Variation in quality between providers is a well established fact in the U.S. healthcare system. Each year HealthGrades studies the impact of this variation at the hospital level and its impact on the Medicare population. This research consistently illustrates that there continues to be large gaps in the quality of care between healthcare providers and that these differences contribute to preventable morbidity and mortality.
In this second annual report, HealthGrades recognizes those hospitals that have demonstrated superior clinical quality for the most consecutive years. These hospitals have been designated by HealthGrades as America's 50 Best Hospitals (A50B). Hospitals that qualify for this designation are those U.S. hospitals that have been designated by HealthGrades as Distinguished Hospitals for Clinical ExcellenceTM the most consecutive times from 2003 to 2008.
The HealthGrades Distinguished Hospitals for Clinical Excellence award is given annually to those hospitals that rank among the top five percent nationally for the lowest overall risk-adjusted mortality and inhospital complications across 27 diagnoses and procedures. Each year the Distinguished Hospitals for Clinical Excellence analysis is based on outcomes from a three year period. A50B hospitals are those hospitals that have been in the top five percent nationally and have been Distinguished Hospitals for Clinical Excellence award recipients for a minimum of five consecutive years.
To assess what it means to be a Distinguished Hospital for Clinical Excellence, HealthGrades recently released the HealthGrades Sixth Annual Hospital Quality and Clinical Excellence Study (released January 31, 2008). In this study, HealthGrades compared the clinical outcomes for Distinguished Hospitals for Clinical Excellence hospitals to all other U.S. hospitals for the years 2004, 2005, and 2006. Using 41 million Medicare patient records from 4,971 acute-care, non-federal, non-children's hospitals, HealthGrades evaluated how these 269 hospitals compare to all other U.S. hospitals in terms of clinical quality.
In the 2008 study, Distinguished Hospitals for Clinical Excellence outperformed all other hospitals across all 27 procedures and diagnoses studied. During 2004 - 2006, they had:
On average, five percent overall lower inhospital risk-adjusted complications associated with the nine procedures where inhospital major complications were the outcome of study.
Among the Medicare beneficiaries admitted to U.S. hospitals during 2004 - 2006, 171,424 lives may have been saved if all hospitals performed at the level of Distinguished Hospitals for Clinical Excellence. For the same time period, 9,671 patients may have avoided an inhospital major complication if they had been treated at Distinguished Hospitals for Clinical Excellence.
HealthGrades America's 50 Best Hospitals are those hospitals that have consistently ranked among the top five percent in the nation for clinical quality. These elite organizations represent the best of the best and set the quality standard for American hospitals.
In order to evaluate overall hospital performance and to identify the 50 best-performing hospitals in clinical excellence across the U.S., HealthGrades uses a three-step methodology process
The HealthGrades Sixth Annual Hospital Quality and Clinical Excellence Study concentrated on the 27 procedures and diagnoses for which HealthGrades has developed a predictive logistic regression model. The 27 procedures and diagnoses are as follows.
To help consumers evaluate and compare hospital performance, HealthGrades analyzes patient outcome data for virtually every hospital in the country (all hospitals with the exception of government/military hospitals). HealthGrades purchases the initial data from the Centers for Medicare and Medicaid Services (CMS). The Medicare data (MedPAR file) from CMS contained the 41 million inpatient records for Medicare patients. The ratings for 27 procedures and diagnoses are based upon the HealthGrades methodology.
The purpose of risk adjustment is to obtain fair statistical comparisons between disparate populations or groups. Significant differences in demographic and clinical risk factors are found among patients treated in different hospitals. Risk adjustment of the data is needed to make accurate and valid comparisons of clinical outcomes at different hospitals. Developing ratings involves two steps.
HealthGrades determines if the difference between the predicted outcome and the actual outcome was statistically significant. This is important because in healthcare, patients differ from one another with respect to their health status, demographics, and type of procedure performed. Risk factors include gender, age, specific procedure performed, and current health conditions such as hypertension, diabetes, and congestive heart failure. The risk adjustment used by HealthGrades takes these factors into consideration to make fair and accurate comparisons of hospitals based upon the types of patients treated.
