09/27/07 — HARRISBURG — Patient mortality rates at Pennsylvania hospitals declined over a three-year period although more people on average needed to be readmitted, a state agency said Thursday in its annual report on hospital performance.
The findings by the Pennsylvania Health Care Cost Containment Council, which monitors hospital quality and finances, reflect trends that have been consistent over the several years that the council has published its hospital reports, said Marc P. Volavka, the agency’s executive director.
“It’s a trend that, I think, has more good than concern,” Volavka said. “The fact that the hospital morality rate continues to drop dramatically is evidence that the (health-care) community does pay attention to public reporting.”
Meadville Medical Center’s showing in patient mortality numbers was “not significantly different than expected,” compared to the state’s or to previous MMC results. And, in readmission results, the Meadville facility’s numbers were “lower-than-expected,” and significantly so for some procedures.
Meadville was ranked significantly lower than expected in readmission rates for kidney and urinary tract infections, said Dr. David McNamara, the hospital’s medical director.
“We have been doing quality improvement for the last five years and stressing patient safety,” he said. “We continue to work on this every day.”
“We’ve won eight quality awards in the last four years,” McNamara said. “Quality improvement drives patient safety, it drives down our financial costs and drives (up) our market share.”
The report evaluates hospital performance for 31 common medical problems and treatments, including respiratory failure, pneumonia, aortic aneurysm repair, and hysterectomies. It examines the three-year change in mortality rates for 26 of those categories and the three-year change in readmission rates for 20 categories.
The study covers more than 685,000 admissions to 177 general hospitals during the 12-month period that ended Sept. 30, 2006, and compares them to similar cases from the 12 months that ended Sept. 30, 2004.
During that period, the mortality rates declined from 4.7 percent to 4.4 percent, and readmission rates increased from 18.7 percent in 2004 to 19.1 percent.
The increase in patient readmissions is hard to explain, Volavka said.
Complications and infections that patients develop while they are hospitalized appear to be among several factors that could account for the uptick, he said. The report found that 26 percent of patient readmissions were related to in-hospital infections and complications.
A statewide lobbying group for hospitals suggested that, while improved quality of hospital care means that fewer patients are dying, chronic illnesses may force them to make repeat hospital visits.
“Many of those surviving patients are the most chronically ill — and therefore most in need for continuing hospital care,” said Carolyn F. Scanlan, president and chief executive officer of the Hospital & Healthsystem Association of Pennsylvania.
Reversing the trend of rising readmissions requires improving coordination of care after a patient is discharged between the hospital and the patient’s primary-care physician, said Harold Miller of the Pittsburgh Regional Health Initiative, a coalition of medical, business and community leaders seeking to improve health care in southwestern Pennsylvania.
For example, a patient may be advised to visit the doctor within two days after being discharged, only to discover that the earliest available appointment is in two weeks, Miller said.
“A lot of the research done on readmissions suggests that what’s happening is a combination of a poor hand-off between the hospital and the community provider or the failure to do things in the community” to help the patient, Miller said.
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