A recent study done by a healthcare information service company points to some strong points and apparent deficiencies in the quality of care offered by area hospitals.

The study was undertaken by CareChex, a division of the privately held Delta Group, based in Greenville, S.C. The Delta Group specializes in rating the quality of hospital and physician care. It used Medicare data from 2007 to 2009 and information provided on the U.S. Department of Health and Human Services’ website to rank hospitals in North Carolina and across the country in three overall categories, and in 35 subcategories that encompass different types of care.

Some of the 2011 ratings for New Hanover Regional Medical Center, health care system partner Pender Memorial Hospital, Novant Health’s Brunswick Community Hospital and the privately operated Dosher Memorial Hospital in Southport may raise some eyebrows.

Officials representing the four hospitals caution those reviewing the CareChex figures to consider a number of factors before making any judgments.

NHRMC, Pender Memorial

New Hanover Regional Medical Center is the area’s primary regional hospital and trauma center. The study ranked the facility No. 36 out of 99 hospitals statewide in the Overall Hospital Care category, considered an average rating.

NHRMC was rated No. 35 out of 98 facilities for overall medical care, in the average category. The hospital was rated No. 30 out of 91 in overall surgical care, again average.

NHRMC scored in the highest category rating in the trauma center category, with a rating of third among 99 hospitals with similar facilities.

CareChex rated NHRMC sixth out of 102 hospitals in the cancer care category, a rating in the highest category; and 10th among 108 hospitals in the heart failure treatment category, also a highest category rating.

New Hanover Regional Medical Center scored no lower than an average rating in any of the categories addressed in the study.
Pender Memorial Hospital in Burgaw did receive several below-average ratings, and was not ranked at all in the three overall categories.

“This could be due to a variety of reasons including poor clinical documentation on the part of the hospital or substandard care delivered by caregivers. More analysis is needed to determine which is the case,” said Dr. Thane Forthman, managing principal with The Delta Group.

PMH rated No. 47 out of 102 hospitals for cancer care, an average rating; and No. 50 out of 106 in the general surgery category, also average.

The hospital ranked No. 84 out of 108 hospitals in the heart failure treatment category, a low rating. It was ranked No. 99 out of 102 hospitals in heart attack treatment, the lowest category rating.

“Quality of care is paramount. At New Hanover Regional Medical Center we monitor, report and implement programs that are always focused on the quality of care. We study best practices and implement them throughout the organization,” said Dr. Sam Spicer, vice president of medical affairs.

NHRMC officials “are pleased to see our ratings high by this assessment tool for cardiac, cancer and trauma. We are also pleased to see that we scored well for many other services, and we have no doubt recent data will continue to show increased ratings,” Spicer said.

The hospital was rated No. 67 out of 104 facilities in the women’s health category, compared to a 32 rating for Pender Memorial Hospital.

“If you consider that the Betty H. Cameron Women’s & Children’s Hospital opened in the middle of this reporting time, it is important to look at recent data and compare data from many reporting sources,” Spicer said. “Just last month our Women’s and Children’s center received an award from the StuderGroup for quality in patient satisfaction. They were among the leaders recognized for patient satisfaction when compared to organizations across the country.”

Pender Memorial Hospital is a critical access hospital, Spicer said.

“This means the role at times for Pender Memorial Hospital is to stabilize and ensure quick local access care. A majority of Pender County cardiac patients are cared for at New Hanover Regional Medical Center, so their numbers are most likely being counted as part of New Hanover Regional Medical Center,” Spicer said.

Brunswick Community Hospital

Brunswick Community Hospital in Supply will be replaced next year by a new, more technologically up-to-date facility, Brunswick Novant Medical Center.

In the top three overall categories compiled by CareChex, BCH was rated average. It scored No. 55 out of 98 facilites in overall hospital care, 61st out of 98 in overall medical care and 34th out of 91 in overall surgical care.

In the cancer care subcategory, BCH was rated near the bottom of the list, at 100th out of 102 hospitals, in the  lowest category.

BCH was rated No. 99 out of 104 hospitals in the women’s health category, also a lowest category ranking.

Heart attack treatment was No. 86 out of 102, for a low rating. BCH was rated at No. 47 out of 108 hospitals in the heart failure treatment category, an average score.

General surgery was rated 79th out of 106, a low ranking; while trauma care received an average rating of 70 out of 99 facilities.
Denise Mihal, CEO/president of BCH, said quality care is one of the hospital’s top priorities.

“We have made great improvements in the past few years. We are glad to see the patients are shopping for healthcare and pursuing quality information more than they have in the past, and we are happy to see that public and private organizations, as well as the media, are responding by providing this information,” Mihal said.

