The Hospital of the University of Pennsylvania has the highest mortality rate of any hospital in the state, according to a recently released statewide hospital assessment based on records from the year 2000.
In the report conducted by the Philadelphia Health Care Cost Containment Council, or HC4, an independent state agency, HUP had "higher-than-expected" death rates in five of 22 categories evaluated: vascular operations, blood infections, kidney failure, kidney and urinary tract infections and hip operations.
The survey covers virtually every hospital in the state and looks at a number of factors, including the amount of patients, length of hospital stay, cost and mortality rates. The hospitals are evaluated based on a "risk adjusted" technique.
"This technique uses data from patient medical records to determine severity of illness and other factors to calculate expected mortality rates, thus equalizing the complexity of each hospital," Joe Martin, a spokesman at HC4 said.
Under this criteria, HUP, as one of the more complex hospital facilities with a high number of critical patients, would be expected to have a larger number of patient deaths, and this was taken into account in the evaluation.
"What is noteworthy is that there are other academic hospitals such as Thomas Jefferson and Temple, which treat an equally large number of critical patients, but have lower rates," Martin said. "This raises a lot of questions."
According to HUP officials, however, the assessment may not have adequately measured some of the underlying factors contributing to the high rating.
"We believe that HC4 methodology underestimates the severity of illness of our patients," Rebecca Harmon, the official spokeswoman for the University of Pennsylvania Health System, said.
HUP receives a high number of critical patients from other hospitals in the area, and officials feel that the survey did not take these transfer patients into account.
"We aren't challenging the findings, but we have to consider whether the model accurately accounts for patient population," said Patrick Brennan, chief of health care quality and patient safety at UPHS. "We found that some factors were excluded from the analysis."
According to Brennan, HUP had the highest complexity level in the Delaware Valley at the time of the survey, yet was shown to have a lower level in the survey's results. Brennan added that the hospital also found many discrepancies in how patient death records were reviewed.
For example, some patients classified as Do Not Resuscitate, who are not considered accidental deaths, had been included in the survey.
Whether the survey will have a negative impact on the hospital's financial outlook -- Penn's health system's finances have been shaky in recent years, although they have begun to stabilize -- is yet to be seen. According to Robert Field, an industry expert and director of health policy at the University of the Sciences in Philadelphia, since insurance reimbursements are based on quality rankings, "this could make a bad financial situation even worse."
Brennan, however, seems to think it unlikely.
"We have received high rankings and performed well in countless other surveys," said Brennan, citing high rankings in past evaluations, including HUP's 14th place ranking in US News and World Report's "Best Hospitals" list for 2001.
HC4's mission in conducting the survey is largely consumer-oriented, trying to help customers find both a high quality of healthcare at an affordable price.
"We hope that HUP sees the data as an opportunity to look at these categories and process of care and try to understand what can be improved," Martin said.
And HUP officials say that they will continue to analyze the hospital's operation.
"It's a complex process," Brennan said of the hospital's ongoing efforts to review patient death records to assess quality of care. "We haven't found any problems. If we do, we'll fix them."
