Two new studies in the latest New England Journal of Medicine found that hospitals have improved but still have some distance to go in making sure cardiac and pneumonia patients get basic measures, and whether a particular patient is treated correctly may depend on where the patient lives.

Patients who arrive at the hospital with a possible heart attack, congestive heart failure, or pneumonia benefit from certain standardized treatments—aspirin and a beta blocker for heart-attack patients, for example, and an antibiotic within 24 hours for pneumonia patients.

The good news on treatment came from researchers at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which certifies hospitals. Looking at how well hospitals complied in 2002 and then in 2004 with recommended guidelines for the three conditions, they found marked improvement in 15 of 18 individual measures in the guidelines. The largest improvements were at hospitals that were the worst two years before.

In the other study, researchers who examined the records of more than 3,000 hospitals discovered that nearly all heart-attack patients treated in the first half of last year received aspirin when they were admitted, for instance. Compliance wasn't as good—generally from about 75 percent to 87 percent—for other heart-attack and heart-failure measures.

Even worse, hospitals only vaccinated 43 percent of pneumonia patients before they were discharged.

"A lot of physicians disagree with the need to do it in the hospital," says Patrick Romano, a professor of medicine and pediatrics at the University of California–Davis, who wrote an accompanying editorial. "They say they'll see the patient in the office the week after they leave the hospital." The problem, he says, is that patients don't always keep their follow-up appointment.

The largest differences in the percentage of patients who got the recommended treatment were geographical. Hospitals in the Midwest and Northeast were more diligent than those in the South and West. Among the 40 largest "referral regions," hospitals in the San Bernardino, Calif., region were at the bottom in treating heart attacks and pneumonia (those in Boston and Oklahoma City were best) and those in the Lexington, Ky., region were worst in congestive heart failure (Boston excelled).

Data on compliance by hospitals along with the guidelines for the three conditions can be found at www.jcaho.org and www.hospitalcompare.hhs.gov.