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Acute heart failure is a growing problem among seniors. Do some California hospitals report more of this potentially deadly condition than others?
To find out, California Watch analyzed three years’ worth of computer data obtained from the Office of Statewide Health Planning and Development, a department of the California Health and Human Services Agency.
The data contains information on the health problems of every patient who was admitted to a state-licensed hospital – up to 25 different diagnoses as reported by the hospitals themselves using the World Health Organization’s ICD-9 coding system.
The data masks personal identifiers but contains basic demographic information. Our analysis focused on Medicare patients age 65 or older who were treated at major acute care, or general, hospitals.
Excluded were small hospitals that treated fewer than 300 patients per year and long-term acute care facilities. We also excluded managed care hospitals, including those of the Kaiser Permanente chain, because of fundamental differences in the way they are reimbursed for treating Medicare patients.
In the end, our analysis focused on data from 2008 through 2010 – capturing 2.24 million patients at 273 hospitals.
Using statistical data analysis software, California Watch identified every patient whose diagnosis contained one of the six ICD-9 codes for acute heart failure. The analysis then calculated the percentage of acute heart failure cases at each of the hospitals.
The analysis found that hospitals in the Prime Healthcare Services chain reported high rates of acute heart failure. Prime’s Chino Valley Medical Center had particularly high rates.
In October, California Watch provided Prime’s lawyer with a description of our methodology and requested comment on our findings.
The lawyer, Anthony Glassman, said in a letter that the heart failure diagnoses made by the chain were accurate. He said California’s Watch’s analysis was “faulty, unfair and biased.”
He said Chino Valley reported high rates of acute heart failure because a high percentage of its patients came from emergency departments and nursing homes; those patients were more likely to be suffering from acute heart failure, he wrote.
California Watch then did another analysis to control for the factors cited by Prime. The new analysis excluded patients from nursing homes and focused solely on patients admitted from the emergency room at more than 270 hospitals. That dropped about 850,000 patients out of the analysis, leaving 1.39 million patients remaining.
The acute heart failure rate at Chino Valley dropped only slightly and still was the highest in California, the analysis showed.