Hospital Quality in South Carolina

In our American Hospital Quality Outcomes 2013: Healthgrades Report to the Nation, Healthgrades measured the quality of care at nearly 5,000 hospitals nationwide for 28 common conditions and procedures, 18 of which are based on an assessment of mortality rates, 10 of which are based on complication rates. A unique feature of this years national report is the inclusion of supplemental state reports for 50 U.S. states and the District of Columbia, like this one, showing how quality varies among hospitals within each state. In this state report, we provide two perspectives to help evaluate the relative performance of South Carolina to the U.S. as a whole. First, we look at risk-adjusted mortality and complication rates in each of the cohorts studied in South Carolina and compare them to rates observed for the U.S. as a whole. Second, we evaluate the distribution of the number of hospitals in South Carolina across each of Healthgrades three performance categories: Statistically better than expected (5-Star), not statistically different than expected (3-Star), and statistically worse than expected (1-Star). We then compare the state hospital distribution to the hospital distribution observed for the U.S. as a whole. Our studies are objective and unique in evaluating hospitals solely on clinical outcomesrisk-adjusted mortality and complication rates. Below are highlights of our findings for the 60 hospitals evaluated in South Carolina.

Mortality-Based Conditions & Procedures - Performance Highlights

For mortality rate-based procedures and conditions, Healthgrades measures the mortality rate after adjusting for patient characteristics such as age, gender and clinical risk factors. During the 2009-2011 study period:

South Carolina did not perform statistically better than the U.S. as a whole in any of the 18 mortality rate-based cohorts studied during the period; however, there were groups of individual hospitals that did. South Carolina had 6.3% of hospitals in Coronary Artery Bypass Surgery (CABG), 5.6% of hospitals in Coronary Interventional Procedures (Angioplasty/ Stent) and 4.8% of hospitals in Respiratory Failure that performed at levels that were statistically better than expected (5-Star). South Carolina, as a whole, performed statistically worse in risk-adjusted mortality than the U.S. average in Heart Attack (8.0% vs 7.4%), Heart Failure (4.0% vs 3.2%), and Stroke (6.0% vs 5.3%). While South Carolina had worse than expected performance in Heart Attack, this poor level of performance was not observed everywhere in the state. In fact, 2.8% of hospitals performed statistically better than expected in Heart Attack across South Carolina. It should be noted however, that this percentage is lower than the percentage of hospitals that performed better than expected in the nation.

Your risk of harm or death can be significantly lower at better performing hospitals. Research your nearby hospitals for the specific care that you need.

Copyright 2012 Health Grades, Inc. All rights reserved.

Complication-Based Conditions & Procedures - Performance Highlights

A hospital-acquired complication is any condition that arises while you are in the hospital that is unlikely to be related to your condition when you were first admitted. Complications may prolong your hospital stay and increase costs. Complication rates are also adjusted for patient characteristics such as age, gender and clinical risk factors. During the 2009-2011 study period:

South Carolina, as a whole, performed statistically better in risk-adjusted complications than the U.S. average in Carotid Surgery (10.2% vs 12.7%), and Back and Neck Surgery (Spinal Fusion) (15.9% vs 18.7%). While South Carolina had better than expected performance in Carotid Surgery, this high level of performance was not observed everywhere in the state. In fact, 4.3% of hospitals performed statistically worse than expected in Carotid Surgery across South Carolina which, on the bright side, is lower than the percentage of hospitals that performed worse than expected in the nation. South Carolina did not perform statistically worse than the U.S. as a whole in any of the 10 complication ratebased cohorts studied during the period; however, there were groups of individual hospitals that did. South Carolina had 28.1% of hospitals in Hip Replacement, 17.5% of hospitals in Total Knee Replacement and 10.3% of hospitals in Prostatectomy that performed at levels that were statistically worse than expected (1-Star).

Your risk of complications can be significantly lower at better performing hospitals. Research your nearby hospitals for the specific care that you need.

The following sections of this report:

Illustrate the range of hospital performance within South Carolina for four key mortality rate-based conditions and procedures and three complication-rate based conditions and procedures. Summarize performance levels for all conditions and procedures studied by Healthgrades, including the percentages of hospitals receiving 5-stars, 3-stars and 1-star for performance in each.

Copyright 2012 Health Grades, Inc. All rights reserved.

Risk-Adjusted Mortality Rate-Based Conditions and Procedures

To evaluate quality for mortality rate-based conditions and procedures in this report, Healthgrades focuses on four key mortality rate-based cohorts: Coronary Artery Bypass Graft (CABG), Heart Attack, Pneumonia and Sepsis. Together, these four key cohorts account for more than half of all deaths (54.2%) among all mortality rate-based conditions and procedures studied by Healthgrades. These four cohorts also account for 33% of the total number of patients in mortality rate-based cohorts included in the 2009-2011 analyses. In addition, these four conditions and procedures are in the top 10 primary diagnoses for all patient discharges nationwide.

