SEATTLE — The VA Puget Sound Health Care System mostly trailed the top performers in the Department of Veterans Affairs health care network in evaluations for overall quality of care over the past year-and-a-half, a newspaper reported Monday.

During that time, the Puget Sound system didn’t receive more than two out of a possible five stars for overall quality, The Seattle Times reported.

The Puget Sound VA has hospitals at Seattle and American Lake and seven outpatient clinics. It served nearly 89,000 patients in the past fiscal year.

The Puget Sound VA received some of the worst scores in a measurement of how many patients die in the hospital while receiving acute care. It often had a mortality ratio more than twice that of facilities that received five stars, and in the most recent quarter was nearly 75 percent higher.

The system also had far higher rates of pneumonia associated with the use of hospital ventilators. During the quarter that ended in June, that rate was more than 300 percent higher than the average for the five-star hospitals.

Puget Sound did have some standout reviews in patient safety areas. For both urinary-tract infections associated with catheters and antibiotic-resistant infections known as MRSA, Puget Sound had rates far lower than the five-star facilities. It also received three stars for efficiency.

VA officials say the evaluations of its hospitals are a learning tool not intended to rank performances for the public. They evaluate two dozen areas, including rates of patient mortality and hospital infections, as well as employee turnover and staff response times to calls.

The documents were obtained by The Seattle Times. The Department of Veterans Affairs does not disclose the reviews on public websites that display many other hospital-performance indicators.

The Puget Sound VA has been assessed in other, broader evaluations and scored high on many important clinical measurements, officials said.

The Puget Sound VA compares “very favorably” with Seattle-area hospitals, said William Campbell, VA Puget Sound’s chief of staff.

“There’s always room for improvements, but I am proud of what we have done here,” he said.

“We are continually creating challenging benchmarks that allow us to find opportunities to improve,” said Megan Streight, a VA regional official.

In the VA evaluation system, 12 of the 127 hospitals around the country earned five stars for quality during the three-month period that ended in March, according to Streight. Under the review system, all the other hospitals were assessed on each measurement on how they compared to a five-star facility.

The Puget Sound VA has had a harder time retaining workers than the top-ranked hospitals. During the past quarter, the turnover rates were more than 20 percent higher than at the facilities that received five stars.

In July, the federal Occupation Safety and Health Administration cited the Puget Sound VA for serious violations related to its safety procedures with patients suspected or confirmed to have tuberculosis.

Those violations included failing to ensure that employees used properly fit-tested, face-piece respirators when operating. Corrective actions were ordered.

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Information from: The Seattle Times, http://www.seattletimes.com