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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.

Author information

1
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut. Electronic address: judith.lichtman@yale.edu.
2
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
3
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
4
Department of Neurology, University of Kentucky College of Medicine and Kentucky Neuroscience Institute, Lexington, Kentucky.

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.

KEYWORDS:

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

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