Hospital Quality Metrics: “America's Best Hospitals” and Outcomes After Ischemic Stroke

Judith H. Lichtman, Erica C. Leifheit, Yun Wang, Larry B. Goldstein

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

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 languageEnglish
Pages (from-to)430-434
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Volume28
Issue number2
DOIs
StatePublished - 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

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