Average Hospital Performance

(Mortality Rate-Based Cohorts)

Distribution of Hospital Performance in Key Mortality RateBased Conditions and Procedures

The figures below illustrate the percentages of hospitals in each of three performance categories (5-star, 3-star and 1-star) for each of the key conditions and procedures. These performance categories are based on in-hospital mortality rates. The differences in outcomes that patients experience differ dramatically between these three performance categories. The best quality of care for a specific condition or procedure is found at hospitals performing at the 5-star level (statistically better than expected) for that condition or procedure.
On the scale above, green depicts states with a lower average risk-adjusted mortality rate and red depicts states with a higher average risk-adjusted mortality rate.

Heart Attack
36 Hospitals Evaluated

Coronary Artery Bypass Graft

16 Hospitals Evaluated

Sepsis
52 Hospitals Evaluated

Pneumonia
59 Hospitals Evaluated

South Carolina U.S. 5-star level indicates that the cohort-specific risk-adjusted mortality rate was statistically better than expected (90% confidence interval). 3-star level indicates that the cohort-specific risk-adjusted mortality rate was not statistically different than expected (90% confidence interval). 1-star level indicates that the cohort-specific risk-adjusted mortality rate was statistically worse than expected (90% confidence interval).

Copyright 2012 Health Grades, Inc. All rights reserved.

Risk-Adjusted Complication Rate-Based Conditions and Procedures

To evaluate quality improvements for complication rate-based cohorts, Healthgrades examines three key complication rate-based cohorts: Hip Fracture Treatment, Total Knee Replacement, and Gallbladder Surgery. These three common procedures performed by hospitals may result in one or more hospital-acquired complications during the hospital stay. Together, they account for 66% of all complications and 59% of all patients in the complication rate conditions and procedures studied by Healthgrades.

Average Hospital Performance

(Complication Rate-Based Cohorts)

Distribution of Hospital Performance in Key Complication Rate-Based Conditions and Procedures

The figures below illustrate the percentages of hospitals in each of three performance categories (5-star, 3-star and 1-star) for each of the key conditions and procedures. The differences in outcomes that patients experience differ dramatically between these three performance categories. The best quality of care for a specific condition or procedure is found at hospitals performing at the 5-star level (statistically better than expected) for that condition or procedure.

On the scale above, green depicts states with a lower average risk-adjusted complication rate and red depicts states with a higher average risk-adjusted complication rate.

Hip Fracture Treatment

42 Hospitals Evaluated

Total Knee Replacement

40 Hospitals Evaluated

Gallbladder Surgery
39 Hospitals Evaluated

South Carolina U.S.

5-star level indicates that the cohort-specific risk-adjusted complication rate was statistically better than expected (90% confidence interval). 3-star level indicates that the cohort-specific risk-adjusted complication rate was not statistically different than expected (90% confidence interval). 1-star level indicates that the cohort-specific risk-adjusted complication rate was statistically worse than expected (90% confidence interval).

Copyright 2012 Health Grades, Inc. All rights reserved.

South Carolina Hospitals Performance Summary

The following table provides a detailed look at how well South Carolina hospitals performed as a group for all conditions and procedures studied by Healthgrades.

Table 3: South Carolina Hospitals Performance Summary

Mortality (M) Complication (C) Rates*
State Average (U.S.) 2.0% (2.2%) 2.2% (2.2%) 8.0% (7.4%) 4.0% (3.2%) 5.5% (5.1%) 1.5% (1.3%) 4.6% (3.8%) 17.2% (16.4%) 20.9% (17.3%) 3.0% (2.5%) 26.2% (26.8%) 2.1% (1.7%) 11.7% (10.7%) 2.8% (2.2%) 6.9% (6.2%) 6.0% (5.3%)

% of Hospitals Performing at 5-Star Level (U.S.) 6.3% (7.7%) 5.6% (9.2%) 2.8% (13.0%) 1.7% (12.3%) 0.0% (10.4%) 0.0% (0.1%) 3.2% (4.8%) 4.8% (18.5%) 3.8% (21.5%) 0.0% (5.8%) 5.1% (14.1%) 7.8% (5.5%) 0.0% (10.3%) 0.0% (1.8%) 0.0% (10.4%) 4.7% (13.9%) 3-Star Level (U.S.) 87.5% (80.4%) 83.3% (77.1%) 80.6% (73.3%) 74.1% (69.6%) 92.9% (75.5%) 84.4% (92.2%) 80.6% (87.3%) 71.4% (63.5%) 46.2% (49.0%) 91.3% (83.1%) 92.3% (71.0%) 66.7% (83.1%) 78.8% (77.2%) 80.0% (89.8%) 80.0% (78.6%) 67.4% (68.9%) 1-Star Level (U.S.) 6.3% (11.9%) 11.1% (13.8%) 16.7% (13.8%) 24.1% (18.1%) 7.1% (14.1%) 15.6% (7.7%) 16.1% (7.9%) 23.8% (18.0%) 50.0% (29.5%) 8.7% (11.2%) 2.6% (14.8%) 25.5% (11.4%) 21.2% (12.6%) 20.0% (8.5%) 20.0% (10.9%) 27.9% (17.2%)

