Front page, bitches! Right below the masthead - good times.

(hopefully the pdf link works, I dunno...)

That's my third front-pager in three weeks. Among the Santa Barbara community, that practically makes me a C-list celebrity!

...C-minus?

...D-plus?

Fine. I hate you all.

But come, do the dance of joy with me! Loh, how my fortunes have turned around this quarter. Third-quarter Dickie is totally bending over second-quarter Dickie. Third-quarter Dickie is pulling a Lyndie England on second-quarter Dickie, holding him tethered to a leash while smoking a cigarette and smiling for the cam- ...alright, you get the picture.

So this is a piece assessing local SB hospitals for their quality of care. Translation: It's for old people. Ha! Old people. 'Never gets old, I tell ya. High entertainment. In fact, I would-

...

Waitaminute. Today's May 3rd. That means tomorrow...

Shit.

Scratch that last paragraph. Apparently, I've just joined the ranks of the geriatrics. I wrote this article just in time for my own Medicare benefits to kick in.

Crap. I hate getting holder. I effing hate it.

****************************************************


U.S. Web site compares Cottage, other hospitals

5/3/05
By DICKIE CRONKITE

Online consumer service gives S.B. facility mixed grade on treatment of heart ailments, pneumonia




NEWS-PRESS CORRESPONDENT

WASHINGTON -- A new government Web site aimed at helping consumers judge the quality of hospital care gave Santa Barbara Cottage Hospital a mixed report card for the treatment of heart ailments and pneumonia compared to thousands of other hospitals in the state and nation.

Cottage scored above average on 11 of 17 categories for which enough data was collected, including giving aspirin to heart attack patients and measuring oxygen in the blood of pneumonia patients.

But the hospital was below average on five other criteria, including administering preventative pneumonia vaccine and providing heart failure patients with instructions about future care of their symptoms.

Last week, the Santa Barbara City Council unanimously approved Cottage's estimated $413 million proposal to rebuild the hospital in the Oak Park neighborhood by 2013.

In the meantime, a Health and Human Services Department report shows the hospital can improve its care of patients with heart troubles or pneumonia.

"We are very supportive of this whole concept of making data available to people," said Dr. Robert Reid, director of medical affairs at Santa Barbara Cottage Hospital. "Whether they're indicative of the (hospital's) entire care is another thing ... but that said, it's a reasonable thing to do."


Santa Barbara Cottage, the county's largest hospital, reported about 38,000 visits to its emergency room last year and admitted more than 18,000 patients. The 366-bed hospital employs nearly 1,700 people.

In April, the federal department launched Hospital Compare, a free online service that provides detailed information on 4,200 Medicare-certified hospitals across the nation, including Cottage Hospital and four others in Santa Barbara County. To create the site, the Health and Human Services Department collaborated with various public and private organizations concerned with health care quality.

Out of the Web site's 17 categories, which cover specific treatment procedures for patients stricken by heart failure, heart attack or pneumonia, Santa Barbara Cottage Hospital had enough patients to offer a reliable picture for 11.

It beat or tied the state and national averages for five of those 11 treatment categories, according to the Web site. It lagged behind in another five, and beat the state but not the national average for a final category.

"They're all common conditions with great importance," said Dr. Terry Hill, medical director for quality improvement at Lumetra, an independent San Francisco-based organization that monitors health care quality in California. Cottage's results did not set off any alarms about patient care, Dr. Hill said. "I'm sure that it got their attention," he added.

The results reflect data collected for the first half of 2004. They will be updated each quarter.

While Goleta Valley Cottage Hospital and Santa Ynez Valley Cottage Hospital also posted data, their patient numbers in each category were too small to lend an accurate picture of their performance.

The most striking statistic in the Santa Barbara Cottage results showed that out of 83 patients deemed appropriate to receive a preventive vaccination for pneumonia, only six actually got it.

As of 2002, pneumonia ranked the seventh-leading cause of death in the United States, according to the Centers for Disease Control and Prevention.

But Dr. Reid said there's a reasonable explanation for Santa Barbara Cottage's lapse in these vaccinations.

Until recently, he said, patients over 65 were typically given the vaccination only during outpatient care -- for example, a doctor's appointment or walk-in clinic.

But a 2002 federal study found that hospitals were missing valuable opportunities to vaccinate elderly patients in the previous visits before they wound up hospitalized with pneumonia. In order to curb this problem, the study recommended hospital personnel verify that patients over 65 visiting the emergency room were properly vaccinated to prevent pneumonia.

