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Joyce Dombrouski, chief executive of Providence St. Patrick Hospital, speaks to reporters in 2015 about the hospital's maternity ward. St. Pat's received an 'A' hospital safety grade from the Leapfrog Group this fall, it's fifth consecutive 'A' grade.

Officials at both Missoula hospitals say they were proactively taking steps to improve patient safety even before a recent health safety report card was issued by an organization that collects information on patient outcomes.

Officials at Community Medical Center in Missoula say the hospital has drastically cut the number of patients infected with a type of bacteria that can cause abdominal pain, diarrhea and sometimes a life-threatening inflammation of the colon.

And St. Patrick Hospital has implemented "value stream teams," which bring members from different departments into management teams centered on patient experience, safety and quality. The result has been a reduction in the rates of patients with all five categories of “hospital-acquired infections," according to officials there.

The Leapfrog Group recently issued its Hospital Safety Grades for 2,600 hospitals in the United States. For the fall of 2018, St. Patrick Hospital received an “A” grade while Community Medical Center received a “C” grade.

However, independent experts and some hospital officials caution that the grades by the Leapfrog Group shouldn’t necessarily be taken as the ultimate arbiter of how a hospital performs. The organization relies on data from the Centers for Medicare & Medicaid Services (CMS) and a survey that the hospitals themselves complete. Also, the organization collects money if a hospital licenses the Leapfrog brand to advertise a good grade, for example.

“It’s important to cultivate a healthy skepticism of rankings generally,” explained Micah Weinberg, the president of the Bay Area Council Economic Institute, a health care strategy consulting firm. “Leapfrog has a very funny name, but they’re a very well-established and well-respected group. These rankings are a real thing. It tells the hospital where their areas for potential improvement are, then big purchasers, private and public, can track progress in improving quality.”

Weinberg was recommended as an independent expert on hospital safety rankings by Cynthia Craft, the director of engagement at the Association of Health Care Journalists.

Part of the reason Community Medical Center didn’t get an A grade was because, according to the Leapfrog Group, there were more infections of a bacteria called C. difficile than expected, given the number of patients cared for on a daily basis and how widespread that type of infection is in the local community.

However, Dr. Nicole Finke, a pathologist and medical director of inpatient quality and laboratory at CMC, said the hospital had already drastically cut those infections before the grades were released.

“As part of our own self-evaluation and prior to receiving the Leapfrog ranking, CMC recognized an opportunity to address our C. difficile infection rate,” she said. “CMC promptly implemented a number of initiatives designed to enhance quality and patient safety.”

By reassessing the manner in which they identify, diagnose, treat and prevent C. difficile infections, Finke said they’ve cut the hospital-acquired C. difficile infection rate this year by roughly 75 percent compared to 2017.

“In 2017, we reported 20 C. difficile infections,” she said. “After implementing evidence-based best practices in the identification, diagnosis and prevention of hospital-acquired C. difficile infections, we have had five reported in 2018 with zero infections over the last five months. This drastic reduction in our infection rate speaks to our vigilance in enhancing patient safety.”

Finke said the Leapfrog Group is using data that is sometimes up to a year old for its rankings.

“Currently, there are a number of public reporting systems, including the Leapfrog Hospital Safety Grade, which evaluates hospital performance,” she said. “These systems use different quality measures, performance data and methodologies to calculate scores. As a result, a hospital may perform well on one report card and poorly on another."

She said patients should have all the information before making a judgment on a particular grade.

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"Because of these variations, the Hospital Safety Grade, as with any public reporting system, must be appropriately interpreted," she added. "For example, some of the data used to calculate hospital grades is outdated, up to a year old for the infection rates, and does not reflect more recent performance improvement efforts.”

In 2017, CMC received two “B” grades from Leapfrog.

Providence St. Patrick Hospital has received an “A” rating from Leapfrog five times in a row. Joyce Dombrouski, the chief executive for Providence Montana, said the rare achievement gives patients a “transparent view” of the hospital's safety culture and its efforts to protect patients from harm by meeting the "highest safety standards in the U.S."

“At Providence St. Patrick Hospital, we’re continuing our progress to ensure patient safety is part of our everyday work,” she said in an email to the Missoulian. “We have implemented many safety measures to prevent errors, and we continually test and review our processes. Everyone in the hospital —each one of us — has a strong commitment to speak up for safety.”

Dombrouski said providing performance data to reporting entities like Leapfrog allows the hospital's clinical and operational care teams to “gauge ongoing improvement in quality care and patient safety.”

“The rating provides a benchmark for our objective and comparative assessment,” she said. “While the premise of groups like Leapfrog are aligned with our commitment to continuously improve patient care, our physician leadership and hospital administration assess all the reporting bodies and focus on those that allow us to improve patient safety, quality and affordability of care.”

One of the categories that Leapfrog dinged St. Pat’s for was the number of mitral valve repair and replacement procedures. Leapfrog said its standard is that hospitals should perform 40 procedures annually to ensure that each surgeon meets the minimum surgeon volume. Leapfrog said St. Pat’s only performed 35 last year, but Dombrouski said the survey only collected numbers for isolated and percutaneous mitral valve surgeries. For all mitral valve procedures, she said St. Pat’s performed 45.

“Our outcomes are above average during the reporting period, with zero mortalities, zero infections and zero major complications,” she said.

Dombrouski also said the hospital has improved on hospital-acquired infections.

“St. Pat’s has a low infection rate in all five categories of Hospital Acquired Infections and zero infections in two of the categories (MRSA and colorectal surgical site infection),” she said. “And, since the time of this survey, our rates have continued to decrease.”

Additionally, she said St. Pat’s received a perfect score on quality and safety, called a Magnet designation, from the American Nurses Credentialing Center.

Erica Mobley, the director of operations at the Leapfrog Group, said her organization is continuously modifying its methodology.

She said patients shouldn’t look at the grades as a sign that it’s more dangerous at one hospital than another.

“Certainly a lot of hospitals get ‘C’ grades and it’s definitely something patients should be aware of. But no one should ever avoid a hospital in case of an emergency,” she said. “And even in ‘A’ hospitals, mistakes and errors still happen. We just advise patients to be extra vigilant regardless of what grades hospitals have.”

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