Condition/Procedure Cardiovascular Service Line Coronary Artery Bypass Surgery (CABG) Coronary Interventional Procedures (Angioplasty/ Stent) Heart Attack Heart Failure Valve Repair/Replacement Surgery Critical Care Service Line

Performance Level ** As expected As expected

# Hospitals 16 18

M/C M M

Worse than expected Worse than expected As expected

36 58 14

M M M

Diabetic Acidosis and Coma As expected Pulmonary Embolism Respiratory Failure Sepsis Gastrointestinal Service Line Bowel Obstruction Gallbladder Surgery Gastrointestinal Bleed Worse than expected As expected Worse than expected Worse than expected As expected Worse than expected

32 31 42 52

M M M M

46 39 51 33 30

M C M M M

GI Surgeries and Procedures Worse than expected Pancreatitis Neurosciences Service Line Neurosurgery Stroke As expected Worse than expected Worse than expected

15 43

M M

Copyright 2012 Health Grades, Inc. All rights reserved.

South Carolina Hospitals Performance Summary (continued)

Mortality (M) Complication (C) Rates*
State Average (U.S.) 13.2% (14.0%) 15.9% (18.7%) 25.8% (25.2%) 11.5% (10.7%) 10.1% (10.1%) 9.7% (9.8%) 1.8% (1.4%) 5.0% (4.2%) 10.2% (12.7%) 19.4% (20.4%) 3.9% (3.6%)

% of Hospitals Performing at 5-Star Level (U.S.) 18.2% (17.4%) 30.8% (21.3%) 11.9% (22.6%) 18.8% (18.5%) 20.0% (23.8%) 0.0% (12.9%) 1.8% (6.5%) 10.2% (14.3%) 34.8% (16.8%) 9.1% (15.9%) 0.0% (5.6%) 3-Star Level (U.S.) 54.5% (65.6%) 61.5% (59.2%) 66.7% (58.5%) 53.1% (63.0%) 62.5% (51.9%) 89.7% (72.6%) 78.6% (80.3%) 62.7% (66.3%) 60.9% (66.9%) 81.8% (69.9%) 93.8% (86.6%) 1-Star Level (U.S.) 27.3% (17.1%) 7.7% (19.6%) 21.4% (18.9%) 28.1% (18.5%) 17.5% (24.3%) 10.3% (14.5%) 19.6% (13.2%) 27.1% (19.5%) 4.3% (16.3%) 9.1% (14.2%) 6.3% (7.8%)

Condition/Procedure Orthopedic Service Line Back and Neck Surgery (except Spinal Fusion) Back and Neck Surgery (Spinal Fusion) Hip Fracture Treatment Hip Replacement Total Knee Replacement Prostatectomy Service Line Prostatectomy Pulmonary Service Line Chronic Obstructive Pulmonary Disease (COPD) Pneumonia Vascular Service Line Carotid Surgery Peripheral Vascular Bypass Resection/Replacement of Abdominal Aorta

Performance Level ** As expected Better than expected As expected As expected As expected

# Hospitals 22 26 42 32 40

M/C C C C C C

As expected

29

Worse than expected Worse than expected

56 59

M M

Better than expected As expected As expected

23 11 16

C C M

Note: Although Healthgrades has evaluated hospitals for quality performance in Appendectomy, it is available only for 19 states and so is not covered in this report. * Mortality and complication rates are risk adjusted to account for differences in severity of illness and other patient factors. At the hospital level: 5-star level indicates that the cohort-specific risk-adjusted mortality or complication rate was statistically better than expected (90% confidence interval). 3-star level indicates that the cohort-specific risk-adjusted mortality or complication rate was not statistically different than expected (90% confidence interval). 1-star level indicates that the cohort-specific risk-adjusted mortality or complication rate was statistically worse than expected (90% confidence interval). ** When assessing state level performance, a 95% confidence interval was used to determine if the average risk-adjusted mortality or risk-adjusted complication rate, calculated across all patients in the state, was statistically different than the national average rate.

Copyright 2012 Health Grades, Inc. All rights reserved.