Patient satisfaction and aggressive care don't necessarily go hand in hand, according to new hospital ratings prepared by Consumer Reports.

Drawing on government surveys compiled on the Hospital Compare web site and the Dartmouth Atlas of Health Care intensity index, the consumer ratings publisher has ranked the nation's more than 3,000 hospitals on its online health site, using the same red and black blobs familiar from ratings of cars or digital cameras.

Patient satisfaction covered eight categories, from cleanliness to communication, and intensity was measured by the number of tests conducted, doctors' visits made, procedures performed, and days spent in the hospital. Consumer Reports reverses how Dartmouth reports intensity, instead presenting aggressive care at the low end and conservative care at the high end of a spectrum from 1 to 100.

The top 28 teaching hospitals -- those that ranked significantly above the national average in patient satisfaction -- on average practiced more conservative medicine than 59 percent of hospitals, according to Dartmouth benchmarks for chronic care.

Brigham and Women's Hospital and Massachusetts General Hospital, the only two hospitals in the state to make the highest performers' list, were among the exceptions. The Brigham's Dartmouth score says it is more conservative than 29 percent of hospitals and Mass. General is more conservative than 18 percent on a spectrum where aggressive scores are low and conservative scores are high.

That stands in contrast to the Dartmouth-affiliated Mary Hitchcock Memorial Hospital in Lebanon, NH. Its overall patient satisfaction score of 81 is one point ahead of the Brigham and one point below Mass. General, but its Dartmouth score says its care is more conservative than 88 percent of hospitals.

"Mass. General does very well and so does the Brigham among better-performing hospitals. They are more toward the aggressive end of the spectrum, but what we try to communicate to folks is a more conservative approach doesn't lessen patient satisfaction," Dr. John Santa, director of the Consumer Reports Health Ratings Center, said in an interview. "It actually appears to be associated with a better experience."

By Liz Kowalczyk, Globe Staff

President Obama and members of Congress have cited high numbers of hospital readmissions as a main driver of soaring health care costs, as well as being bad for patients. Now, consumers can find out which hospitals have the highest -- and lowest -- readmission rates for three common conditions, heart attack, heart failure, and pneumonia.

The federal Centers for Medicare and Medicaid Services, which posted the information today on its website, says most Boston hospitals performed close to the national average between July 2005 and June 2008.

Massachusetts General Hospital was the only Boston hospital that scored better than average for any condition; 22 percent of Mass. General's heart failure patients are readmitted to the hospital within 30 days, compared with 24.5 percent of patients nationally.

Other hospitals fell below average on some of the measures. Tufts Medical Center scored worse than average for the readmission of heart failure patients, and Caritas St. Elizabeth's Medical Center scored below average for heart attack readmissions, Beth Israel Deaconess Medical Center was the only Boston hospital to score worse than average on all three measures. The hospital's highest readmission rate was for heart failure -- 27.5 percent of patients, compared with 24.5 percent nationally.

By Patricia Wen
Globe Staff

The child psychiatrist of 4-year-old Rebecca Riley, who died of an overdose of psychiatric drugs, will not be criminally prosecuted in the girl's death, clearing one of several legal hurdles that the doctor faces in connection to the child's death.

Plymouth County District Attorney Timothy J. Cruz today announced that a grand jury has declined to indict Dr. Kayoko Kifuji of Tufts Medical Center. Kifuji had treated the Hull girl for bipolar disorder and attention deficit hyperactivity disorder since she was 2. When the girl died on Dec. 13, 2006, she was taking three psychotropic medications.

While Rebecca's death cast a harsh spotlight on Kifuji and renewed calls for tighter restrictions on psychiatric drugs for children, Kifuji's lawyers have asserted that she was a compassionate clinician who ordered safe dosages of all medications. Kifuji has said it was the girl's parents who killed their child by dispensing the fatal levels of drugs. Michael and Carolyn Riley face murder charges for what prosecutors say was a pattern of over-medicating their daughter in an effort to sedate her.

Soon after Rebecca died, the Board of Registration in Medicine began an investigation, and Kifuji voluntarily suspended her practice.

"The next step for her will be the reinstatement of her license to practice medicine," said her lawyer, Bruce Singal of Boston, today.

Kifuji also faces a medical malpractice suit filed by the administrator of the girl's estate. In that case, Kifuji is accused, among other things, of poor oversight of the girl's medications and ignoring reports from Rebecca's school that she often seemed overly drugged and too tired.

The head of Tufts Medical Center became chair of the Massachusetts Hospital Association's board of trustees today at the group's annual meeting in Chatham.

Ellen M. Zane, Tufts president and CEO, succeeds Dale Lodge, president and CEO of Winchester Hospital.

Cambridge Health Alliance CEO Dennis D. Keefe is chair-elect (equivalent to vice-chairman), Lowell General Hospital president and CEO Normand E. Deschene is treasurer, and Massachusetts General Hospital president Dr. Peter L. Slavin is secretary of the hospital group.

There is a risk of miscarriage when doctors perform a test on pregnant women to see if their fetus has Down syndrome, a Tufts Medical Center obstetrician-gynecologist writes in today's Wall Street Journal.

Dr. Adam Wolfberg says he recently referred a patient to a more experienced doctor to do the test, called chorionic villus sampling for the cells a needle siphons from the placenta. He based his decision on reports that show the more CVS procedures a doctor does, the fewer miscarriages. The risk is estimated to be about 1 percent, higher than for amniocentesis, which is performed later in pregnancy.

