LEBANON — A nonprofit that reviews hospitals across the nation based on safety has given Dartmouth Hitchcock Medical Center a grade of C, but hospital leaders said the grade is not reflective of the care patients are currently receiving.
Leapfrog Group, a watchdog based in Washington D.C., assigns grades to nearly 3,000 hospitals twice a year. The hospitals are graded based on 30 national performance measures from the Centers for Medicare and Medicaid Services, the Leapfrog Hospital Survey and information from other data sources.
Earlier this month, Leapfrog released its spring 2025 grades. Dartmouth Hitchcock Medical Center, or DHMC, is the only hospital in the Upper Valley to receive a grade.
Since 2022, DHMC had earned straight As, with the exception of one B last spring.
“No one likes to hear they got a C,” Dr. Michael Calderwood, chief quality officer at DHMC, said in an interview. “We take each of these as an opportunity to say, ‘What do we learn from this and how do we get better?’ ”
DHMC scored the same or better than it did in fall 2024 on most of the criteria Leapfrog evaluates. The dip in the hospital’s grade was caused by issues in four areas: the rate of central line-associated bloodstream infections, preventable infections that occur when bacteria enters the bloodstream through a central venous catheter; the rate of C. diff, a bacteria that causes diarrhea; its patient safety and adverse events composite score; and its death rate among surgical inpatients with serious treatable conditions.
The patient safety and adverse events composite score takes into account 10 measures, most of which have to do with mistakes and complications during or after surgery, and is the most heavily weighted factor in Leapfrog’s safety grade. DHMC scored poorer than it had in last fall on eight of the measures.
The stated purpose of the safety grades are to “reduce the over 200,000 yearly deaths from hospital errors and injuries by publicly recognizing safety and exposing harm,” Leapfrog’s website says. “A hospital may have the best surgeons and greatest technology in the world, but unless it is preventing infections and eliminating errors, it is not delivering on a very basic premise: ensuring the safety of you and your loved ones.”
Leapfrog gave a grade to six hospitals in Vermont: Southwestern Vermont Medical Center received a B; Brattleboro Memorial Hospital, Northwestern Medical Center, and Rutland Regional Medical Center all got a C; University of Vermont Medical Center got a D; and Central Vermont Medical Center an F.
Because both the University of Vermont Medical Center and Central Vermont Medical Center do not participate in Leapforg’s survey, the nonprofit assigned the hospitals low scores on some “practices to prevent errors” criteria. UVM Medical Center also had high rates of complications after surgery and Central Vermont Medical Center had a high rate of C. diff infection.
Of the 13 New Hampshire hospitals graded, four earned an A, one a B, six (including DHMC) received a C and two got a D.
At DHMC, Calderwood said the mediocre spring grade does not paint a full picture of the care patients are getting at this time. For one, Leapfrog’s hospital safety grade is based on information from 2021-2024, not current statistics.
“By the time Leapfrog comes out they’re looking at historical data,” Calderwood said. “This is data we have already acted upon.”
The hospital saw a spike in central line-associated bloodstream infections two winters ago and an increase in C. diff for a one-month period last year.
In both cases, DHMC leadership assembled a task force and decreased the complications within a handful of months, Calderwood said.
For example, by reducing the amount of time a patient is on a central line and adopting new technology, DHMC’s rate of central line associated bloodstream infections improved 49% by the end of last summer to the “lowest rates we’ve seen,” Calderwood said.
Similarly, through a focus on cleanliness, handwashing and training, the rate of C. diff improved 62% over a three-month period in 2024.
In regards to the poor patient safety and adverse events composite score and the higher death rate among surgical inpatients with serious treatable conditions, “the patients coming in to DHMC are going to have a higher risk of complication because of how sick they are coming in,” Calderwood said. “The patients we’re trying to bring in and give access to are the sickest patients in the region.”
As of December 2024, DHMC’s patient safety and adverse events composite score improved to reflect fewer patient safety and adverse events than would be expected based on the severity of the hospital’s patient population, Calderwood said. The death rate among surgical inpatients with serious treatable conditions also dipped below what is expected, but is still slightly higher than the national median.
Still, Calderwood is not discounting the data.
“We look at all of these numbers to see if there were preventable deaths,” he said. There have been no significant increases in preventable deaths over the past year at DHMC, Calderwood said.
Calderwood anticipates DHMC’s hospital safety grade from Leapfrog will rise again now that the hospital has made improvements.
“We’re always seeking to get to better because we’re learning new things,” Calderwood said. “That’s the reality of health care.”
Emma Roth-Wells can be reached at erothwells@ vnews.com or 603-727-3242.
