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New Methodology Means Lowers Grades for NJ Hospitals on National Survey

Garden State facilities drop from fifth to 22nd place nationally; experts warn against directly comparing results of 2016 Leapfrog report with earlier rankings

New Jersey hospitals dropped from fifth to 22nd place in a nationwide study that judges quality at these facilities. Nearly a third of the Garden State’s acute-care facilities also got lower grades than in the past, according to the Spring 2016 survey from the Leapfrog Group, a nonprofit healthcare watchdog that issues a semiannual report on the prevalence of medical errors, accidents, infections, and other quality-of-care measures in more than 2,500 hospitals nationwide.

Experts said revisions to the survey methodology account for many of the changes in the latest Hospital Safety Scores, which Leapfrog has published twice a year since 2012.

“It’s not necessarily that New Jersey hospitals got worse,” explained Erica Mobley, Leapfrog’s director of communications. “Perhaps other hospitals [in other states] saw more accelerated improvement.”

Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, agreed it is not fair to compare the state’s latest ranking against last year’s results. “Those are factually accurate, but you can’t necessarily say we dropped,” Schwimmer explained. “It’s just with a new methodology we stack up differently.”

Leapfrog reviewed data from 2,571 hospitals nationwide -- including 67 in New Jersey -- on 30 measures, half based on facility processes and half on patient outcome. It assigned points for each metric, which were used to calculate letter grades A through F. Nationwide, nearly one-third of hospitals scored an A; one-quarter earned a B; and more than one-third received a C grade. Only six percent of hospitals got a D and one percent scored an F.

The report card takes into account procedures that can help improve patient outcomes, like a hospital’s tendency to use antibiotics before and after surgery, the existence of a computerized system for tracking medications, and staff members’ tendency to wash their hands. It also considers medical errors, like surgical objects left inside a patient during a procedure, and the number of patients who end up with a catheter or intravenous infection after visiting the hospital.

The Spring 2016 survey is the first to take into account patient experience, factoring in responses from five standard consumer-assessment questions, Leapfrog officials explained. They also included statistics on two common and deadly infections, MRSA and C.diff, and removed references to five surgical safety protocols that are now fairly common.

Mobley explained that the changes reflect recommendations from the group’s blue-ribbon advisory panel, which meets every six months to review the survey before the next round. “New research shows these specific measures that we use [to assess patient experience] have a strong tie to patient safety,” she said, adding, “Everything is very scientifically oriented.”

Kerry McKean Kelly, with the New Jersey Hospital Association, said facilities take report cards like Leapfrog’s seriously and are more focused on patient safety than in the past. But patients in different parts of the country respond differently to care, she said. “New Jerseyans demand excellence, and we wouldn’t have it any other way! But there’s actually research that shows that folks in the northeastern states are among the toughest critics in these surveys, and it’s possible that is showing up here in the Leapfrog scores as well,” she said.

In New Jersey, 23 hospitals scored an A -- nine fewer than the last time; 16 facilities earned a B -- one more than last fall; and 26 got C’s --an increase of six facilities. One hospital -- Meadowlands Hospital Medical Center -- received a D; another one -- Saint Michael’s Medical Center, in Newark -- got an F. No Ds or Fs were assigned last time.

Saint Michael’s, which has struggled in recent years financially and was just purchased by a for-profit national operator, Prime Healthcare Services, received a C last fall and a string of Ds in previous reports. Meadowlands also received a C last fall, but scored Bs and even As in past years.

“These are hospitals that are facing some very serious challenges when it comes to patient safety. It is not to say that a patient shouldn’t go there,” Mobley said, “but they should be extra vigilant.”

David Ricci, president and CEO of Saint Michael's Medical Center, said the F grade is “not at all an indication of the high quality of care that is provided” at the hospital, but instead reflects the fact that Leapfrog did not have a full picture of the operation. In recent years, as Saint Michael’s awaited a sale, it did not have the resources to voluntarily participate in the survey, he said.

“Physicians, nurses, and staff at Saint Michael’s are focused on continually improving patient safety and the quality of care. Quality is not one department; it’s everyone’s responsibility,” Ricci said. Efforts are already underway to improve outcomes at the Newark hospital, he said, adding that the new ownership “is fully committed to participating in the Leapfrog survey in the future and having Saint Michael's scores truly reflect the quality of healthcare that we provide to our patients.”

Officials with Meadowlands did not respond to requests for comment on Monday.

Several hospitals have fared well over the years of testing. Englewood Hospital and Medical Center, Hackensack University Medical Center, Jersey City Medical Center, Our Lady of Lourdes Medical Center, in Camden, Saint Barnabas Medical Center, in Livingston, and Saint Clare’s Hospital in Denville all received straight A grades in the seven report cards issued since Spring 2013.

While there is not one path to good grades, Mobley said hospitals that tend to do well invest significant time and energy in reviewing the Leapfrog results and working consistently to improve their standings. “We see that those who do get As over time there is a strong culture of patient safety that starts with the executive leadership and permeates all the way down,” she said.

McKean Kelly, with NJHA, said that various groups create report cards to assess hospital quality, but they measure facilities in different ways and come to different conclusions. “We encourage consumers to gather all sorts of hospital information -- from data reports, from recommendations from healthcare professionals, from hospital websites, and even through word of mouth.”

While many hospitals provide data to Leapfrog willingly, others -- including Saint Michaels -- do not and are graded instead on information available from public sources, Schwimmer explained. The handful of hospitals not included are either too specialized to compare (like Children’s Specialized Hospitals) or don’t have enough public data on file (like East Orange General Hospital), she said.

“We’ve come a long way in terms of hospital leaders embracing transparency and embracing this type of process,” Schwimmer said, but there are still gaps in the process. With East Orange, for example, “That’s a transparency issue -- we don’t have enough information to tell people how they are doing. And that’s a concern.”

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