Compliance With Treatment Recommendations in Some Southern California Hospital Service Areas Among Lowest in U.S., Study Finds

A study that evaluated how hospitals in 40 regions across the country comply with care recommendations for heart failure, heart attack and pneumonia ranked hospitals in San Bernardino and Riverside counties among the lowest in the nation in adherence to the medical standards, the Los Angeles Times reports.

In addition, hospitals in the San Diego region ranked among the bottom five regions in the nation for heart failure and pneumonia treatment, while the Los Angeles area was the second-lowest region in the nation for treatment of pneumonia, the study found. Meanwhile, Orange County was in the bottom half of regions for treatment of all three conditions, according to the study, which was published last week in the New England Journal of Medicine.

No region in California ranked among the top five for treatment of any of the three conditions, the Times reports (Ornstein, Los Angeles Times, 7/28).

For the study, Ashish Jha, an assistant professor of health policy and management at the Harvard School of Public Health and colleagues examined data on care provided at more than 3,500 hospitals from the Hospital Quality Alliance, which includes CMS, the American Medical Association and 10 other organizations (California Healthline, 7/21). Researchers analyzed whether hospitals adhered to national standards shown to increase patients' chances of survival, such as administering antibiotics or monitoring oxygen levels in patients' blood (Los Angeles Times, 7/28).

The study found that hospitals nationwide did not comply with care recommendations for 19% of heart failure patients, 11% of heart attack patients and 29% of pneumonia patients (California Healthline, 7/21).

Overall, the study found that hospitals in the Northeast and Midwest did "far better" in adhering to the care standards than hospitals in the South and West, the San Diego Union-Tribune reports (Clark, San Diego Union-Tribune, 7/28). The study found that hospitals in the Northeast and Midwest ranked two to three percentage points higher than facilities in the South and West in compliance with care recommendations for heart failure and heart attack patients. Hospitals in the Midwest ranked the highest in compliance with care recommendations for pneumonia patients, the study found (California Healthline, 7/21).

Facilities in the 22-hospital San Diego region scored in the lowest 12% of hospitals nationwide in compliance with the care recommendations. The region ranked 31st out of the 40 regions for treatment of heart attack patients, 36th for heart failure treatment and 38th for pneumonia treatment.

Health care providers at hospitals in the region often failed to vaccinate pneumonia patients with a pneumococcal vaccine, which can prevent or reduce potentially life-threatening complications from the disease, the Union-Tribune reports. Furthermore, many hospitals in the region did not administer antibiotics to pneumonia patients within four hours of the patients being admitted.

The study also found that providers in the San Diego region frequently failed to administer an angiotensin converting enzyme inhibitor to congestive heart failure patients and often did not administer beta blockers to heart attack patients upon admission (San Diego Union-Tribune, 7/28).

The 21-hospital San Bernardino region, which included most of San Bernardino and Riverside counties, ranked last out of all regions for treatment of heart attack and pneumonia patients, the Times reports. The region ranked 34th for treatment of congestive heart failure patients.

However, there was "considerable variation" in treatment among hospitals and even within hospitals, according to the Times (Los Angeles Times, 7/28).