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Nothing But the Best?

For patients with acute MI, the best hospital may not be among "America’s Best."

The annual U.S. News & World Report rankings of "America’s Best Hospitals" are among the most visible of the rapidly proliferating reports that evaluate hospitals. Whether the hospitals ranked by U.S. News & World Report generate the best outcomes for patients with common conditions, such as acute MI, has not been closely examined. Using a methodology endorsed by the National Quality Forum, researchers assessed risk-standardized 30-day mortality rates (RSMRs) after acute MI in Medicare patients at 3863 American hospitals, 50 of which were ranked by U.S. News & World Report as "America’s Best" for cardiovascular disease, in 2003.

Overall, RSMR was lower among U.S. News & World Report-ranked hospitals than among non-ranked hospitals (16% vs. 18%). However, one third of ranked hospitals were not in the lowest national RSMR quartile, and four of them were in the highest quartile. Although a much larger proportion of ranked hospitals than of unranked hospitals (22.0% vs. 0.73%) had standardized mortality ratios that were significantly better than the national average, this category included more unranked hospitals than ranked hospitals (28 vs. 11).

Comment: On average, the hospitals that U.S. News & World Report ranks as "America’s Best" for cardiovascular care have lower adjusted acute MI mortality rates than do the hospitals that are not so ranked. Still, many hospitals with excellent outcomes (as measured by RSMR) are not included in this highly publicized list. This discrepancy is probably due to the fact that U.S. News & World Report’s rankings are based on a composite of both objective and subjective attributes that include risk-adjusted, in-hospital mortality rate; hospital infrastructure (which has only a limited association with outcomes); and an assessment of reputation culled from physicians. Editorialists point out that the difficulties in identifying superior hospital performance extend beyond the limitations of the U.S. News & World Report rankings, and that no rating of processes and outcomes should be interpreted in isolation. Ultimately, no hospital should become complacent because of a favorable rating, and all hospitals should strive to improve outcomes.

— Frederick A. Masoudi, MD, MSPH

Published in Journal Watch Cardiology July 25, 2007

Citation(s):

Wang OJ et al. "America’s Best Hospitals" in the treatment of acute myocardial infarction. Arch Intern Med 2007 Jul 9; 167:1345-51.

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O’Brien SM and Peterson ED. Identifying high-quality hospitals: Consult the ratings or flip a coin? Arch Intern Med 2007 Jul 9; 167:1342-3.

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• Medline abstract (Free)