Hospitals in New Jersey continue to report lower infection rates, fewer errors and accidents, and improved methods to keep patients safe and appropriately informed, according to the latest report from a national watchdog organization. But the state still hasn’t regained its original standing in the biannual Hospital Safety Grade issued by the Leapfrog Group.
More than one-third of the Garden State facilities that shared data with Leapfrog received “A’s” on the Fall 2016 report, a slight increase over the spring scores. This change helped lift New Jersey from 22nd nationwide to 17th, tied with Texas, for the percentage of hospitals with top grades. (These standings reflect care both in New Jersey and the impact of changes in other states, Leapfrog notes.)
While Leapfrog’s methodology has evolved — and sparked some controversy in the process — certain healthcare facilities have scored well since 2013, the year after the nonprofit patient advocate launched the review. Jersey City Medical Center and Saint Barnabas Medical Center, both now run by RWJ/Barnabas, and Englewood Hospital and Medical Center have received straight A’s all along.
Other facilities have struggled to elevate their scores. Saint Michael’s Medical Center, owned by the for-profit chain Prime Healthcare, Meadowlands Hospital Medical Center, another for-profit operation, and University Hospital, a state-owned facility affiliated with Rutgers, have received Cs, Ds, and even an F in recent years.
Leapfrog examined data from 68 acute-care hospitals across the state and assigned letter grades A through D and F, as part of its review of more than 2,600 facilities nationwide. The organization considers dozens of factors in its assessment, including the rates of common infections like MRSA and C. diff; surgical problems like blood clots or open wounds; preventative protocols like hand-washing and tracking medications; safety issues like patient falls or bed sores; and staffing issues, including patient ratios, specialty training, and communication.
Leapfrog President and CEO Leah Binder said the data can help patients make informed choices and assist advocates seeking to improve the larger healthcare system. “We believe everyone has the right to know which hospitals are the safest and encourage community members to call on their local hospitals to change, and on their elected officials to spur them to action,” she said. “States that put a priority on safety have shown remarkable improvements.”
Observers note that direct comparisons to years past are difficult, as Leapfrog adjusted its methodology in 2016 to include input from patients, provided through standard consumer-assessment surveys, and factor in key infection rates. Those changes helped account for the decline in New Jersey’s overall standing; in the past, it had amassed enough A grades to rank fifth nationwide.
“It’s gone up a little bit since last time, but it’s still not as great as where we where when we started,” said Amanda Mellilo, chief of staff at the New Jersey Health Care Quality Institute, who leads the organization’s work on Leapfrog. “New Jersey was usually in the top ten.”
Linda Schwimmer, the Quality Institute’s president and CEO, suggested this trend of “creeping upwards” would continue. “I’m just speculating, but I think that this shows that as our hospitals become more familiar with the new methodology they are becoming more focused on it and more focused on doing well at it,” she said.
Overall, nearly 37 percent of New Jersey’s hospitals received A grades, compared to 32 percent nationwide. Just over 22 percent scored a B this time, versus 25 percent in the United States as a whole. The nearly 37 percent that received a C tracks closely with the nationwide numbers and the Garden State received fewer D’s — 4.4 percent versus 6 percent — and no F’s this fall, compared to .8 percent nationwide.
[related]While the scores are welcomed by healthcare advocates like NJHCQI, and praised by hospitals that do well, the process has sparked some criticism from facilities that said it does not reflect their efforts or outcomes. Others note that Leapfrog’s findings don’t necessarily align with the results of other surveys, like the Hospital Quality Star Rating system developed by the Centers for Medicare and Medicaid Services, which critics said penalizes teaching hospitals and safety-net facilities.
“The Leapfrog letter grades are based on data that is one year outdated and are based on a methodology that is controversial,” said Stacie Newton, who heads public affairs at University Hospital, in Newark. The hospital always strives to improve outcomes, she said, and is working to revamp its data collection methods to help improve scores in the future.
Dr. Claudia Komer, the chief medical officer at Saint Michael’s, noted that the Leapfrog report reflects some data that predates the takeover by Prime Healthcare, which received final state approval in May.
“As with all Prime Healthcare hospitals, we share the goals and high performance encouraged by Leapfrog,” Komer said. “In the areas of the Leapfrog report that cover a more recent period under Prime Healthcare’s ownership, the report shows we have made vast improvements in our processes in a short period of time.”
Schwimmer praised New Jersey’s hospitals for their “strong participation” in the process, which provides a wealth of additional data that Leapfrog shares to help organizations like the Quality Institute craft patient-safety initiatives. Facilities that have received low letter grades, “these are hospitals that have been in transition from a financial position or from an ownership position,” she said.