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J Stroke Cerebrovasc Dis. 2019 Feb;28(2):430-434. doi: 10.1016/j.jstrokecerebrovasdis.2018.10.022. Epub 2018 Nov 8.

Hospital Quality Metrics: "America's Best Hospitals" and Outcomes After Ischemic Stroke.

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Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut. Electronic address:
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Neurology, University of Kentucky College of Medicine and Kentucky Neuroscience Institute, Lexington, Kentucky.



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.


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.


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%).


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.


Medicare; ischemic stroke; mortality; quality of health care; readmission

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