Delivery of Basic Cardiovascular Care Varies Substantially by State, According to Solucient Study

EVANSTON, IL — Nov. 6, 2006 — The likelihood of a hospital patient receiving cardiovascular care that meets minimum standards varies substantially, depending on the state in which the patient seeks treatment, according to a new analysis published today by Solucient®, a Thomson healthcare business (NYSE: TOC; TSX: TOC).

As measured by the national core measures standards for congestive heart failure (CHF) and heart attacks (acute myocardial infarction or AMI), cardiovascular patients treated in the Northeast have the greatest likelihood of receiving care meeting the minimum treatment criteria for hospitals.

These findings, published in the 2006 Solucient 100 Top Hospitals: Cardiovascular Benchmarks for Success, were released by Solucient, the nation's leading source of information products for the healthcare industry, and are available at www.100tophospitals.com.

According to the study, based on an analysis of eight core measures relevant to AMI and CHF, the percentage of patients receiving the minimum standard of care varies from a high of about 97 percent in Maine to a low of about 88 percent in Louisiana. (For information on compliance rates for all states and the District of Columbia, click here.)

Core measures — a set of widely accepted minimum standards of care for all patients, based on scientific evidence — are used by the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and approved by the National Quality Forum. Performance of specific hospitals on all core measures can be accessed by the public at www.hospitalcompare.hhs.gov or www.qualitycheck.org.

The Solucient study showed that the Northeastern states performed best in meeting the CHF and AMI standards, with six of nine in the top quintile. Notably, five of six of the New England states demonstrated exceptional performance. States in the Southern region performed the worst, with nearly half performing in the bottom quintile.

"A possible explanation for this may be New England's history of voluntarily comparing and improving cardiovascular care through regional consortia," said Janet Young, M.D., M.H.S.A., senior scientist at Solucient and author of the study. "In the late 1980s, New England led the nation in the formation of a consortium to improve cardiovascular care. Today, such consortia exist in many states, but later adoption may explain some of the regional variability."

"The variation in delivering basic standards of care to cardiovascular patients is still a problem, but progress is being made now that hospital performance is public," said Jean Chenoweth, senior vice president, performance improvement and 100 Top Hospitals programs, Solucient Center for Healthcare Improvement. "Winners of the 100 Top Hospitals® Cardiovascular award were also found to perform substantially higher on the cardiovascular core measures, regardless of state. The communities in which these hospitals are located are receiving very high quality cardiovascular care."

The eighth edition of the Solucient 100 Top Hospitals: Cardiovascular Benchmarks for Success study analyzed acute-care hospitals nationwide using detailed empirical performance data from publicly available 2004 and 2005 Medicare MedPAR data and 2005 Medicare cost reports.

To confirm the reliability of this publicly available data, the 2006 study also compared mortality rankings of the 100 Top Hospitals winners with the rankings that would have resulted if all-payer data had been used. "We found that hospital rank in risk-adjusted mortality rate was highly correlated in all-payer and Medicare data," said Young. "Our conclusion is that ranking hospitals on mortality using Medicare data reflects performance on the same measures as using all-payer data."

In addition, the study announced the nation's new benchmark hospitals for cardiovascular performance. The 2006 list identifies 100 benchmark-setting hospitals in three categories: teaching with cardiovascular residency programs, teaching without cardiovascular residency programs and community. The list of winning hospitals is published in the Nov. 6 issue of Modern Healthcare magazine.

"The 100 Top Hospitals Cardiovascular winners bring great value to their communities," noted Chenoweth. "These hospitals have set national benchmarks for clinical process, outcomes and efficiency, as well as reasonable cost. These hospitals also meet volume standards for both percutaneous coronary interventions (PCIs) and coronary artery bypass grafts (CABGs)."

The annual Solucient study on cardiovascular services objectively measures performance against key criteria at the nation's top performing acute-care hospitals. Among the study's other findings:

• If peer hospitals (non-winners) provided the same quality of care as the 100 Top Hospitals facilities, survival rates could increase by more than 8,000 patients each year.
• Complications of care could also decrease in peer hospitals. Approximately 575 additional patients could be complication-free.
• The average 100 Top Hospitals Cardiovascular winner uses the recommended core measures standards for 95 percent of its AMI patients, compared with 93 percent at the average peer, or non-winning, hospital. Similar differences were seen for CHF patients.
• Both medical and surgical cardiovascular patients experience markedly higher survival rates at winning hospitals. For example, winning hospitals had 21 percent fewer deaths than expected for CABG patients while peer hospitals had only 1 percent fewer deaths than expected.
• Winning hospitals performed up to 80 percent more PCIs than their peers, and about 50 percent more CABGs. Previous research has shown that procedure volume is a critical factor in outcomes for cardiovascular patients.
• Benchmark hospitals are proving more efficient in treating cardiovascular patients. The average 100 Top Hospitals Cardiovascular winner discharges patients half a day earlier and at an average cost that is about 13 percent less than its peers.

• Teaching with cardiovascular residency programs, 30 winners
• Teaching without cardiovascular residency programs, 40 winners
• Community, 30 winners