Hospitals put under the microscope by new industry monitoring are doing a better job of treating three potentially deadly conditions, with the worst hospitals improving the most, researchers found.
Meanwhile, a second study found disparities in the quality of hospital care around the country, with hospitals in the Northeast and Midwest, not-for-profit hospitals and teaching institutions doing slightly better than the rest.
The two studies, published in Thursday’s New England Journal of Medicine, examined how consistently thousands of U.S. hospitals provide proven treatments for the top causes of death in hospitals: pneumonia, heart attacks and congestive heart failure.
“We’ve made substantial improvements. There’s no doubt about that,” but there are still big variations among hospitals, said Dr. Patrick S. Romano, a professor of medicine and pediatrics at the University of California at Davis who was not involved in the studies.
While past studies of hospital quality have produced snapshots of care at small numbers of hospitals or just among elderly patients, the new studies are more comprehensive, including data submitted by more than 3,000 hospitals — most of the country’s full-service, acute-care hospitals.
One study, by the industry group that accredits hospitals, examined how well 3,087 hospitals followed its guidelines for providing care for the three conditions. It included younger patients as well as Medicare patients.
From July 2002 through June 2004, the hospitals improved as much as 33 percent on 18 indicators of quality care, though some went up just 3 percent, the Joint Commission on Accreditation of Healthcare Organizations found.
Those indicators include urging patients to quit smoking; giving heart attack victims aspirin and clot-busting drugs quickly; promptly prescribing antibiotics to people with pneumonia; and checking how well the heart’s main pumping chamber was working in heart-failure patients.
Overall, the death rate for heart attack patients in the hospital dipped from 9 percent to 8 percent over the two years.
The second study, by researchers at Harvard School of Public Health and other institutions, used data collected as part of a collaboration among the federal government and hospital and consumer groups. It examined 10 quality measures for the three conditions and included 3,558 hospitals — but only their Medicare patients.
The researchers found hospitals handling large numbers of patients outscored those with few patients on nearly every count.
Teaching hospitals outperformed nonteaching hospitals in treating congestive heart failure, with 85 percent and 81 percent, respectively, doing all the recommended steps. The teaching hospitals were 2 percentage points better in treating heart attacks, but lagged behind the nonteaching hospitals by the same amount on pneumonia care.
Nonprofit hospitals scored 1 to 2 percentage points better than for-profit hospitals in handling all three conditions. Hospitals in the Northeast and Midwest scored 2 to 3 percentage points better than those in the South and West for the two heart conditions, while Midwestern hospitals were the best when it came to pneumonia care.
