Mortality and readmission for patients with heart failure among U.S. News & World Report's top heart hospitals.
BACKGROUND
The rankings of "America's Best Hospitals" by U.S. News & World Report are influential, but the performance of ranked hospitals in caring for patients with routine cardiac conditions such as heart failure is not known.


RESULTS
Using hierarchical regression models based on medical administrative data from the period July 1, 2005, to June 30, 2006, we calculated risk-standardized mortality rates and risk-standardized readmission rates for ranked and nonranked hospitals in the treatment of heart failure. The mortality analysis examined 14 813 patients in 50 ranked hospitals and 409 806 patients in 4761 nonranked hospitals. The readmission analysis included 16 641 patients in 50 ranked hospitals and 458 473 patients in 4627 nonranked hospitals. Mean 30-day risk-standardized mortality rates were lower in ranked versus nonranked hospitals (10.1% versus 11.2%, P<0.01), whereas mean 30-day risk-standardized readmission rates were no different between ranked and nonranked hospitals (23.6% versus 23.8%, P=0.40). The 30-day risk-standardized mortality rates varied widely for both ranked and nonranked hospitals, ranging from 7.9% to 12.4% for ranked hospitals and from 7.1% to 17.5% for nonranked hospitals. The 30-day risk-standardized readmission rates also spanned a large range, from 18.7% to 29.3% for ranked hospitals and from 19.2% to 29.8% for nonranked hospitals.


CONCLUSIONS
Hospitals ranked by U.S. News & World Report as "America's Best Hospitals" in "Heart & Heart Surgery" are more likely than nonranked hospitals to have a significantly lower than expected 30-day mortality rate, but there was much overlap in performance. For readmission, the rates were similar in ranked and nonranked hospitals.
Mulvey
Gregory K
GK
Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
Wang
Yun
Y
Lin
Zhenqiu
Z
Wang
Oliver J
OJ
Chen
Jersey
J
Keenan
Patricia S
PS
Drye
Elizabeth E
EE
Rathore
Saif S
SS
Normand
Sharon-Lise T
SL
Krumholz
Harlan M
HM
D000368:Aged; D000369:Aged, 80 and over; D016507:Cardiology Service, Hospital / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology