Ohio quality project shows success with cardiac health

Hospitals and business leaders put their heads together and lower the number of deaths caused by heart attacks.

By Andis Robeznieks, AMNews staff. Dec. 16, 2002.

Business leaders in the Dayton, Ohio, area retreated from their plan to publish hospital outcome data, and their efforts to launch a health plan with quality performance bonuses is moving forward at glacial speed. Yet despite these setbacks, they're getting credit for helping save 150 lives.

Working together, the Tri-River Employers Healthcare Coalition and five hospitals in the Greater Dayton Area Hospital Assn. helped reduce heart attack deaths by 36% in their community over three years.

"It's been a communitywide effort that I think is reproducible in other communities," said Stephen House, MD, director of clinical management at Kettering Medical Center. "We started looking at processes all along the line -- not just the ER and cardiology. Everyone looked at the whole process and said: 'Guys, we can do better than this.' "

Dr. House, who is the vice chair of the AMA's Organized Medical Staff Section, said there were opportunities for built-in excuses, such as serving a large population of Medicare patients with do-not-resuscitate orders. But he said pressure from the business community -- including talk of publishing hospital outcome data -- ignited the competitive nature of the physicians and led to positive results.

Business leaders "may have driven the process," Dr. House said. "If they weren't at the table, we may have looked at the data and said: 'Big deal, we have sicker patients.'

"But the whole threat of publishing hospital-specific data raised the bar and increased competition," he added. "All the hospitals got aggressively competitive, and the docs became competitive. Most of the doctors work at a specific hospital and thought: 'It's my hospital; I don't want it to look bad.' " [...]