Judging the quality of care at any given hospital can be difficult for consumers.

Only a limited amount of comparative data is publicly available, and healthcare professionals and others continue to debate whether that information provides an adequate gauge of quality.

What is available for Tripler Army Medical Center presents a mixed picture.

The hospital is fully accredited by the Joint Commission on Accreditation of Healthcare Organizations, the agency that evaluates the nation's hospitals, and Tripler's quality of care in individual treatment categories generally compares favorably to other major hospitals here, according to the commission's data.

In one of the categories, treatment of heart-failure patients, the picture is less favorable when Tripler is compared on a nationwide basis.

For the past three rating periods, Tripler has scored a minus — the lowest of three possible marks — in that category, compared with hospitals nationally, according to the commission's data. Tripler's latest minus mark was issued last month as part of the commission's quarterly quality-of-care evaluations, this one covering the one-year period ended in June 2005.

The repeated minus mark is significant, says Dr. Ashish Jha, a Harvard University assistant professor of health policy and an expert on hospital quality issues. "It suggests to me that there isn't enough attention being paid to these quality measures. That would not be comforting to me if I was a patient or one of my family members was there," Jha said.

The commission's evaluation system, despite its limitations, is the only comprehensive one that allows consumers to compare quality of care at military hospitals with care at other hospitals, military or civilian, and on a statewide or nationwide basis.

The U.S. Department of Health and Human Services has a similar system, but it does not include military hospitals.

The practices the commission reviews generally are relatively simple, inexpensive and proven effective (such as giving a heart-attack patient an aspirin upon arrival), and should be done by all hospitals, regardless of size, location or patient demographics, Jha said.

The Army Medical Command, which oversees Tripler, did not respond to written requests for comment on Tripler's ratings. In a general statement, Tripler officials said the hospital provides high-quality care and noted that outside inspectors have described its practices as the best anywhere.

In heart-attack care, the other broad quality-improvement category in which Tripler was assigned an overall rating, it received a checkmark, indicating that its performance was similar to that of most accredited organizations nationwide.

A minus rating means an institution's performance was below the level of most accredited hospitals, while a plus rating would indicate it was above. Tripler has been rated by the commission on quality improvement goals for only the past three periods. It scored no pluses in the latest period.

In heart-failure care, Tripler's rating was hurt because it provided sufficient discharge instructions to only 29 percent of 68 eligible patients, according to the commission. The commission measures what percentage of patients receive information about their condition and care when they leave the hospital.

On a statewide basis, Tripler's heart-failure rating was a checkmark, instead of a minus, meaning its performance was similar to that of most accredited hospitals here.

Hawai'i hospitals collectively did not score as well as their national counterparts in most of the treatments evaluated by the commission, which helps explain why Tripler compared more favorably on a statewide basis.

In all 11 of the treatments rated for heart-attack and heart-failure patients, for example, the local industry scored below the national averages, according to the commission's latest data. In five of the nine treatments for pneumonia patients, Hawai'i's average marks also failed to meet the national ones.

Using the nationwide standards, Tripler's overall marks were comparable to those of four of the Army's six other U.S.-based medical centers. The remaining two Army hospitals received higher ratings.

"Tripler basically seems on par with several of the hospitals, none of which are performing as well as they could," Jha said of the five Army centers with comparable marks. He reviewed the ratings at the request of The Advertiser.

Reach Rob Perez at rperez@honoluluadvertiser.com.