State Reveals Death Rates at East Bay Hospitals
By Sandy Kleffman
Contra Costa Times
Posted: 01/06/2011 05:00:40 PM PST
Updated: 01/07/2011 08:29:54 AM PST
A new state study designed to empower consumers reveals a significant difference in death rates at East Bay hospitals.
The state compared 2008 and 2009 mortality rates for 12 procedures and conditions -- including heart attacks, pneumonia, strokes, hip fractures and balloon angioplasty -- at 335 hospitals throughout California.
Institutions such as Alta Bates Summit Medical Center in Oakland and John Muir Medical Center in Walnut Creek had strong showings.
Other East Bay hospitals had worse-than-average death rates for at least one condition, including Kaiser Permanente Medical Center in Walnut Creek, Contra Costa Regional Medical Center in Martinez and Highland Hospital in Oakland.
To put all hospitals on a level field, researchers at the Office of Statewide Health Planning and Development adjusted the rates to take into account such risk factors as a patient's age and other health problems.
They then identified which hospitals had death rates significantly better or worse than the state averages.
The report is part of a national movement toward more transparency in health care for patients, insurers and employers.
The findings also can help hospitals identify areas where they need to improve.
Statistics for all facilities can be found by going to www.oshpd.ca.gov and clicking on Hospital Inpatient Mortality Indicators for California, 2008 and 2009.
Most hospitals ranked average in most categories. But the report revealed distinct differences in death rates at some Alameda and Contra Costa county institutions.
Alta Bates Summit Medical Center in Oakland became one of only 17 hospitals statewide that ranked significantly better than average in three categories in 2009.
Its death rate of 4.6 percent for acute heart attacks compared with a statewide average of 7.1 percent.
Its death rate for pneumonia patients was 2.5 percent, compared with the average of 4.6 percent. And its 0.3 percent mortality rate for gastrointestinal hemorrhage was much better than the 2.3 percent state average.
Another top-performer was John Muir Medical Center in Walnut Creek, which excelled in two categories in 2009. It had a 3.6 percent death rate for acute heart attack patients and a 2.4 percent mortality rate for pneumonia patients. In 2008, it also ranked as significantly better-than-average in two categories: congestive heart failure and pneumonia.
Among the hospitals with at least one worse-than-average ranking was Kaiser Walnut Creek. In 2009, its 4.2 percent death rate for balloon angioplasty exceeded the average of 1.9 percent.
In a letter to the state, Kaiser noted that it performs angioplasty only on emergency patients who arrive at the hospital with a severe form of heart attack known as a STEMI.
"The risk of mortality in this select population is recognized as higher than in facilities performing both elective and (emergency angioplasty)," Kaiser wrote.
In 2008, Kaiser ranked as worse-than-average for two conditions: acute stroke, with a death rate of 14.3 percent compared to the average of 10.6 percent, and for hip fractures, with a 4.6 percent mortality rate compared to the 2.7 percent average.
Kaiser has moved to improve its performance and received an average rating for both conditions in 2009, noted Ginger Campbell, a senior vice president for Kaiser Northern California.
Kaiser in 2008 reviewed stroke cases in its Walnut Creek medical center and set the best practices for care, Campbell said. The hospital earned an award for stroke care from the American Heart Association and American Stroke Association in 2010, she said.
The improvement for hip fractures was part of a facility-wide program to improve patient outcomes, she said.
Kaiser supports reporting such statistics, she said, but, she added, "To get the full picture of Kaiser Permanente's quality, it's important to review and balance both inpatient and outpatient ratings, and performance over time."
One of the report's authors agreed that it is not a definitive measure of quality, but said it is one factor for consumers and others to consider.
"We don't believe that by itself, this information should be used to make decisions about where to go for care," said Joseph Parker, manager of the state Healthcare Outcomes Center. "But when combined with other information from reliable sources or family or friends, it can inform decision making."
The findings sent some institutions searching for answers. Highland Hospital ranked worse-than-average for strokes in 2009 with a death rate of 14.6 percent, compared with the 10.4 percent state average.
Highland leaders noted that the hospital's stroke mortality rate had dropped from 13.8 percent in 2006 to 11.3 percent in 2008, placing it in the average category.
"We cannot identify any specific change in practices or doctors to account for the sudden jump this year, and suspect it may be related to random year-to-year fluctuation, although a hidden factor is possible," said Dr. Sang-ick Chang, chief medical officer.
Chang said that Highland leaders suspect the increase may be a result of employees inaccurately classifying cases as strokes or underreporting other medical conditions in data used for the state report. The hospital will soon set guidelines for the treatment of stroke, which should help standardize care, he said.
"We will do everything we can to improve our care of patients with stroke."
The statistics have prompted changes at Contra Costa Regional Medical Center. The hospital received a worse-then-average ranking for acute heart attacks in 2009 with a 30 percent mortality rate, compared with a state average of 7.1 percent.
