Thirty-day mortality rates were lower and patient satisfaction was higher at the nation’s top-ranked hospitals for cardiology and heart surgery compared with unranked hospitals, according to a report published in JAMA Cardiology.
The national retrospective cross-sectional study was conducted from 2017 to 2018 and included 3,552 U.S. hospitals, with a focus on determining whether the 50 hospitals that U.S. News & World Report ranked as “Best Hospitals for Cardiology and Heart Surgery” performed better than the 3,502 unranked hospitals on mortality rates, patient satisfaction and readmission measures.
“Understanding whether [U.S. News & World Report] top-ranked hospitals perform better than nonranked hospitals on mortality rates and readmission measures is important given the significant influence that these rankings may have on patients and hospitals,” David E. Wang, MD, from Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, and colleagues wrote.
The researchers analyzed 30-day risk-standardized mortality and readmission rates derived from CMS data for patients who had acute MI or HF or underwent CABG. To assess patient satisfaction, the researchers used Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction star ratings. Researchers also divided the 50 top-ranked hospitals in quintiles based on rank.
For 30-day mortality rates, the ranked hospitals had lower rates for acute MI (11.9% vs. 13.2%; P < .001), HF (9.5% vs. 11.9%; P < .001) and CABG (2.3% vs. 3.3%; P < .001).
The ranked hospitals also had higher patient satisfaction compared with the 3,412 nonranked hospitals for which ratings were available (3.9 vs. 3.3; P <.001).
For 30-day readmissions, the ranked and unranked hospitals had similar rates in the acute MI (16.7% vs. 16.5%; P = .64) and CABG (14.1 vs. 13.7%; P = .15) groups, and the unranked hospitals had a lower rate in the HF group (21% vs. 19.2%; P < .001).
According to Wang and colleagues, the readmission discrepancy raises some concerns about whether it is an acceptable metric to determine hospital care quality.
“In recent years, financial incentives for hospitals to reduce readmissions following the enactment of the Hospitals Readmissions Reduction Program have been 10-fold to 15-fold greater than incentives to improve mortality rates and have resulted in significant declines in cardiovascular readmissions,” Wang and colleagues wrote.
In the quintile analyses, the 30-day morality rates were lower in the top 10 hospitals vs. the hospitals ranked between 41 and 50 in acute MI (10.5% vs. 12.5%; P < .001) and HF (8.2% vs. 10.7%; P = .001), but were similar in CABG (2% vs. 2.4%; P = .23), whereas 30-day readmission rates between the first and fifth quintiles had little variance (acute MI, 17.4% vs. 16.2%; P = .11; HF, 21% vs 20.5%; P = .73; CABG, 13.8% vs. 13.4%; P = .49).
Patient satisfaction favored the top quintile vs. the fifth quintile (4.2 vs. 3.8; P = .01).
“We chose to use [U.S. News & World Report] hospital rankings, which use CMS data to determine the rankings. Other hospital ranking systems use all-payer data, which capture non-Medicare patients and result in different hospital rankings than [U.S. News & World Report],” the researchers wrote. – by Earl Holland
Disclosures: Wang reports no relevant financial disclosure. Please see the study for all other authors’ relevant financial disclosures.