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Hospital Care: Does Your State Rate?

All states -- even ones at the bottom of the barrel when it comes to hospital care -- have good hospitals and bad hospitals. What do you look for in a good hospital?

By Jennifer Warner
WebMD Feature

Reviewed By Michael Smith

Suffering a heart attack in a state such as Mississippi is likely to be much more dangerous than in Colorado.

In fact, a new report shows where you live may play a major role in the quality of hospital care you get for various conditions.

The sixth annual HealthGrades Hospital Quality in America Study shows the quality of healthcare at the nation's hospitals varies greatly among states.

Researchers ranked each of the country's nearly 5,000 hospitals on 26 common procedures and conditions and found better-performing hospitals tended to be in northern or sparsely populated states.

Here's how the 50 states and District of Columbia fared:

Rank

State

1

North Dakota

2

Florida

3

Ohio

4

Michigan

5

Maryland

6

Colorado

7

Pennsylvania

8

Connecticut

9

Utah

10

South Dakota

11

Virginia

12

Minnesota

13

Arizona

14

Montana

15

New Jersey

16

Maine

17

Illinois

18

Rhode Island

19

Washington

20

Indiana

21

Oregon

22

Washington, D.C.

23

New Hampshire

24

Idaho

25

California

26

Massachusetts

27

Missouri

28

Louisiana

29

North Carolina

30

Texas

31

New Mexico

32

Nebraska

33

New York

34

Kentucky

35

Delaware

36

Nevada

37

Georgia

38

Wisconsin

39

Alaska

40

Iowa

41

West Virginia

42

South Carolina

43

Wyoming

44

Hawaii

45

Oklahoma

46

Vermont

47

Kansas

48

Tennessee

49

Arkansas

50

Alabama

51

Mississippi

Hospital Care, State by State

"The quality chasm at American hospitals is real, and it is very alarming and concerning -- despite evidence of process improvements," says Samantha Collier, MD, HealthGrades' vice president of medical affairs, in a news release.

Although there are exceptional hospitals in even the lowest-ranking states, researchers say that, on average, patients get better quality healthcare in the higher-ranking states.

For example, the report shows that a person has a 55% increased chance of dying if he or she had a balloon angioplasty or other similar heart procedure in Texas rather than in New York.

"In Mississippi, your chance of dying from a heart attack is 49% higher, on average, than if you were treated in Colorado," says Collier.

Researchers say that the greatest differences at the state level were among certain heart procedures, such as balloon angioplasty, stenting, and others. For these procedures, New York was the best performing state and Alaska was the worst.

The report shows states such as Texas and Tennessee also had above-average death rates associated with these procedures -- which resulted in hundreds of unnecessary deaths between 2000 and 2002, researchers say. Meanwhile, hospitals in New York, New Jersey, and Florida had lower-than-normal death rates associated with these procedures that prevented many deaths.

A complete list of rankings for each of the 26 procedures studied at almost 5,000 hospitals is available at www.healthgrades.com.

Researchers compiled the rankings based on whether the patient outcomes at the various hospitals were better or worse than could normally be expected. A five-star rating reflects performance significantly better than expected, three stars reflects an average level of performance, and a one-star rating reflects care that was significantly worse than expected.

Finding a Quality Hospital

How can you choose the best quality hospital for the care you need? It is important to consider quality because research shows that some hospitals simply do a better job than others. For example, we know that hospitals that do a greater number of the same surgeries have better outcomes for their patients.

Look for a hospital that:

  • Is accredited by the Joint Commission on Accreditation of Healthcare Organizations
  • Is rated highly by state or consumer or other groups
  • Is one where your doctor has privileges, if that is important to you
  • Is covered by your health plan
  • Has experience with your condition
  • Has had success with your condition
  • Checks and works to improve its own quality of care

Asking the Right Questions

Asking the right questions can help you make the best choices.

Does the hospital meet national quality standards?

Hospitals can choose to be surveyed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to make sure they meet certain quality standards. The standards address the quality of staff and equipment and the hospital's success in treating and curing patients. If a hospital meets those standards, it becomes accredited (gets a "seal of approval"). Reviews are done at least every three years. Most hospitals participate in this program.

You can order JCAHO's performance reports free of charge by calling (630) 792-5800. Or check the JCAHO's Web site at www.jcaho.org for a hospital's performance report or for its accreditation status.

How does the hospital compare with others in my area?

One important way to learn about hospital quality is to look at hospital report cards developed by states and consumer groups. A recent study about such reports found that besides helping consumers make informed choices, they also encourage hospitals to improve their quality of care. This is a very good reason to look for and use consumer information about hospitals. Also, ask your doctor what he or she thinks about the hospital.

Does the hospital have experience with my condition?

For example, "general" hospitals handle a wide range of routine conditions, such as hernias and pneumonia. "Specialty" hospitals have a lot of experience with certain conditions (such as cancer) or certain groups (such as children). You may be able to choose General Hospital "X" for gallbladder surgery, Specialty Hospital "Y" if you need care for a heart condition, and Specialty Hospital "Z" for your children.

You also may want to find out if the hospital has a special team of health professionals that works with people with your condition or treatment.

Has the hospital had success with my condition?

Research shows that hospitals that do many of the same types of procedures tend to have better success with them. In other words, "practice makes perfect." Ask your doctor or the hospital if there is information on:

  • How often the procedure is done there
  • How often the doctor does the procedure
  • The patient outcomes (how well the patients do)

How well does the hospital check and improve on its own quality of care?

More and more hospitals are trying to improve the quality of their care. One way is to keep track of patient outcomes for certain procedures. Another way is to keep track of patient injuries and infections that occur in the hospital. By finding out what works and what doesn't, the hospital can improve the way it treats patients.

Ask the hospital quality management (or assurance) department how it monitors and improves the hospital's quality of care. Also, ask for any patient satisfaction surveys the hospital has done. These will tell you how other patients have rated the quality of their care.

Published Sept. 24, 2003.


SOURCES: HealthGrades Hospital Quality in America Study, Sept. 23, 2003. News release, HealthGrades, Inc. WebMD Public Information from the Agency for Healthcare Research and Quality: "Choosing a Hospital."

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Last Editorial Review: 1/31/2005 6:52:17 AM



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