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Tuesday, October 19, 2010

CMS Statistics Meaningless according to study published in the Archives of Surgery


If a surgical procedure is in your future, the Centers for Medicare and Medicaid Services would like to make your life a little easier by helping you choose a hospital with a good safety record. Its Hospital Compare website allows you to search hospitals in your area and see whether they do a good job of some seemingly important things, like giving patients antibiotics when they’re supposed to and heading off dangerous blood clots.
But don’t put too much stock in the Hospital Compare ratings. According to a study being published in Tuesday’s edition of Archives of Surgery, patients who went under the knife in the lowest-scoring hospitals did just as well as patients who were treated in the best hospitals.
“Currently available information on the Hospital Compare website will not help patients identify hospitals with better outcomes for high-risk surgery,” wrote the researchers, who were from the University of Michigan and the Michigan Surgical Collaborative for Outcomes Research and Evaluation in Ann Arbor. “Patients who choose their hospital based on high rates of process compliance will not improve their chance of survival or complications.”

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In coming to this conclusion, the researchers examined data on nearly 230,000 Medicare patients who had one of six surgical procedures (abdominal aortic aneurysm repair, aortic valve repair, coronary artery bypass graft, esophageal resection, mitral valve repair or pancreatic resection) in 2,038 hospitals in 2005 or 2006. They ranked those hospitals according to their compliance with various safety measures. Then they compared the experiences of patients treated in the best hospitals with those treated in the worst.
It turned out that patients were just as likely to die within 30 days of their surgeries in the “safe” hospitals as in the “unsafe” ones. There was one exception – patients who had an aortic valve replacement were less likely to die in hospitals that had the best compliance with the safety measures. Overall, degree of compliance accounted for only 3.3% of the variation in mortality rates observed at different hospitals.
What’s more, patients experienced fewer complications in hospitals that did the worst job complying with the safety measures, and more complications in hospitals with the best compliance records.
The researchers didn’t seem to be terribly surprised by their findings. As they pointed out, blood clots (due to deep venous thrombosis or pulmonary embolism) are rare, and there may not be enough cases to distinguish “good” hospitals from “bad” ones. Other things the government keeps track of, like surgical site infections, are important but don’t have a huge impact on mortality.
The researchers concluded that more research is needed to determine whether it’s worthwhile for hospitals to spend so much time in tracking and reporting this “safety” information. Perhaps the government – and patients – would be better off with other kinds of safety data, they wrote.
-- Karen Kaplan / Los Angeles Times

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