Hospital questions death-rate study


Officials at Harford Memorial Hospital and the Maryland Hospital Association said last week that they have misgivings about the recent "Consumer Guide to Hospitals," which lists the Havre de Grace hospital as having the second-highest death rate in Maryland.

Allan Acton, vice president of the Upper Chesapeake Health System, which operates the 275-bed hospital, said he questions the study because it is based on federal Medicare figures, which are concerned with mortality rates for people 65 and older.

"A broader sample would be better," he said.

TC The report said that from 1989 to 1991, Harford Memorial had a death rate of 10.3 percent, compared with an average death rate for Maryland hospitals of 8.7 percent. The latter rate is about the national average.

Johns Hopkins Bayview Medical Center, formerly Francis Scott Key Medical Center, in Baltimore had the highest death rate in the state, 10.6 percent, the report said.

Nancy Fiedler, the Maryland Hospital Association's senior vice president for communications, said she, too, has "serious concerns" about the report's data.

"The publication is focused on a snapshot in time," said Ms. Fiedler, referring to the 3- to 5-year-old figures used in the study.

Robert Krughoff, president of the Center for the Study of Services, the Washington nonprofit consumer group that published the guide, said that current data would be best but that 3-year-old figures shouldn't be discounted.

Ms. Fiedler also questioned the guide's use of Medicare figures for patients 65 and older. "They [that age group] have the highest mortality rate anyway," she said.

Mr. Krughoff doesn't agree that age is a factor.

"I would guess that if a hospital does badly with people over 65, you wouldn't want to go to the hospital if you're 25," he said.

Mr. Acton said he is waiting to receive a copy of the report to look at the figures and the rating system. But he said he prefers to use another study, the Maryland Hospital Association's Quality Indicator Project (QIP), as a guideline.

"It is considered a good basis for hospitals to see how they do with hospitals of the same size," he said.

According to that study, Mr. Acton said, Harford Memorial's mortality rate was about the same as those of similar hospitals. The QIP results are not available to the public.

"The research project is shared only with the participants," Ms. Fiedler said, "principally because it is in the research stage."

The project, which began as a Maryland-based research study in 1986, includes 800 national and international hospitals.

That study's purpose "is to monitor the performance of a hospital and compare it with like institutions and to serve as a warning indicator to hospitals," Ms. Fiedler said.

Mortality rates in the QIP study are based on all age groups, said Nell Wood, the hospital association's director of program development. She is involved in the Quality Indicator Project.

The Center for the Study of Services obtains its information on more than 5,500 national hospitals from the Health Care Financing Administration, which administers Medicare to senior citizens, Mr. Krughoff said.

He said that, "as a practical matter, people don't react that strongly" to hospital statistics.

"They're much more strongly influenced by where their doctor suggests they go," he said.

What is important, Ms. Wood said, is that the data should cause citizens to ask questions.

"Don't take the data at face value," she said. "The thrust here is you can't think that a hospital with a low mortality rate is the best, or one with a high mortality rate is the worst."

The effectiveness of a hospital depends on the population it is serving and the services it provides, she said.

"People look at mortality rates and say, 'Oh, I'm not going there.' But some of the best hospitals have higher mortality rates because they take the most challenging cases," she said.

Mr. Krughoff agrees. "People should take the information in the context of everything else [they] could learn about a hospital," he said. "I hope the information brings about discussion."

The 224-page "Consumer Guide to Hospitals" costs $12 and is available by writing: Hospital Guide, 733 15th St. N,W., Washington, D.C. 20005.

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