Abstract
Background: Developing quality metrics to assess hospital-level care and outcomes is increasingly popular in the United States. The U.S. News & World Report ranking of “America's Best Hospitals” is an existing, popular hospital-profiling system, but it is unknown whether top-ranked hospitals in their report have better outcomes according to other hospital quality metrics such as the Centers for Medicare and Medicaid Services (CMS) publicly reported 30-day stroke measures. Methods: The analysis was based on the 2015-2016 U.S. News & World Report ranking of the 50 top-rated hospitals for neurology and neurosurgery and 2012-2014 CMS Hospital Compare Data. We used mixed models adjusted for hospital characteristics and weighted by hospital volume to compare 30-day risk-standardized mortality and readmission between top-ranked and other hospitals. Among the 50 top-ranked hospitals, we determined whether ranking order was associated with the CMS outcomes. Results: Compared with 2737 other hospitals, the 50 top-ranked hospitals had lower 30-day mortality (14.8% versus 15.3%) but higher readmission (14.5% versus 13.3%). These patterns persisted in adjusted analyses with top-ranked hospitals having.72% (95% confidence interval [CI] −1.09%, −.34%) lower mortality and.41% (95% CI.16%,.67%) higher readmission. Among top-ranked hospitals, rank order was not associated with mortality (.05% decrease in mortality with each rank, 95% CI −.10%,.01%) or readmission (.02% increase; 95% CI −.03%,.06%). Conclusion: Admission to a top-ranked hospital for neurology or neurosurgery was associated with lower 30-day risk-standardized mortality but higher readmission after ischemic stroke. There was heterogeneity in outcomes among the 50 top-ranked hospitals.
Original language | English |
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Pages (from-to) | 430-434 |
Number of pages | 5 |
Journal | Journal of Stroke and Cerebrovascular Diseases |
Volume | 28 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2019 |
Bibliographical note
Publisher Copyright:© 2018
Keywords
- Medicare
- ischemic stroke
- mortality
- quality of health care
- readmission
ASJC Scopus subject areas
- Surgery
- Rehabilitation
- Clinical Neurology
- Cardiology and Cardiovascular Medicine