How good is the general hospital near you in carrying out standards set by the Health Ministry for performing angioplasty after a heart attack, advising heart attack patients to take aspirin regularly, performing a hip replacement after fracturing the bone, or giving preventive antibiotics within an hour after performing elective colorectal surgery? The Health Ministry’s annual report on these four quality indicators in all the country’s general hospitals – issued for the first time with individual medical centers’ performance listed by name – finds that “significant improvement” has been made.
Yet, in general, the indices here are lower here than in the US and other advanced countries, and there are gaps between the periphery and the center of the country, between female and male patients, and whether the patient was treated during the week or on weekends.
The report, covering 2013 and 2014, describes the situation in large, medium-sized, and smaller general hospitals.
A total of 14 performance indicators were established by the ministry’s service quality and safety administration to rate the hospitals’ performance, but only the first four are presented in the current report because data collection on the others has not yet been completed by the ministry.
Despite longtime opposition from hospitals to disclosure of their ratings – on the grounds that it could be misleading and that the medical centers are of varying size and conditions – it was decided to name names from now on.
The purpose, wrote ministry officials, is that it helps patients decide where to go for specific treatments (even though there is not always free choice), and it puts pressure on hospital managements to improve.
The ministry hopes publication of the first four indicators will lead to improvements in clinical conditions and raise the level of Israeli medicine when the next report is issued.
Deputy Health Minister MK Ya’acov Litzman said he intends to include in next year’s health-indicators report the waiting times for treatment in hospital emergency rooms, for medical treatment of various kinds in hospital outpatient clinics, and for an ambulance.
He added that he would also focus on the rate of nosocomial (hospital-acquired) infections that are commonplace.
The report was planned and written over the course of three years by ministry professionals headed by Dr. Anat Aka-Zohar, with a 14-member advisory committee and cooperation from the directors- general of 28 public general hospitals.
Outgoing ministry director- general Prof. Arnon Afek, who was actively involved in the report, said that the Organization for Economic Cooperation and Development rated Israel’s primary healthcare very highly, but recommended a few years ago that the nation’s hospitals be measured according to health-quality indicators.
The indicators by which the hospital system is rated – which are to increase by five additional ones per year – were chosen because how well a hospital does in meeting the goals is a direct reflection on the clinical results of treatment.
For some of the four initial indicators, the minimum satisfactory score was 70 percent to 95 percent, depending on how difficult it was to execute.
There were no hospitals that always excelled or always performed relatively poorly.
When judged by how many hospitals performed angioplasty (threading a thin tube through a blood vessel in the arm or groin up to the involved site in the coronary artery and then inflating a tiny balloon to open it if it is clogged with fatty plaque to restore blood flow), the minimum was set at 70%.
In 2013, the average rate of the general hospitals that carried out the procedure within 90 minutes of entering the emergency room’s doors was 68%, but by the following year, it rose impressively to 79%.
However, the 2014 figure was low compared to that in Britain (98%), the US (96%) and Ireland (95%); among older Israelis (82% among people up to the age of 64 and only 73% in those 65 and older; 71% among women compared to 80% in men; and 81% in the periphery of the country compared to 78% in the center.
Among the larger hospitals, Rambam Medical Center in Haifa scored the minimum of 70% and Sheba Medical Center reached 74% last year, while Hadassah-University Medical Center in Ein Kerem reached 95%; among middle-sized hospitals, Assaf Harofeh was way down at 52%, while Meir Medical Center in Kfar Saba excelled at 95%. Among the smaller hospitals, all rose above the minimum.
As for cardiologists in the wards recommending at the heart-attack victims’ release to take aspirin regularly to help reduce the risk of a recurrence, the target rate was 95%.
While Singapore excelled with 100% success and the US with 99.3%, Israel was satisfactory but lower at 96%. Here too, only 93% of Israeli women were given this advice, compared to 97% of the men.
Older patients of both genders were less likely than younger people (94% compared to 98% respectively) to get the necessary recommendation.
Patients in the periphery and in the center of the country were equally informed about taking aspirin.
Two of the country’s leading medical centers – Sheba and Tel Aviv Sourasky – failed to meet the minimum 95%, while among the medium-sizes ones, Bnei Zion in Hafa, Assaf Harofeh in Tzrifin, and Barzilai in Ashkelon failed, as did the Holy Family Hospital and the Scottish Hospital in Nazareth.
Fractured hip joints need to be replaced surgically within 48 hours; if not, complications such as deadly clots could occur. The minimum target set by the ministry was 80%. Here, too, Israel’s rating was only 79% compared to 94% in Denmark and 88% in England.
Older Israelis waited longer than younger people on average.
Women waited less (81%) than men (76%). Hospitals in the periphery were more likely to meet the minimum target (84%) compared to the center (78%).
Sheba and Hadassah-Ein Kerem were rated below the minimum at 60% and 72% respectively among the largest hospitals, with middle-sized Bnei Zion and Shaare Zedek below the minimum at 52% and 65% respectively, and Hadassah-Ein Kerem, Poriya in Tiberias, and Ziv in Safed below the minimum.
As to giving antibiotics to prevent infections after colorectal surgery, the target was 85%. The average rate was only 82% in Israel compared to 97.2% in the US. Eighty-two percent of older Israelis got the proper advice compared to 82% of patients under 65; 83% of women received the recommendation, compared to 81% of the men.
Hospitals in the center of the country were slightly more likely (82%) to give the advice than in the periphery (80%). Rambam, Barzilai, Wolfson, Bnei Zion, Kaplan, Assaf Harofeh and Shaare Zedek ranged (respectively) from 64% to 84% in carrying out instructions.
Shaare Zedek Medical Center director-general Prof. Jonathan Halevy told The Jerusalem Post that because it received many complex cases and had nearly to “take over” for the Hadassah-University Medical Center and treat many more patients during Hadassah’s months of strikes and sanctions, SZMC’s ratings were a bit lower than expected. However, he expects it will again be among those at the top in next year’s report.