Patients on average rate their experiences at Hawai'i hospitals lower than the national average, according to a new federal survey.

In Hawai'i, 58 percent said they "would definitely recommend" their hospital, compared with the national average of 68 percent.

The national Hospital Consumer Assessment of Healthcare Providers and Systems survey asked patients about 10 measures of care, including communication with doctors and nurses, whether their help calls were answered promptly, if their rooms were clean and whether the area around their room was quiet at night.

About half of the Hawai'i patients gave their hospital an overall rating of 9 or 10 on a scale of 10, while 16 percent gave a rating of 6 or lower.

The survey is a new component of the recently updated Hospital Compare Web site provided by the Centers for Medicare & Medicaid Services. The survey was developed by the centers and the Agency for Healthcare Research and Quality.

Hospital Compare offers information on clinical quality measures, such as the percentage of heart attack patients who were given aspirin upon arrival, the percentage of surgery patients who received preventive antibiotics one hour before incision, and the percentage of pneumonia patients given the most appropriate initial antibiotics.

Consumers also can access information based on a type of surgery or procedure, such as angioplasty, hip replacement or gall bladder removal.

Hospitals voluntarily submit their performance information on the clinical quality measures, receiving a 2 percent incentive on their Medicare payments for doing so.

Seventeen Hawai'i hospitals participated in the Hospital Compare program, but not all provided data for every category.

For example, three of the state's largest hospitals — The Queen's Medical Center, Kapi'olani Medical Center for Women and Children and Straub Clinic & Hospital — did not participate in the patient-assessment survey but did provide information regarding clinical standards.

In many cases involving smaller facilities, such as Wahiawa General Hospital and Molokai General Hospital, patient numbers were too small to provide meaningful data.

CLINICAL STANDARDS

At all of the reporting facilities, the death rates from heart attack, heart failure or pneumonia were no different than the national rate.

The differences in clinical standards among local hospitals in treating heart attack, heart failure, pneumonia and surgical patients did not vary greatly except in a handful of instances, and the Hawai'i facilities for the most part were within range of the national average.

"Most times, the differences are not significant and are within the range of reasonableness," said David Sayen, regional administrator for the Centers for Medicare & Medicaid Services.

Results of the Hawai'i patient-assessment survey show that two-thirds said nurses "always" communicated well during the patient's hospital stay, explained things clearly, listened carefully to the patient and treated the patient with courtesy and respect; three-quarters said the same about their doctors.

Only 55 percent said they were always able to get help quickly when they used the call button or needed help getting to bathroom or using a bed pan, and 62 percent said their pain was always well controlled and that hospital staff did everything they could to help with their pain.

Only 56 percent of patients said that when given medicine they had not taken before, the staff always explained what it was for and the side effects.

Two-thirds said their room was always clean, and three-fourths said staff always discussed the help they would need at home as they were getting ready to leave the hospital or got written information about symptoms or health problems to watch for during recovery.

WAIMEA FACILITY TOPS

Although when taken together, the participating Hawai'i hospitals didn't do as well as the national average, North Hawaii Community Hospital in Waimea on the Big Island got marks well above other hospitals in the state and nationally.

The community-owned, nonprofit 40-bed facility trumpeted the patient survey results, saying it rated in the top 10 percent of hospitals nationwide.

"The thing that made this one important to us is that it's a patient survey, and when your patients are telling you you're doing a good job, you want people to know it," said Paul Dunne, vice president of fund development and marketing.

He said the small hospital is known for its strong patient relations.

North Hawaii Community Hospital took a hit in July when it laid off 59 employees, but Dunne said some have been rehired and staffing levels remain above national recommendations.

"The other piece is that we're a blended-medicine hospital that offers holistic services. Patients can get Healing Touch or reiki or one of the other healing services done before surgery, and we've gotten tremendous feedback from that," Dunne said.

Although some question the validity of various hospital rating systems, Dunne said they can be helpful to administrators by "challenging us to raise the bar in areas that need improvement."

"It helps consumers and allows us to keep our eye on certain benchmarks."

The financially troubled Hawaii Medical Center East in Liliha and Hawaii Medical Center West in 'Ewa Beach received the lowest results in the Hospital Compare patient-assessment survey and in some areas of clinical standards.

Chief implementation officer Salim Hasham said different surveys produce different results.

"This study conducted by the Centers for Medicare & Medicaid Services provides us useful information to continue to improve services for our patients, medical staff and the community, as do other similar surveys. Our results in these surveys have varied and, in many cases, Hawaii Medical Center has scored medium to high in different categories," he said in an e-mail.

The physician-owned company, which purchased both facilities from St. Francis Medical Center in 2007, entered Chapter 11 bankruptcy in August after amassing $21.8 million in debt and laid off more than 300 workers.

HMC East, licensed for 188 beds, and HMC West, with 102 beds, each are averaging 50 beds in use daily, officials said.

CONSUMERS UNAWARE

Consumers have yet to take full advantage of Hospital Compare and other rating services, and don't appear to have much faith in the data, according to a recent survey by the Kaiser Family Foundation.

Only two in 10 Americans have seen information comparing the quality of different hospitals in the past year, and fewer than one in 10 said they used the information to make a healthcare-related decision, the foundation survey reported.

Only 6 percent said they were aware of the Hospital Compare Web site.

Even those who are aware of hospital ratings indicated they favor familiarity over expert ratings. Nearly 60 percent said they would choose a hospital that is familiar to them rather than a higher-rated facility.

"We know that not very many people use comparative tools to use healthcare," Sayen said. "The most important function of these services is that they generate improvement across the board because the institutions look at them and boards and government agencies look at them.

"It provides more transparency into how hospitals operate. In the past, it was kind of a black box."

Sayen said he finds it puzzling that consumers do more research before buying a car or renting a video than picking a hospital.

"We think empirical data about the quality of service and clinical appropriateness is something you can't ignore. In the future, it will become the norm," he said.

Many patients experiencing medical emergencies or who live in areas, such as Maui, that are serviced by a single hospital don't have a choice about where they are treated. But Sayen said, "That doesn't mean people don't have a choice to ask questions about the kind of care they are getting."