Sharing similar information on the Brunswick Community Hospital website is a priority, Mihal said.

“If you visit the website, you will see an honest and open display of each of the patient quality measures currently reported by the Federal Centers for Medicare & Medicaid Services. We are committed to providing clear, accurate and honest information about the quality of care we provide to our patients,” she said.

The Federal Centers for Medicare & Medicaid data “are derived at the federal and state level, and hospitals are not required to pay in order to promote these results as with some other private quality data sources,” Mihal said.

Forthman replied: “Unlike these one-dimensional data sources, CareChex ratings provide a multidimensional analysis of the hospital’s quality performance by evaluating process of care, outcomes of care and patient satisfaction collectively. Since state and federal sites do not report on a hospital’s composite performance across these key components of care, the findings can be misleading to the public when viewed in isolation.”

Mihal said Brunswick Community Hospital uses information from www.NCHospitalQuality.org and www.HospitalCompare.HHS.gov for data sources. They find their reports better align with agencies like the Center for Medicare & Medicaid Services, the U.S. Department of Health and Human Services and the Hospital Quality Alliance, she said.

Mihal cited information on the N.C. Hospital Quality website updated on March 31 that ranks Brunswick Community Hospital in the top 10 percent of all hospitals in North Carolina “for the care we provide to patients with pneumonia and heart failure, as well as for our surgical care improvement efforts.”

In addition, Mihal said the N.C. Center for Hospital Quality and Patient Safety named Brunswick Community Hospital “a most improved hospital for surgical care and pneumonia care in 2008 and a most reliable hospital for surgical care in 2009.”

“We are proud of our progress and will continue to concentrate our efforts on improving our quality of care and the service we provide,” Mihal said.

“Public awareness and transparency of data holds us and all healthcare organizations accountable to our patients,” she said.

Dosher Memorial Hospital

Dosher Memorial Hospital in Southport received average ratings in the top three overall categories: 61st out of 99 facilities in overall hospital care, 71st out of 98 in overall medical care and 53rd out of 91 in overall surgical care.

Trauma care rated 99th out of 99 hospitals included in the subcategory.

Cancer care was 54th out of 102 hospitals, for an average rating; cardiac care information was not available to CareChex.

General surgery at Dosher Memorial Hospital was ranked No. 21 out of 106 hospitals, a high category rating. Also receiving a high category rating was women’s health, rated No. 62 out of 104 hospitals.

Heart attack treatment was ranked 86th out of 102 hospitals, a low rating; while heart failure treatment was ranked No. 73 out of 108, an average category rating.

Dosher Memorial Hospital spokesman Kirk Singer said the facility “spends a great deal of time and energy promoting excellence and quality in the services we provide.”

Transparency and the release of information related to patient care is important at Dosher, Singer said.

“We are accredited by the Joint Commission, the ‘gold standard’ in hospital accreditation across the nation, which holds us to the highest standard of care,” Singer said.

“Being a community hospital in a rural community, we are not a trauma center, yet our emergency department was the 2010 recipient of the Southeastern Regional Advisory Committee Trauma Award by the Southeastern Regional Advisory Committee of the Emergency and Trauma Services of New Hanover Regional Medical Center.”

As a critical care hospital, Dosher is exempt from many hospital reporting requirements, “(but) we still hold ourselves to the same rigorous quality of care standards as non-critical access facilities. We closely monitor our results, and are continually taking steps to ensure the very best quality of care,” Singer said.

He said the hospital’s surgical infection rates are consistently very low and the Dosher’s Optimal Care Rates, which are derived from following and documenting proper protocol to prevent post-operative infections, “are extremely good” compared to other North Carolina hospitals.

Dosher’s Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores exceed the state average and are higher than 12 of the 13 hospitals in the Wilmington area and southern region of North Carolina, Singer said.

“More than 70 percent of our patients surveyed gave Dosher a rating of 9 or 10,” he said.

Hospital officials did not immediately have familiarity with the indicators used by CareChex to reach its ratings determinations.

“For instance, this CareChex report gives our hospital an average rating in cancer care, but cancer care is not a service we provide,” Singer said.

Quality Indicators

A Delta Group spokeswoman said six quality indicators are used in the CareChex report: patient satisfaction, patient safety, complications, mortality, inpatient quality and core measures like protocols used by a hospital to get the best results.

CareChex also released a study in September that ranks overall patient satisfaction with hospitals, by state and metropolitan area.

North Carolina was ranked eighth at 84.3 percent. The top patient satisfaction state was Vermont at 98 percent. The lowest was the District of Columbia at 0.1 percent.

The two studies reflect a broad disparity in the quality of healthcare in different states and metropolitan areas, Forthman said.
To access the hospital quality rankings, go to www.carechex.com.