Because ambulances route most severe heart attack patients to other hospitals that have the capability to do angioplasties and other procedures, Contra Costa Regional Medical Center saw only 19 heart attack patients in 2009. Four of those patients died. Researchers concluded that this represented a 30 percent death rate after they adjusted for such risk factors as a patient's age and other medical problems.
When hospital leaders became aware of the statistics, they partnered with John Muir Medical Center in Concord and set new procedures, said Dr. David Goldstein, chief medical officer for the county-owned hospital.
The Regional Medical Center now quickly assesses and transfers heart attack patients to John Muir in Concord. The result: Transferred patients can have an angioplasty within 90 minutes of arriving at Contra Costa Regional Medical Center, Goldstein said. Twenty such patients have been transferred within the past 15 months.
"Everybody is looking at this data and looking at their bad outcomes and trying to figure out how they can do better," Goldstein said.
Washington Hospital in Fremont continued to show improvement from its 2006 ranking, when it had worse-than-average death rates in four categories.
In 2008, Washington Hospital had a worse-than-average ranking in one category: pneumonia. By 2009, it ranked at least average in all categories, and earned a better-than-average rating for acute strokes, with a death rate of 7.5 percent compared to the statewide average of 10.4 percent.
"We hope that the hospitals will look at this data because for most of them, it's the only opportunity for them to benchmark their performance against all California hospitals," Parker said.
Contact Sandy Kleffman at 925-943-8249.
A new state report reveals hospital mortality rates for 12 procedures and conditions in 2008 and 2009. To put all hospitals on a level field, researchers adjusted for such risk factors as a patient's age and health problems.
Below are East Bay hospitals that ranked significantly better or worse than average in a particular category. Included is the hospital mortality rate, with the state average in parentheses.
The full report with statistics for all hospitals is online at www.oshpd.ca.gov . Click on Hospital Inpatient Mortality Indicators for California, 2008 and 2009.
BETTER-THAN-AVERAGE DEATH RATES
Alameda County - 2009
- Alta Bates Summit in Oakland, acute heart attacks, 4.6 percent (Average: 7.1 percent)
- Alta Bates Summit in Oakland, gastrointestinal hemorrhage, 0.3 percent (Average: 2.3 percent)
- Alta Bates Summit in Oakland, pneumonia, 2.5 percent (Average: 4.6 percent)
- Eden Medical Center in Castro Valley, gastrointestinal hemorrhage, no deaths (Average: 2.3 percent)
- Kaiser Hayward, acute stroke, 7.3 percent (Average: 10.4 percent)
- Kaiser Oakland, acute stroke, 7.1 percent (Average: 10.4 percent)
- San Leandro Hospital, acute stroke, 3.7 percent (Average: 10.4 percent)
- Washington Hospital in Fremont, acute stroke, 7.5 percent (Average: 10.4 percent)
Alameda County - 2008
- Alta Bates Summit in Oakland, pneumonia, 2.8 percent (Average: 4.8 percent)
- Eden Medical Center in Castro Valley, pneumonia, 0.8 percent (Average: 4.8 percent)
Contra Costa County - 2009
- John Muir in Walnut Creek, acute heart attacks, 3.6 percent (Average: 7.1 percent)
- John Muir in Walnut Creek, pneumonia, 2.4 percent (Average: 4.6 percent)
- Sutter Delta in Antioch, congestive heart failure, 1.3 percent (Average: 3.3 percent)
Contra Costa County - 2008
- Doctors Medical Center in San Pablo, acute heart attacks, 4 percent (Average: 7.5 percent)
- John Muir in Walnut Creek, congestive heart failure, 1.3 percent (Average: 3.4 percent)
- John Muir in Walnut Creek, pneumonia, 3 percent (Average: 4.8 percent)
WORSE-THAN-AVERAGE DEATH RATES
Alameda County - 2009
- Highland Hospital in Oakland, acute stroke, 14.8 percent (Average: 10.4 percent)
- Alta Bates Summit in Berkeley, carotid endarterectomy, 12.9 percent (Average: 0.7 percent)
- St. Rose Hospital in Hayward, balloon angioplasty, 3.7 percent (Average: 1.9 percent)
Alameda County - 2008
- Kaiser Oakland, pneumonia, 7.9 percent (Average: 4.8 percent)
- Washington Hospital in Fremont, pneumonia, 7.6 percent (Average: 4.8 percent)
Contra Costa County - 2009
- Contra Costa Regional Medical Center in Martinez, acute heart attacks, 30 percent (Average: 7.1 percent)
- Kaiser Walnut Creek, balloon angioplasty, 4.2 percent (Average: 1.9 percent)
Contra Costa County - 2008
- Kaiser Walnut Creek, acute stroke, 14.3 percent (Average: 10.6 percent)
- Kaiser Walnut Creek, hip fractures, 4.6 percent (Average: 2.7 percent)