Consumer Reports rates hospitals on aggressive or conservative late-life care

A magazine long known for rating cars and washing machines is branching out to hospitals, encouraging people to shop around for ones that provide "conservative" instead of "aggressive" care.

In the Sacramento region, the conservative list includes Woodland Healthcare, which sits atop Consumer Reports' local scale and is No. 2 statewide.

Relying on data already compiled by researchers at Dartmouth College, the service launched by Consumer Reports on Thursday uses a simple, if counterintuitive, yardstick:

For older people struggling with chronic diseases, too much medical care can be dangerous, said Dr. John Santa, director of Consumer Reports' new Health Ratings Center.

"Aggressive" hospitals keep people with chronic diseases hospitalized more days during the last two years of their lives. And doctors affiliated with aggressive hospitals see chronically ill patients more often.

"Conservative" hospitals provide the fewest doctor's visits and shortest hospitalizations in those final years of life.

"More care is not better care," said Dr. Philip Laughlin, vice president of medical affairs at Woodland Healthcare, a collection of medical offices and a 108-bed hospital in Yolo County.

"If anything, evidence suggests there is a negative correlation between quality and expenditure in health care," he said. "It's been demonstrated multiple times in numerous studies."

Aggressive treatment creates more potential for risky drug interactions, hospital-acquired infections and medical errors, Santa said.

"I would probably advise people to seek out aggressive care if they have a condition that is more treatable and they're not doing well; if they're younger; or if they have an unusual presentation of a disease that is treatable," he said. "People who are older, who have multiple chronic problems, have to be much more careful."

Santa stressed that the conservative-aggressive yardstick, which is the first of 15 or 20 measures the Consumer Reports ratings center hopes to offer, won't be helpful for everyone.

It would be completely irrelevant, he said, to a 20-year-old pregnant woman sizing up maternity wards, or to an otherwise healthy 50-year-old thinking about knee surgery.

But for older people with conditions such as congestive heart failure, cancer, dementia or diabetes with organ damage, the yardstick can be useful in deciding whether a hospital's treatment style matches their needs.

"Whether it's health or autos or electronics, patients and consumers deserve value," Santa said.

The Health Ratings Center joins an expanding array of rankings, grades and evaluations that compare hospitals or doctors. Some are buried in government reports, while others are assembled by nonprofit groups, consumers or businesses.

So many measures are springing up that the California HealthCare Foundation is "constantly playing catch-up," said the foundation's Maribeth Shannon.

The nonprofit group aims to consolidate federal, state, and other evaluations and summarize them online.

So far, though, not many people seem to be acting on such information. In a survey done for the foundation late last year, 2 percent of respondents said they had made health care decisions based on online ratings.

"Even though there's been a lot more information presented in the last three years, there aren't a lot more consumers using the information," Shannon said. "Finding a hospital is not on most people's 'to do' list."

Such ratings end up being useful in a different way, Shannon said, by driving low-ranked hospitals to improve.

Dartmouth research used by Consumer Reports evaluates hospitals nationwide and has concluded that aggressive care clusters in regions with many hospitals and lots of specialists. Researchers suspect that happens partly because health care providers are paid more when they do more, and because doctors unconsciously modify practices to their local medical realities. When more services are available, they use them.

Sometimes hospital beds and specialists are in such oversupply that it seems to actually hurt the quality of care, said Dr. David Goodman, one of the co-authors of the 2008 Dartmouth Atlas of Health Care.

In California, the most aggressive care is delivered in the Los Angeles area. The most conservative is in Santa Barbara.

The Sacramento area is relatively conservative on Dartmouth's scale, with hospitalizations ranging from 14 to 21 days and doctor's visits ranging from 43 to 59 in the final two years of life.

Although Rideout Memorial Hospital in Marysville shows up as most aggressive in the Sacramento region, so many complex factors can lie behind such statistics that "you have to take it with a grain of salt," said Dr. Robert Plass, chief medical officer of Fremont-Rideout Health Group.

"I'm very confident that we're providing appropriate levels of care, and that we are not keeping patients beyond how long they need to be in the hospital," Plass said.

Kaiser hospitals are not included in the Dartmouth scale because it is drawn from Medicare claims, and Kaiser is paid differently by Medicare. It doesn't generate the same kind of claims data.

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