That raises the question of how to acquire proficiency.

"CVS mavens got that way by practicing, so their present-day patients benefit at the expense of previous patients," Wolfberg writes.

Fewer than 100 doctors are trained in CVS in the United States each year, he writes, meaning there aren't enough doctors to meet demand. After performing his 15th supervised CVS, he is considered trained. None of his patients miscarried.

"I have colleagues who have done the procedure 1,500 times, but they are swamped and I probably won't refer my patients to them," he writes. "I'll do CVS myself."

By Liz Kowalczyk, Globe Staff

Tufts Medical Center has won approval as a major trauma center, a designation that will change where ambulances take some of the region's most critically injured patients.

Until now, Tufts in Boston's Chinatown neighborhood has been the only major Boston teaching hospital not approved as an adult trauma center. As a result, ambulances carrying victims of car accidents, falls, or violence often have bypassed that hospital for Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women's Hospital, or Massachusetts General Hospital, all state-designated trauma centers.

Some doctors at other Boston hospitals have argued that the city already has enough trauma centers, and that to spend several million dollars to open another one is a poor use of resources.

Women who called 911 for help with heart attack symptoms were more likely than men to experience delays in their care once emergency responders reached them, according to a study by Boston researchers conducted in Texas.

Writing in the journal Circulation, Thomas W. Concannon of Tufts Medical Center and colleagues from Harvard report that women in Dallas County, Texas, were 52 percent more likely to have a lag time of 15 minutes or more beyond the average 34 minutes it took emergency medical services workers to reach them and get them to a hospital.

Other studies have focused on differences in care once patients arrive at a hospital. This study tracked emergency calls made by 5,887 patients from January through December 2004.

"Although our analysis does not reveal why women were more likely to be delayed, previous research suggests a plausible explanation: symptom presentation in women with cardiac disease differs from that of men and a coronary event may not be recognized as readily by the patient or by EMS personnel," the authors write.

Making a distinction between ordinary sadness and clinical depression doesn't help patients, a Tufts professor of psychiatry says in an essay in today's New York Times.

Dr. Ronald Pies of Tufts University School of Medicine debates criticism that says psychiatry in recent years has medicalized normal sadness, increasing depression diagnoses and prescriptions for drugs to treat it. He says it's not so simple. The incidence of depression hasn't changed very much in recent decades, isolating the cause of depression isn't easy, and deciding when sadness crosses the line into a disorder hasn't become clear, he says.

"Most psychiatrists believe that undertreatment of severe depression is a more pressing problem than overtreatment of 'normal sadness,' " he writes.

Tufts Medical Center heard some praise and some reminders from four surveyors who finished a surprise visit from the Joint Commission last week.

"We have some processes to improve and some strengths on which to build," hospital management said in an e-mail message to employees and trustees.

A formal report will follow from the accrediting organization. Here's the e-mail:

Dear Medical Center Community:

Today was the final day of the Joint Commission's five-day survey of our Medical Center. Many of you met the surveyors and spent time with them, showing them the professional manner in which we deliver care here. Thank you to everyone for your welcoming attitudes, your professionalism, your honesty and diligence throughout their entire stay. The four surveyors - two physicians, a nurse and an engineer -- covered much of our Medical Center during the visit. They saw many best practices happening at our hospitals that they will now take to other organizations they visit. They also provided us with opportunities for learning and improvement. We have some processes to improve and some strengths on which to build. A few highlights: the surveyors complimented us on our Ticket to Safety in the OR, our hand hygiene campaign, our medication reconciliation initiative, the pediatric summary and problem list, our teamwork and our upcoming handoff pilot. They did not note one instance of poor hand hygiene or one problem with a patient's medication reconciliation. At the end of their visit, they communicated to us that this had been an outstanding survey. These are significant achievements and you should be very proud.

We will receive the official report concerning our survey in a few months. We met with all managers this afternoon to recap the survey; all managers will be holding staff meetings with their reports this week to provide an overview of the early survey findings. Once we have the official report we will review it in more detail with the managers and staff.

The surprise nature of their visit starting on a Wednesday reinforces to us all that we are charged with providing the highest level of quality care every day of the week, every week of the year. We owe nothing less to our patients and their families. The Joint Commission visit may be over, but our job of delivering exceptional care continues on. Keep up the good work.

The four of us want you to know that we are very proud to work with each and every one of you and sincerely thank you for your hard work during the visit and your dedication every day to our patients. It is a pleasure to be part of the Tufts Medical Center and Floating Hospital community with you.

Sincerely,

Ellen Zane, President and CEO
Margaret Vosburgh, Chief Operating Officer
David Fairchild, MD, Chief Medical Officer
Therese Hudson-Jinks, RN, Acting Chief Nursing Officer

A Boston hospital is in the middle of a mid-week surprise.

Surveyors from the national accrediting organization known as the Joint Commission showed up at Tufts Medical Center on Wednesday morning to begin their five-day study of about 250 measures of quality and safety.

Hospital inspections used to be anything but unexpected. Until 2000, even "random unannounced surveys" came with advance notice. Now hospitals have to be on their toes for 12 months, anticipating visits that come every three years.

"Typically they come on a Monday, so to show up on Wednesday, we were a little bit surprised," Dr. David Fairchild, the hospital's chief medical officer, said in a phone interview this morning, day 5 of the visit. "Their mantra is, 'We can come any time.' Our strategy is to be ready no matter what day they come. They could come back next week."