"That kind of research really made everyone stand up and take notice," Dr. Hill said.

Because this vaccination procedure is in flux, the numbers are low across the country -- just 43 percent of patients deemed appropriate are receiving it. In California hospitals, that number plummets to 22 percent.

"It makes sense that this would score the lowest (for Santa Barbara Cottage)," Dr. Hill said. "It is in transition. Hospital Compare will help drive this change in process."


Added Dr. Reid: "Everybody's going to be 100 percent on that within a year."


The pneumonia vaccination isn't the only process in transition, according to Dr. Reid. "Part of it is learning to appropriately document so you get credit for what you do," he said. He attributed some of Santa Barbara Cottage's lower scores to lack of proper paperwork.

For instance, Hospital Compare showed Santa Barbara Cottage giving only 33 percent of heart failure patients the proper discharge instructions, or advice on managing symptoms once patients return home.

This was another category where both U.S. and California averages beat Cottage, although their percentages weren't much better, with the country scoring 45 percent and the state only 40.

"Everybody gets (the instructions), but unless you get a document you don't get credit," Dr. Reid said. He added that the hospital is trying to work with its physicians to get treatment down on paper.

Dr. Hill backed this up: "A number of hospitals weren't documenting appropriately, so they just couldn't prove it."


Dr. Reid said he thought documenting treatment wouldn't just improve the hospital's statistics on paper, but would also improve patient care.

"A lot of times when you feed data back to physicians, they're shocked to learn they didn't give (a certain treatment)," he said. "They may be failing to do it but not realizing it."


Santa Barbara Cottage also came up short compared with both the state and the nation in its percentage of patients shown to be given an ACE inhibitor drug, which is used to treat heart attacks.

Dr. Reid said physicians at Santa Barbara Cottage Hospital were treating many of their heart attack and heart failure patients with similar drugs called ARBs instead of the ACE inhibitor to get the same clinical results.

Dr. Hill confirmed that while ARBs are essentially the same as ACE inhibitors, they're not included in the data for the first half of 2004. Dr. Hill said they will be, however, included in future Hospital Compare data, and that Santa Barbara Cottage's numbers should subsequently rise.

Santa Barbara Cottage also scored below average in two categories relating to beta blockers: drugs that help lower blood pressure, treat chest pain, and prevent a heart attack. The hospital was found to have given a beta blocker upon arrival to only 70 percent of its 64 patients shown to need the treatment. This compared to 86 percent among state hospitals and 83 percent in the nation.

It didn't fare any better giving a beta blocker to patients who required the drug when the were discharged, giving the drug to only 69 out of 100 patients. California's hospitals scored an 83 percent, while the nation achieved 84 percent.

Dr. Reid again mentioned the need for proper documentation with these categories, and he predicted that the numbers would rise when the results are updated.

The Health and Human Services Department gives hospitals an incentive to report their results. The disclosure is voluntary, but in accordance with the 2003 Medicare Modernization Act, hospitals that don't report are now docked 0.4 percent of their annual Medicare financial reimbursement.

The department plans to expand the criteria beyond heart and pneumonia patient care. The next factor to be added probably will be surgical infection prevention, although the exact implementation date has not been set.


Dickie Cronkite writes from Washington, D.C., for Medill News Service.


HOW MARIAN SCORED

In contrast to Santa Barbara Cottage Hospital, Marian Medical Center's first-half 2004 results consistently beat the state's hospital average, according to the Hospital Compare Web site. Marian beat the national hospital average in all but one category -- the same pneumonia vaccination that hurt Santa Barbara Cottage's results. Marian vaccinated 40 percent of its 114 patients deemed appropriate.

"We work at it," said Dr. Chuck Merrill, an emergency medical physician at Marian. "It's good they're making people look at this."

He said Marian has a "care management team" that meets regularly to discuss quality improvement. "We might tweak a process that helps patients get antibiotics sooner -- we work with pharmacy and emergency departments."


Dr. Merrill said Marian's care management team predates the federal government's plans for the Hospital Compare program. "We've been working on this for over two years," Dr. Merrill said. "We are a crowded hospital, so we really want patients to get better and go home."


While he said Marian deserves its high rating, he acknowledged that proper documentation plays a big role in the Hospital Compare survey.

"We struggle with that, too. The commission is very strict on documentation guidelines," he said. "You're really comparing who documents as well as who provides the best care."