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Brief Report
December 2018

Association of Rankings With Cardiovascular Outcomes at Top-Ranked Hospitals vs Nonranked Hospitals in the United States

Author Affiliations
  • 1Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts
JAMA Cardiol. 2018;3(12):1222-1225. doi:10.1001/jamacardio.2018.3951
Key Points

Question  Do US News & World Report top-ranked hospitals for cardiovascular care have better outcomes than nonranked hospitals?

Findings  In this cross-sectional study, US News & World Report top-ranked hospitals for cardiovascular care had lower 30-day mortality rates for acute myocardial infarction, heart failure, and coronary artery bypass grafting and higher patient satisfaction ratings compared with nonranked hospitals. However, 30-day readmission rates were either similar (for acute myocardial infarction and coronary artery bypass grafting) or higher (for heart failure) at top-ranked hospitals compared with nonranked hospitals.

Meaning  The observed discrepancy between readmissions and other performance measures raises concern that readmissions may not be an adequate metric of hospital care quality.

Abstract

Importance  The US News & World Report (USNWR) identifies the “Best Hospitals” for “Cardiology and Heart Surgery.” These rankings may have significant influence on patients and hospitals.

Objective  To determine whether USNWR top-ranked hospitals perform better than nonranked hospitals on mortality rates and readmission measures as well as patient satisfaction.

Design, Setting, and Participants  This national retrospective study evaluated outcomes at 3552 US hospitals from 2014 to 2017.

Exposures  US News & World Report 2018 to 2019 Cardiology and Heart Surgery rankings (top-ranked vs nonranked hospitals).

Main Outcomes and Measures  Hospital-level 30-day risk-standardized mortality and readmission rates for Medicare fee-for-service beneficiaries age 65 years or older hospitalized for 3 cardiovascular conditions: acute myocardial infarction (AMI), heart failure (HF), and coronary artery bypass grafting (CABG) as well as Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction star ratings obtained from publicly available Centers for Medicaid and Medicare Services data.

Results  Thirty-day mortality rates at top-ranked hospitals (n = 50), compared with nonranked hospitals (n = 3502), were lower for AMI (11.9% vs 13.2%, P < .001), HF (9.5% vs 11.9%; P < .001), and CABG (2.3%vs 3.3%; P < .001). Thirty-day readmission rates at the top-ranked hospitals (n = 50) when compared with nonranked hospitals (n = 2841) were similar for AMI (16.7% vs 16.5%; P = .64) and CABG (14.1% vs 13.7%; P = .15) but higher for HF (21.0% vs 19.2%; P < .001), Finally, patient satisfaction was higher at top-ranked hospitals (n = 50) compared with nonranked hospitals (n = 3412) (3.9 vs 3.3; P < .001).

Conclusions and Relevance  We found that USNWR top-ranked hospitals for cardiovascular care had lower 30-day mortality rates for AMI, HF, and CABG and higher patient satisfaction ratings compared with nonranked hospitals. However, 30-day readmission rates were either similar (for AMI and CABG) or higher (for HF) at top-ranked compared with nonranked hospitals. This discrepancy between readmissions and other performance measures raises concern that readmissions may not be an adequate metric of hospital care quality.

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