A federal survey shows that Hawai'i hospitals failed to provide adequate levels of treatment that is basic, yet critical, for heart attacks, heart failure and pneumonia.

Some of the care was as simple as giving patients aspirin or a vaccination.

The national survey measured the rates in which hospitals during the first half of last year provided widely accepted treatments for three of the most common causes of death.

In 10 of the 17 measures, Hawai'i hospitals collectively fell below the national average, including in eight of the 12 heart-care categories. The group achieved the desired compliance rate of 100 percent in only one area, testing blood oxygen levels of pneumonia patients.

Many Mainland hospitals also fell well short of the 100 percent goal in multiple categories, a finding that experts called alarming because the care is considered crucial and sometimes even lifesaving.

Officials from several local hospitals said the Department of Health and Human Services survey, which was released in April, reflects treatment information more than a year old. If another survey were taken today, they said, their numbers would be significantly improved, largely because the hospitals are paying greater attention to quality of care issues. That, in turn, is benefitting patients, they said.

The federal survey for the first time provides the public a relatively easy way to compare, albeit on a limited basis, quality of care at more than 3,500 hospitals nationwide, including 17 in Hawai'i. The institutions also can be compared with state and national averages.

The survey shows what percentage of a hospital's patients who should have received the recommended care actually got it, based on the hospital's records. Patients who suffered heart attacks, for instance, generally have a reduced risk of death if they are given an ACE inhibitor, medication for treating poor heart function, within 24 hours of the first symptoms of the attack. Yet only 67 percent of the Hawai'i heart-attack patients on average were given the medication, according to the survey.

Another example: Patients who receive pneumococcal vaccines are believed to have lower risks of pneumonia complications caused by bacteria, and the vaccines may prevent future infections, according to DHHS. Yet only 38 percent of pneumonia patients received the vaccine, the survey showed.

Health experts said Hawai'i residents should be concerned about the state's poor numbers.

"It's concerning because we're talking about simple, basic things that doctors and hospitals should be able to do very consistently," said Dr. Ashish Jha, a Harvard University assistant professor of health policy and management who published a study last month based on the federal data.

"The fact is too many hospitals have not put the systems in place that are necessary to ensure consistently high-quality care," he said.

Local hospital officials say patients in some cases received the basic treatment, but it wasn't sufficiently documented, leaving the inaccurate impression of a breakdown in care.

In other cases, physicians opted not to give the treatment for legitimate medical reasons, but sometimes those reasons weren't documented, again creating an inaccurate impression, officials said.

They acknowledged, however, that in some cases the care wasn't given because of shortcomings in a hospital's operations. A doctor may have been so busy that he or she forgot to order the treatment, or it was ordered but not delivered. Sometimes the patient simply refused the treatment

"If it's bad care, we need to know that. We can't hide it," said Dr. Todd Seto, director of a quality-enhancement program at Queen's Medical Center, Hawai'i's largest hospital.

Queen's, which as the state's only trauma center receives Hawai'i's most critically ill or injured patients, had among the poorest ratings of the large local hospitals. It scored below the national average in eight of the 15 categories in which it was rated.

The low numbers were due more to gaps in record-keeping than failure to deliver appropriate care, Seto said. But the records problem nonetheless reflects a quality-of-care issue, he added.

Queen's typically treats 1,500 to 2,000 patients annually for heart attacks, heart failure and pneumonia.

Like other institutions, Queen's has stepped up efforts to boost quality levels, and it has since improved its scores in all the survey categories except one, which already was at 100 percent, Seto said.

"The goal is to keep improving," he said. "We just want to do good care."

Executives at other institutions said the survey numbers reflected a more even split between record-keeping and care issues.

"It's not just documentation," said Kevin Roberts, president of Castle Medical Center.

O'ahu consumers who have used local hospitals said they believe having publicly available data to compare institutions will pressure some to improve their care.

"I think it's a good idea," said Nu'uanu resident John Zimmerman, 58, a retired merchant marine who suffered a stroke more than a year ago. "But take (the information) with a grain of salt. Don't just depend on one source."

Ian Rand, 57, a loan processor from Makiki, also liked the idea but cautioned against drawing conclusions from the initial survey. "If the federal government is doing it, it may need to be tweaked a couple more times."

The government intends to build on the Hospital Compare survey, including other measures of care, as a way to provide consumers with more information on selecting a hospital. Historically, hospitals have been reluctant to provide performance data to the public, but that is changing as more attention is focused on quality issues. Hospitals voluntarily report data for the Hospital Compare survey, but they get a bonus on Medicare payments in exchange.

The 17 measures surveyed have been backed by scientific studies and are widely accepted as effective treatments.

Industry experts noted that the survey results can differ substantially from hospital to hospital and therefore cautioned against using the state averages to draw conclusions about an individual institution.

Straub Clinic & Hospital, for instance, exceeded the national average in 11 of 12 categories in which it was rated, one of the best showings among local hospitals. Straub officials attributed the results partly to an organizational structure — almost all physicians there work for the same company — that is more conducive to coordination of care and a team approach.

Michael McInerney, director of analytic services for Mountain-Pacific Quality Health Foundation, which tracks quality-of-care issues in Hawai'i and two other western states, said he believes the quality in Hawai'i hospitals is comparable to the U.S. average, "but that isn't good enough."

McInerney said all hospitals should strive for 100 percent compliance to the Hospital Compare measures. "Why do even 5 percent (of patients) fall between the cracks? To me, that's fairly alarming," he said.

Some hospital executives said the survey results are not a precise measure of quality, only a guide that consumers can track to determine whether an institution is making progress.

"It's a wonderful tool for improving healthcare," said Castle's Roberts.

Reach Rob Perez at rperez@honoluluadvertiser.com.