The following rating system was applied to the data for all procedures and diagnoses:
In general, 70 percent to 80 percent of hospitals in each procedure/diagnosis are classified as three stars, with actual results statistically the same as predicted results. Approximately 10 percent to 15 percent were one-star hospitals and 10 percent to 15 percent were five-star hospitals.
Visit www.HealthGrades.com to view hospital ratings and to read the complete methodology white paper Hospital Report CardTM Mortality and Complication Based Outcomes 2008 Methodology White Paper.
For the Distinguished Hospital Award for Clinical ExcellenceTM, hospitals were segregated into two groups: teaching and non-teaching.
Teaching hospitals are identified by the following method: A hospital is designated by HealthGrades as a teaching hospital if they indicated they were a teaching hospital in their Medicare Cost Report, or if their IME (Indirect Medical Education) payment was at least one percent of their overall reimbursement, as indicated in the most recent year of MedPAR data. If a hospital indicated they were a teaching hospital but did not receive IME payment, they were contacted to confirm teaching status.
To be considered for the Distinguished Hospital Award for Clinical Excellence (DHA-CE), a hospital had to have had inhospital mortality or complication ratings in at least 20 of the 27 HealthGrades ratings using MedPAR data.
After creating a list of hospitals that met the above criteria, HealthGrades took the following steps to determine the DHA-CE recipients.
HealthGrades America's 50 Best Hospitals award recognizes hospitals for consistent excellence by identifying those hospitals that have received HealthGrades' Distinguished Hospital Award for Clinical ExcellenceTM (DHACE) designation for the most consecutive years.
The HealthGrades America's 50 Best Hospitals designation recognizes hospitals that have demonstrated superior and sustained clinical quality over an eight-year time period, based upon an analysis of tens of millions of Medicare patient records from 1999 through 2006 (the most current year available).
Recipients of the HealthGrades America's 50 Best Hospitals award were selected by identifying those hospitals that have received the HealthGrades Distinguished Hospital Award for Clinical ExcellenceTM (DHA-CE) the most consecutive times from 2008 and previous years. Hospitals that are recognized by HealthGrades' Distinguished Hospital Award for Clinical ExcellenceTM award rank among the top five percent nationally for quality.
As presented in HealthGrades Sixth Annual Hospital Quality and Clinical Excellence Study, Distinguished Hospitals for Clinical Excellence outperformed all other hospitals across all procedures and diagnoses studied. During 2004 - 2006, they had:
This year's study found that if all Medicare patients, who were admitted to U.S. hospitals between 2004 and 2006 with any of the 27 conditions studied, were treated in hospitals that performed at the level of Distinguished Hospitals for Clinical Excellence, 171,424 lives may have been saved and 9,671 patients may have avoided one or more inhospital major complications. Considering that this study evaluates just 27 diagnoses and procedures and looks at the Medicare population only, it is likely that this number is a gross under-estimation of the true numbers.
In conclusion, since 1999, America's 50 Best Hospitals have consistently out-performed all other hospitals in terms of risk-adjusted mortality and inhospital major complications. In this arena of transparency and accountability, it is important to look to these hospitals as benchmarks for an improved U.S. healthcare delivery system. For a nation where healthcare spending constitutes 16 percent of the Gross Domestic Product2, consumers should expect this level of quality from all hospitals and all hospitals should look to and learn from America's 50 Best Hospitals.
1) Health Insurance Cost. 2008 National Coalition on Healthcare. Available at http://www.nchc.org/facts/cost.shtml. Accessed 1/25/2008.
* Cannot be used without a Licensing Agreement from HealthGrades, Inc.
Some of the recipients of the America's 50 Best Hospital award have multiple locations that report under the same
Medicare Provider ID. In these cases, results for all locations were used in the analysis and each of the facilities is
designated as a recipient of the award.
Source: HealthGrades Second Annual America's 50 Best Hospitals Report (February 2008)
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