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2011 Hospital Performance Report Pinpoints Strengths, Shortcomings

Data reveals how NJ hospitals compare with peers, measure up against national standards.

The state health department on Monday posted to its website the eighth annual Hospital Performance Report, which lets consumers assess the quality of care for every hospital in New Jersey -- a boon when trying to choose a facility or make other healthcare decisions.

The report also makes it possible for New Jersey hospitals to see how they stack up against their peers, determining where they lead and where they lag in relation to dozens of quality indicators -- from how consistently a hospital gave the right care for pneumonia and heart failure to the frequency of hospital-acquired infections.

Further, the report delivers the data needed to put New Jersey hospitals in a national perspective, and there's good news on this front. Mary E. O’Dowd, commissioner of Health and Human Services, cited a national study ranking New Jersey ninth in the U.S. for overall healthcare quality, up from 41st in 2000.

But O'Dowd also noted that "there are still some indicators where New Jersey hospital performance was below the national average, and we encourage those hospitals to examine and improve their delivery of care, which will ultimately lead to better outcomes for all of New Jersey’s patients.”

One major goal: reduce hospital-acquired infections. The state, according to O'Dowd, is working with the New Jersey Hospital Association to drive down rates for hospital errors and complications in general.

This is just the second year that hospitals reported their rates of central line infections, which are associated with IV sites. O'Dowd indicated that New Jersey fares better than the national average for this quality indicator. When it comes to surgical site infections, reported for the first time this year, the state is in line with the rest of the country for coronary artery bypass, abdominal hysterectomies, and catheter-associated urinary tract infections, Dowd said.

“This is reassuring for New Jerseyans but we cannot become complacent,” she said. “[We should] continue to work to drive infection rates down and get as close to zero as possible.”

New Jersey outperformed the national average on seven out of 10 safety measures. It lagged for postoperative hemorrhage, postoperative sepsis, and newborn birth trauma.

“This clearly says that more work needs to be done, and the department will continue to work with the hospital industry toward an ultimate goal of eliminating all hospital errors,” O'Dowd stated.

O’Dowd said that since reporting began in 2003, New Jersey has made significant long-term progress on 25 indicators that reveal how often hospitals deliver the recommended treatment to their patients. New Jersey outperformed the national averages on 15 of 25; tied for eight, and fell behind in two areas.

O’Dowd said New Jersey continues to fall below the national average when it comes to performing angioplasty within 90 minutes of a heart attack, and controlling patient's blood sugar after cardiac surgery.

But New Jersey has been making steady progress: The national score for angioplasty in 2010 was 91, while New Jersey was at 89. The state has steadily improved its score since 2006, when it was 55. And on controlling blood sugar after cardiac surgery, New Jersey scored 93, just one point below the national average of 94.

Given the wealth of data the report provides, an individual hospital may outperform its peers on one indicator and lag on another.

Dr. Fred Jacobs, former state health commissioner and co-chair of the health department’s Quality Improvement Advisory Committee, said “the reason you do all of these measurements is because you create in the hospital an environment for quality. That might be missed if you focus generically on cardiac surgery or surgical site infections. All of this put together means the hospital as an institution is geared towards quality in everything it does."

Hospitals tend to cluster at or near the top for a number of benchmarks. When it comes to providing recommended treatment for heart attacks, for example, the top 10 percent scored 100 percent, while the top 50 percent of hospitals scored 99 percent.

"You can create a very good environment and maybe you do one thing correctly 97 percent of the time -- but if it takes 99 percent of the time to be in the top half, because everyone is doing it just a little better . . . you could be even better,” Jacobs said.

He said the New Jersey Hospital Association, in collaboration with the state health department, has created an environment “for everyone to get in it together and improve together. That is one thing the report really helps.”

Dr. Peter Gross, co-chair of the state’s quality committee and co-chair of Hackensack University Medical Center, said “Looking back over the years the improvement in New Jersey has really been remarkable and this did not just happen by chance. The health department made a major effort in the beginning to educate all hospitals, and by setting up this report encouraged competition among hospitals to get better and it obviously has worked.”

“New Jersey is ahead of most of the country in terms of providing a lot of information publicly, and that’s a very good thing,” said David Knowlton, president of the New Jersey Health Care Quality Institute.

He noted that the report is strongest on patient safety indicators and hospital-acquired infections. The patient safety data allows consumers to compare hospitals on the frequency of adverse events and complications, and also provides aggregate data for the entire hospital sector. For example, in 2010, there were 1,461 cases in which a patient suffered a postoperative pulmonary embolism, or deep vein thrombosis.

“That is a serious condition that kills people, and it is something we have to improve,” Knowlton said. New Jersey ranks better than the national average for this complication, “but this is something that everyone has to work on.” He also noted that the report provides data on the rate at which particular complications occurred at each hospital. “They tell you the actual rate, so you can see what is the likelihood that this will happen to me if I go to a particular hospital.”

The infection data is extremely valuable, because it adjusts for the severity of the patient population the hospital is treating, Knowlton explained. The report gives the number of observed cases of each of the types of infection, and the number that was expected for that hospital.

“When you look at observed vs. expected, you are correcting for severity,” Knowlton said.

“Often hospitals will say they have more adverse events because their patients are sicker. This data set corrects for that. But I think we need data that consumers can use," Knowlton continued, "This is not terribly consumer friendly. We need something that consumers can get their hands around.”

“Infections are a high priority, and the new idea is to try to drive these hospital-acquired infections down to zero, and everyone is in some point on that journey,” said Dr. Charles Riccobono, chief quality and patient safety officer at Hackensack University Medical Center. The report presents 2010 data, and “we have a lot of internal data over the past year to show a significant amount of improvement in what we are doing," he said. "We have units that have spent months and months without an infection. That is where we are headed.”

Dr. Ihor Sawczuk, chief medical officer of Hackensack, said “These exercises are good for the patients, and they are good for the institution. It brings to the forefront the issues that we strive to address every day. The data is the data: if you find something that is not going well it’s brought to your attention and you work to correct it. So overall for the healthcare consumers it’s good to have the data out there.”

Robert Wood Johnson University Hospital spokesman Peter Haigney said “Zero adverse events is the only goal at Robert Wood Johnson, and since 2010 when this data was gathered, we have further strengthened our processes based on best practices from other leading medical centers across the country.”

Robert Forman, spokesman for University Hospital in Newark, said “As a state, New Jersey is especially strong in pneumonia care. Every hospital in New Jersey, including University Hospital, is in the top 10 percent nationwide, and we are very pleased to be in that group, especially since we serve a patient population that often lacks basic primary care.”

Virtua Chief Medical Officer Dr. James Dwyer said, “Virtua welcomes these reports as a method to compare our performance with other hospitals in the state. Virtua is focused on quality and improvement, which is why we participate in the New Jersey Hospital Association’s Hospital Engagement Network which targets improving patient safety and patient care in hospitals. We support transparency of data to help educate the public and drive overall healthcare improvement.”

Most of the 2011 report is based on data from 2010, and some is from 2009; this is the most recent information available, O’Dowd said.

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