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"America's Best Hospitals" in the Treatment of Acute Myocardial Infarction
Oliver J. Wang, MD;
Yun Wang, PhD;
Judith H. Lichtman, PhD, MPH;
Elizabeth H. Bradley, PhD;
Sharon-Lise T. Normand, PhD;
Harlan M. Krumholz, MD, SM
Arch Intern Med. 2007;167(13):1345-1351.
Background The ranking of "America's Best Hospitals" by U.S. News & World Report for "Heart and Heart Surgery" is a popular hospital profiling system, but it is not known if hospitals ranked by the magazine vs nonranked hospitals have lower risk-standardized, 30-day mortality rates (RSMRs) for patients with acute myocardial infarction (AMI).
Methods Using a hierarchical regression model based on 2003 Medicare administrative data, we calculated RSMRs for ranked and nonranked hospitals in the treatment of AMI. We identified ranked and nonranked hospitals with standardized mortality ratios (SMRs) significantly less than the mean expected for all hospitals in the study.
Results We compared 13 662 patients in 50 ranked hospitals with 254 907 patients in 3813 nonranked hospitals. The RSMRs were lower in ranked vs nonranked hospitals (16.0% vs 17.9%, P<.001). The RSMR range for ranked vs nonranked hospitals overlapped (11.4%-20.0% vs 13.1%-23.3%, respectively). In an RSMR quartile distribution of all hospitals, 35 ranked hospitals (70%) were in the lowest RSMR or best performing quartile, 11 (22%) were in the middle 2 quartiles, and 4 (8%) were in the highest RSMR or worst performing quartile. There were 11 ranked hospitals (22%) and 28 nonranked hospitals (0.73%) that each had an SMR significantly less than 1 (defined by a 95% confidence interval with an upper limit of <1.0).
Conclusions On average, admission to a ranked hospital for AMI was associated with a lower risk of 30-day mortality, although about one-third of the ranked hospitals fell outside the best performing quartile based on RSMR. Although ranked hospitals were much more likely to have an SMR significantly less than 1, many more nonranked hospitals had this distinction.
Author Affiliations: Departments of Medicine (Drs O. J. Wang, Bradley, and Krumholz) and Epidemiology and Public Health (Drs Lichtman, Bradley, and Krumholz) and the Robert Wood Johnson Clinical Scholars Program (Drs Bradley and Krumholz), Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven (Drs Y. Wang and Krumholz); and Department of Health Care Policy, Harvard Medical School, and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts (Dr Normand).
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Arch Intern Med. 2007;167(13):1342-1344.
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