Report releases hospital findings

Five area hospitals had a total of eight high-death rate findings in seven illness categories last year, according to the annual hospital performance report of the Pennsylvania Health Care Cost Containment Council.

Altoona Regional Health System – now UPMC Altoona – had high death rates for kidney and urinary tract infection, pneumonia with aspiration and septicemia, according to the report.

Nason Hospital, Roaring Spring, had a higher death rate than “expected” for chest pain; Tyrone Hospital for hypotension and fainting; Conemaugh Miners Medical Center, Hastings, for infectious pneumonia; and Mount Nittany Medical Center, State College, for congestive heart failure and pneumonia with aspiration, according to the report.

In keeping with usual practice, hospital spokespeople sought to extenuate the findings, arguing generally that the patients whose deaths resulted in the findings were deathly sick, and in some cases, that minor differences threw the hospitals into the “black mark” category.

PHC4 uses “a complex mathematical formula to risk-adjust the mortality” data to make the findings fair – taking account of sickness acuity, number of co-morbidities and age, information that takes indirect account of do-not-resuscitate orders, which are often cited by hospitals to explain the negative findings, according to the agency.

Altoona’s number of deaths from kidney and urinary tract infection was just one over the normal range, and all the patients whose deaths contributed to it were on “comfort measures only,” said Linanne Batzel, the hospital’s chief medical officer.

The hospital was also just one death over normal for pneumonia with aspiration, and many of the patients whose deaths contributed to the finding were also on comfort measures only, were severely disabled, and had prior strokes and swallowing problems, Batzel said.

The hospital tries to do “what’s right for the families,” she said, regarding comfort-measure-only orders.

The finding for septicemia is hard to evaluate, because PHC4 defines that illness differently than the hospital, which tracks it according to the “classic” definition – those with a systemic inflammatory response to a bacterial infection of the blood, characterized by hypotensive fever, high white blood cell count, confusion and organ failure, she said.

In that category, the hospital had a low death rate, she said.

PHC4 includes any patients with a “positive blood culture,” which means that patients who die of some other problem, but happen to have a positive culture as a result of skin bacteria, for example, would be part of the finding, she said.

Nason Hospital’s high-death finding for chest pain resulted from just one death in 13 cases, said hospital CEO Garrett Hoover. And that patient was an 83-year-old woman with “multiple co-morbidities and complications,” he said.

Overall, the hospital compares “extremely well” to others in western Pennsylvania and the state as a whole for mortality rates – as well as readmissions and stated monetary charges, which were also part of the report, Hoover said.

Tyrone Hospital’s high-death finding for hypotension and fainting resulted from patients whose deaths were “not an unexpected outcome, as the patients were chronically ill and had elected either a ‘do not resuscitate status’ or [had] received comfort care,” stated Amy Vereshack, director of performance improvement.

“One or two cases can greatly impact the data,” because of relatively small numbers of patients, said Miners President William Crowe, regarding that hospital’s high-death finding for infectious pneumonia and a high readmissions finding for medical management of diabetes. There were 85 total infectious pneumonia cases, according to the report – which doesn’t include specific death numbers. The hospital reviews “all outcomes data carefully to look for trends and opportunities for improvement,” he added.

Ninety-three percent of the patients whose deaths that led to Mount Nittany’s high death rate for congestive heart failure and pneumonia with aspiration had do-not-resuscitate orders or were on comfort care, said Gail Miller, vice president for quality. “We believe that these deaths were anticipated, given the severity of the patients’ illnesses and the expressed wishes of the patients and [their families],” she stated.

Altoona had a favorably low rate of readmissions for congestive heart failure, while Clearfield Hospital had favorably low rates of readmission for abnormal heartbeat and acute kidney failure.

Mirror Staff Writer William Kibler is at 949-7038.