care given in

the intensive care unit that's responsible for lower mortality, "

LaBelle said.

The state reports show that California pneumonia mortality has

stayed at about 12 percent since 1999. Asked why these reports

haven't nudged hospitals to adopt practices that lowered mortality,

thinks that probably they have, but the percentage hasn't

changed because patients are much sicker.

For example, he said, there has been an increase in patients

admitted with kidney and liver failure of about 45 percent since the

first report period, 1999 to 2001.

Pneumonia deaths

Mortality rates for patients admitted into the hospital with

pneumonia between 2003 and 2005. The state average was 12.16

percent.

Better than expected:

Paradise Valley in National City – 6.28 percent

Scripps Encinitas – 7.17 percent

Sharp Chula Vista – 7.65 percent

Scripps Memorial in La Jolla – 7.92 percent

UCSD Medical Center in Hillcrest – 8.62 percent

Scripps Chula Vista – 9.07 percent

Worse than expected:

Tri-City Medical Center in Oceanside – 14.88 percent

Palomar Medical Center in Escondido – 16.18 percent

Pomerado Hospital in Poway – 17.15 percent

SOURCE: Office of Statewide Health Planning and Development