Dr. Linda Remy, one of the study's co-authors, said, "With two consistent state reports, there is support for concerns about the quality of care at MGH. The findings are similar to the 1996 report by U.S. News and World Report, which placed Marin in the lowest tier of California's large hospitals. The higher mortality rates likely are related to the facility's registered nurse staffing ratio. It was very low when the data were collected and it is much lower today. Other hospitals in the Sutter/CHS system had an average nurse staffing ratio almost double that of MGH. Obviously CHS is willing to pay for registered nursing care in its other facilities but is unwilling to do so in Marin."
The 1994 OSHPD report found the statewide risk adjusted heart attack mortality rate was 13.3%. The 1995 report indicates the statewide rate improved slightly to 13%. In the six CHS hospitals, death rates ranged from 7.9% to 10.5%, for an average of 9.4%. In the 15 Sutter hospitals, which recently took over CHS, average mortality was 11.1%, with rates ranging from 4.7% to 17.5%. The MGH rate was 12.4%.
Except for Marin General, CHS hospitals ranked among the top in the state. When evaluating CHS hospitals as a group, mortality rates so low are likely to occur by chance less than one out of a thousand times. The Sutter hospitals' system-wide rating is likely to occur by chance less than one in 10 times.
Release of the mortality study was withheld a year pending completion of a validation study which also was released today. The validation study included measures of hospital practice patterns, and found that better hospitals used certain medications more aggressively when patients were admitted emergently.
Dr. Remy prepared a figure comparing Marin General Hospital to the other CHS hospitals and to the Sutter hospitals, which were separate corporations when the studies were conducted. To make comparisons across years, hospital outcome rates were divided by the statewide rate in 1994 and 1995. At .96 and .95 for two consecutive years, MGH was at best an average hospital. It compares poorly relative to the .85 and .72 ratios for Sutter and CHS.
The three-volume report is available from OSHPD. The data are in Volume Three, Detailed Statistical Results, which also describes the grouping method used to do the comparison. Further information and detailed statistics tables for the hospitals are available from Dr. Remy at (415) 435-3075.