Hospital Ranking Linked to Mortality Rates, Patient Satisfaction
Top-ranked hospitals for CV care have lower 30-day mortality rates and higher patient satisfaction.
Compared with nonranked hospitals, the top-ranked hospitals by US News & World Report for cardiovascular care have lower 30-day mortality rates and higher patient satisfaction, according to a study published in JAMA Cardiology.
Investigators of this retrospective cross-sectional study sought to compare performance outcomes between the 50 top-ranked hospitals for cardiovascular care according to the US News & World Report vs nonranked hospitals, specifically assessing 30-day mortality and readmission rates and patient satisfaction ratings.
The study included 3552 US hospitals, including 50 top-ranked hospitals by US News & World Report between 2017 and 2018. Investigators extracted outcome data from the Centers for Medicaid and Medicare Services Hospital Compare Dataset for fee-for-service beneficiaries aged ≥65 years on risk-standardized 30-day mortality rates and readmission rates for 3 cardiovascular conditions (acute myocardial infarction, heart failure, and coronary artery bypass grafting). Patient satisfaction star ratings from the Hospital Consumer Assessment of Healthcare Providers and Systems were also obtained from publicly available data.
Compared with nonranked hospitals, 30-day mortality rates at top-ranked hospitals were lower for acute myocardial infarction (11.9% vs 13.2%; P <.001), heart failure (9.5% vs 11.9%; P <.001), and coronary artery bypass grafting (2.3% vs 3.3%; P <.001). Top-ranked hospitals had higher 30-day readmission rates for heart failure (21.0% vs 19.2%; P <.001) compared with nonranked hospitals (n=2841), and reported similar readmission rates for acute myocardial infarction (16.7% vs 16.5%; P =.64) and coronary artery bypass grafting (14.1% vs 13.7%; P =.15). When comparing patient satisfaction between top-ranked hospitals vs nonranked hospitals (n=3412), top-ranked hospitals received a higher average star rating (3.9 vs 3.3; P <.001).
One limitation to the study was using US News & World Report hospital rankings, which are based on Centers for Medicaid and Medicare Services data rather than all-payer data that includes non-Medicare patients, resulting in different hospital rankings.
The investigators concluded that the "discrepancy between readmissions and other performance measures raises concern that readmissions may not be an adequate metric of hospital care quality."
Multiple authors declared associations with the pharmaceutical industry. Please see the reference for a full list of authors' disclosures.
Wang DE, Wadhera RK, Bhatt DL. Association of rankings with cardiovascular outcomes at top-ranked hospitals vs nonranked hospitals in the United States [published online November 28, 2018]. _JAMA Cardiol. _doi: 10.1001/jamacardio.2018.3951