National Rankings for Hospitals

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These data have limitations that people should be aware of when interpreting the data. Click here for more information.

The hospital rankings are computed using publicly reported data downloaded from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website (last accessed 4/18/2013¹).

Quality Measures

The Hospital Compare data set contains hospital-specific performance on process of care quality measures for over 4,500 hospitals nationwide². The quality measures show how often hospitals give recommended treatments that are known to get the best results for patients. The quality measures used to compute the rankings are drawn from four clinical topic areas: heart attack; heart failure; pneumonia; and surgical care. Information about these treatments is taken from patients' records. Hospitals voluntarily report their data, and some hospitals may not provide data for some topics or measures. For each measure the denominator is the number of eligible cases, and the numerator is the number of eligible cases where the recommended care was provided. CMS does not report data for a measure when the number of eligible cases is less than 11.

The hospital ranks presented here are determined by first calculating the overall performance rate for each hospital by summing the numerators and denominators over all topics for all measures in the measure set and reported for the facility. We rank hospital performance on this overall rate and then convert the ranks to percentiles.

Hospitals' performance on the quality measures has improved dramatically over time, with the result that for a number of measures the great majority of hospitals are achieving perfect or near perfect performance. Including these 'topped out' measures in the set of measures used to rank hospitals has the effect of obscuring the real performance differences between hospitals, and results in a situation where very small differences in overall performance on the quality measures produce large differences in hospitals' ranks. Therefore, we exclude two topped out measures, which we define as measures for which 50% or more of the hospitals have a performance rate of 100%, from our measure set.

Our hospital rankings are based on the set of 16 remaining quality measures, representing four clinical topic areas: heart attack; heart failure; pneumonia; and surgical care. We do not exclude any hospitals or measures based on the number of cases in the denominator. This means that for some hospitals the rankings are based on only a few eligible cases; and the rankings for these facilities should be interpreted cautiously.

HCAHPS

The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a national, standardized survey of patients' perspectives of hospital care. The survey asks a random sample of discharged patients 27 questions about their recent hospital stay. For each participating hospital results on 10 measures (six summary measures, two individual survey items and two global ratings) are publically reported on the Hospital Compare website³.

The national rankings presented here are based on the percentage of survey respondents who give the most favorable response for each of these measures. For each hospital these 10 response rates are averaged to get the mean most favorable response rate, hospitals are ranked based on this mean and then the ranks are converted to percentiles.⁴

Mortality and Readmission Measures

The Hospital Compare data set contains hospital-specific 30-day risk-standardized mortality and readmission measures for patients hospitalized for heart attack, heart failure, and pneumonia. These measures are produced from Medicare claims and enrollment data using statistical techniques that adjust for patient-specific characteristics and differences between hospitals in patient populations. The three mortality models estimate hospital-specific, risk-standardized, all-cause 30-day mortality rates for patients hospitalized with a principal diagnosis of heart attack, heart failure, and pneumonia. All-cause mortality is defined as death from any cause within 30 days, regardless of whether the patient dies while still in the hospital or after discharge. The three readmission models estimate hospital-specific, risk-standardized, all-cause 30-day readmission rates for patients discharged alive to a non-acute care setting with a principal diagnosis of heart attack, heart failure, and pneumonia. The mortality and readmission measures are based on three years of data.

The star ratings for mortality and readmissions presented here are based on hospitals' performance for each of the three conditions. The ratings are calculated by assigning hospitals a score for each condition, based on which quartile they fall in. Hospitals in the first quartile have the lowest risk-standardized rates and are assigned a score of 3; hospitals in the second quartile are assigned a score of 2; hospitals in the third quartile are assigned a score of 1; and hospitals in the fourth quartile, which have the highest risk-standardized rates, are assigned a score of 0. These ratings are averaged over the three conditions and the average scores are rounded to the nearest 0.5 and converted to stars.

¹ This currently includes data from the time period 7/1/2011 to 6/30/2012 for the Quality Measures and HCAHPS and 7/1/2008 to 6/30/2011 for 30-day mortality and readmissions. To obtain a copy of the database, go to: Hospital Compare and click on "Download Database".

² These Quality Measures are (* indicates topped out measures excluded from our analysis):

• Fibrinolytic medication within 30 minutes of arrival
• Statin prescribed at discharge
• PCI within 90 minutes of arrival
• *Aspirin at discharge

• Discharge instructions
• Assessment of Left Ventricular Function
• ACE Inhibitor for Left Ventricular Systolic Dysfunction

• Blood culture prior to first dose of antibiotics
• Appropriate Initial Antibiotic

• Preventative antibiotics within one hour before surgery
• Preventative antibiotics stopped within 24 hours after surgery
• Appropriate preventative antibiotic(s)
• Cardiac surgery patients with controlled blood glucose post surgery
• Patients on a Beta Blocker prior to arrival who received a Beta Blocker during the perioperative period
• Surgery patients whose urinary catheters were removed on the first or second day after surgery
• Treatment to prevent blood clots within 24 hours before or after selected surgeries
• Doctors ordered treatments to prevent blood clots for certain types of surgeries
• *Surgery patients with perioperative temperature management

³The HCAHPS Measures and the response levels reported by CMS are (most favorable responses are in bold):

• How often did nurses communicate well with patients? (Sometimes or Never; Usually; Always)
• How often did doctors communicate well with patients? (Sometimes or Never; Usually; Always)
• How often did patients receive help quickly from hospital staff? (Sometimes or Never; Usually; Always)
• How often was the patient's pain well controlled (Sometimes or Never; Usually; Always)
• How often did staff explain about medicines before giving them to patients? (Sometimes or Never; Usually; Always)
• Were patients given information about what to do during their recovery at home (No; Yes)
• How often were the patients' rooms and bathrooms kept clean? (Sometimes or Never; Usually; Always)
• How often was the area around the patient's rooms kept quiet at night? (Sometimes or Never; Usually; Always)
• How do patients rate the hospital overall? [on a scale of 1-10: 6 or lower (low); 7 or 8 (medium); 9 or 10 (high)]
• Would patients recommend the hospital to friends or family? (No, Probably; Definitely)

⁴For more details on hospital participation, the Quality Measures, and HCAHPS go to: Hospital Compare

Quality Measures for Hospitals

The hospital quality measures come from data collected and submitted by hospitals to the QIO Clinical Warehouse. Below is a list of the 19 measures used to calculate the hospital rankings. All are process measures with higher percentages indicating better performance.