Measurable Patient Safety Improvement Seen at a Few Hospitals Across the Nation

Most U.S Hospitals Show Little Progress Since 1999

EVANSTON, IL – April 25, 2005 — A new study by Solucient has found that while a handful of hospitals across the nation are beginning to show significant improvements in operational and clinical outcomes, including patient safety, the hospital industry's overall ability to demonstrate significant improvements in these and other areas is weak.

Solucient's 100 Top Hospitals®: Performance Improvement Leaders, 2nd Edition study recognizes U.S. hospitals that achieve the fastest rate of consistent annual clinical and organizational improvement over a five-year period (1999-2003). Awards were given in five categories, based on hospital size and teaching status. The study was published in the April 25 issue of Modern Healthcare.

Patient safety became a national issue in 1999 when the Institute of Medicine (IOM) published its report "To Err Is Human," which concluded that more than 98,000 patient deaths occur per year as a result of medical errors. Solucient Performance Improvement Leaders (PILs, winning hospitals) improved their risk-adjusted patient safety index by 14 percentage points over the five years of the study. (They went from having 6 percent more adverse patient safety events than expected to having 8 percent fewer events than expected.) Peer hospitals' (non-PIL winners) patient safety index ranking worsened by 10 percentage points. (Peer hospitals went from having 15 percent fewer patient safety events than expected to having 5 percent fewer patient safety events than expected.) The risk-adjusted patient safety index takes into account a variety of factors related to patient safety, including mortality and errors in patient care.

"The Performance Improvement Leaders are hospitals that have started their improvement programs at various levels of performance," says Jean Chenoweth, senior vice president, performance improvement & 100 Top programs, Center for Healthcare Improvement at Solucient. "The PILs have improved faster and more consistently than their peers across the nation. These hospitals are increasing the value they bring to their communities year over year," she says.

"Change won't come overnight, but we are beginning to see the first small groups of hospitals of all types and sizes really improve patient safety," says David Foster, Ph.D., vice president of clinical informatics at Solucient. Hospitals that showed the fastest rate of improvement in patient safety tended to be the smaller hospitals, according to Foster, where making improvements is generally easier.

Small (25-99 beds) community hospitals were the only group to reduce their expenses, and both small and medium size (100-249 beds) hospitals saw the greatest profit increases.

"Improvement is very difficult to achieve consistently, but the Performance Improvement Leaders have been able to attain outstanding results in boosting patient safety, decreasing mortality and improving their financial status," says Chenoweth.

Nationally, most hospitals showed little improvement in general over the five-year period. About two-thirds showed no measurable change in mortality, and three-quarters had no improvement in patient safety or complications. PIL hospitals showed a clear ability to make positive changes and improve clinical outcomes and efficiency while growing in financial strength. In addition, PIL hospitals also showed significant improvement in patient safety measures. In comparison, only 6 percent of all hospitals studied showed significant improvement on measures of patient safety.

PIL hospitals were also able to significantly improve their mortality rates and complications, and discharged patients about three-quarters of a day earlier in 2003 than they did in 1999. In addition, PIL hospitals were better able to manage costs, increasing their expenses by only 7 percent while peer hospitals expenses increased by 21 percent.

"Improvement in multiple areas among PIL winners is indicative of good alignment in these organizations," says Foster. "That means that leaders in all departments of the hospital are working together to achieve sustainable goals of performance improvement."

"Incorporating more measurements across all areas, and insisting on looking closely at ROI and patient outcomes when adopting new technology have also really helped the PIL hospitals achieve their impressive rates of improvement," explains Chenoweth. "The executives receiving Solucient's PIL award are true leaders who have affected a culture of change in their organizations that is evident in consistent performance improvement across key areas of their hospitals."

The study also found that PIL hospitals made the following gains between 1999 and 2003:

• Had fewer patient deaths, complications, and adverse safety events than expected.
• Went from being unprofitable to maintaining a healthy positive profit margin.
• Discharged patients three-quarters of a day earlier in 2003 compared to 1999.
• Operating profit margin rose more than six percentage points from -1.55 percent to +4.53 percent, while peer hospitals saw nearly flat profit margins.
• PIL hospitals went from having 17 percent more deaths than expected in 1999 to having 7 percent fewer deaths than expected in 2003.
• Expense per discharged patient rose $399, or 7 percent, at PIL hospitals (over the five years) while it rose $902, or 21 percent, at non-winning hospitals.
• 87 percent of all hospitals studied showed no significant change in profitability.

The study looked at all U.S. hospitals licensed to treat Medicare patients. Nine performance measures were examined at each hospital: risk-adjusted mortality and complications, average length of stay, expenses, profitability, cash-to-debt ratio, growth in percent of community served, tangible assets, and risk adjusted patient safety index. The study used publicly available Medicare cost reports and MedPAR data from 1999 - 2003.

Facilities recognized on the PI Leader list represent five hospital classes:

• Major Teaching - 15 winners
• Teaching - 25 winners
• Large Community, 250+ Beds - 20 winners
• Medium Community, 100 to 249 Beds - 20 winners
• Small Community, 25 to 99 Beds - 20 winners

Media Notes:
More information on these studies and other 100 Top Hospitals research is available at www.100tophospitals.com. An executive summary of the 100 Top Hospitals: Performance Improvement Leaders, 2004 study is available to the media by emailing sparmet@solucient.com or by registering at http://www.100tophospitals.com/media/Register.asp. To schedule an interview with Jean Chenoweth, senior vice president, performance improvement and 100 Top Hospital programs, Solucient Center for Healthcare Improvement, contact Sharon Parmet at (847) 424-4265 or sparmet@solucient.com.

About Solucient
Solucient® is an information products company serving the healthcare industry. It is the market leader in providing tools and vital insights that healthcare managers use to improve the performance of their organizations.

By integrating, standardizing and enhancing healthcare information, Solucient provides comparative measurements of cost, quality and market performance. Solucient's expertise and proven solutions enable providers, payers and pharmaceutical companies to drive business growth, manage costs and deliver high quality care. For more information, visit www.solucient.com.