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Which hospitals do the best to prevent infection? Local report ranks hospitals

This article first appeared in the St. Louis Beacon, June 2, 2010 - Want to know which area hospital offers the best care for a heart attack or pneumonia? Has the most impressive record for preventing certain surgical infections? Provides the most charity care or has done the most to cut cost without compromising quality?

One good place to turn is in the latest report from the St. Louis Area Business Health Coalition: St. Louis Health Care Industry Overview, 2010, Financial and Quality Performance.

Its new study cites two hospitals in the St. Louis SSM health care network -- DePaul Health Center in Bridgeton and St. Mary's Health Center in Richmond Heights -- as ranking among the top five in providing all or nearly all of the recommended care for heart attacks, pneumonia and surgical infections.

Reducing infection

St. Mary's Health Center probably wasn't surprised that it ranked high on some quality measures in the St. Louis Area Business Health Coalition report. For two  years in a row, the hospital  has reported zero infections for hip surgery. It performed 162 such procedures in 2008; 134 in 2009. The hospital also reports zero infections for the 69 hip operations performed this year.

The results are impressive, considering that infection rates in Missouri hospital ranges from 0.7 to 3.3 for every 100 hip procedures, with the ranges based on the risks associated with the surgery. Missouri's rates are higher than the national average -- 0.67 to 2.40 per 100 procedures.

The hospital says it expects to add a wider range of specialists, including shoulder and sports medicine physicians, to its orthopedics team.

"We are looking to improve the patient-care experience by providing a full continuum of orthopedic services at St. Mary's," said Drew Rector, SSM Orthopedics service-line executive.

Sharon Schaefer, SSM St. Mary's orthopedic clinical program coordinator, says the "zero-infection success is definitely a team effort" that begins "with the education of the patients and family members." Before the surgery, the patients and family members learn how to shower with Hibiclens soap, reducing skin bacteria and post-surgical infections.

Nurse Nancy Kuhlman says, "From sterile technique in the operating room to proper hand washing and dressing-change practices, the physicians and nurses follow a standard prevention protocol to eliminate infections."

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The other three facilities in the top five were St. John's Mercy Hospital in Washington, Mo.; Jefferson Regional Medical Center in Crystal City; and St. John's Mercy Medical Center in West County. DePaul was third on the list and St. Mary's ranked fifth. Ranking at the bottom was Forest Park Hospital, which eliminated some jobs and combined some managerial services with St. Alexius Hospital earlier this year.

The Business Health Coalition study also reviewed 2008 Medicare claims data for eight patient safety indicators, based on a list developed by the federal Agency for Healthcare Research and Quality. Only three area facilities -- Christian Hospitals, Missouri Baptist Medical Center and Barnes-Jewish Hospital in West County -- scored above 66 percent on the federal scale, with 100 percent being the highest score.

The average score for all St. Louis hospitals was 46 percent. (A higher score indicates lower rates of preventable complications and other adverse events.) The BHC report said complications at hospitals performing below average included lung collapse during surgery or other procedures; serious blood infection after surgery; respiratory failure after an operation; or a surgical incision that reopens after abdominal pelvic surgery. St. Louis University Hospital ranked at the bottom of the list, meeting only 13 percent of the federal patient safety indicators, the report said. The Business Health Coalition data was based on information from 2008.

The study said DePaul and St. Mary's in Richmond Heights were among hospitals taking part in an initiative where health-care providers are paid more when quality of patient care improves. The Business Health Coalition has pushed for rewarding health providers for superior care as a way of encouraging better treatment and reducing the cost of health care.

More than 200 of the region's physicians have been recognized for consistently providing high-quality, evidence-based care for several of the most prevalent chronic illnesses. These include diabetes, heart and stroke, and low back pain.

Karen Roth, director of research for the coalition, says this information can be quite useful for people in deciding which provider might offer the best care for certain illnesses. She says the report also provides for the first time information about health plans, showing their medical losses, profit margins and other data. She says this information is essential as more consumers are required to take more responsibility for health costs and many health plans aren't necessarily transparent about what the service will cost consumers.

Roth said the coalition wished area hospitals provided more transparency in terms of how much of their cost reduction gains were based on improved quality and how much was based on shifting to cheaper care through outpatient services.

Louise Probst, executive director of the Business Health Coalition, adds in a statement, "Health reform will not succeed by expanding access alone" and that the way health care is organized and delivered must change. "This will require the committed leadership of all dependent on a high-quality, high-value health system. Consumers, physicians, hospitals, employers, insurers and the government must work community-by-community toward the common goal of better health and system sustainability."

The Business Health Coalition has been in existence for nearly three decades. Its 45 member businesses have worked with health providers for high-quality, high-value health care for their workers.

Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.

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