Does lay media ranking of hospitals reflect lower mortality in treating acute myocardial infarction?
BACKGROUND
Ranking of hospitals by lay media has attracted widespread attention but may not accurately reflect quality. Acute myocardial infarction (AMI) mortality is a straightforward measure of clinical outcome frequently used by ranking algorithms.


OBJECTIVE
Our aim was to assess whether ranking among top hospitals correlated with lower in-hospital risk-adjusted mortality following admission for AMI.


METHODS
Using a hierarchical regression model and the comprehensive nationwide database of hospital AMI admissions from 2004 to 2007 in France, we analysed crude and risk-adjusted hospital mortality rates in the ranked ('best') hospitals versus non-ranked hospitals. We subsequently restricted the comparison to non-ranked hospitals with matching on-site facilities.


RESULTS
We analysed 192,372 admissions in 439 hospitals, 43 of which were in the ranked group. Patients admitted to the 396 non-ranked hospitals tended to be older with more comorbidities and underwent fewer revascularization procedures than patients admitted to ranked hospitals. Between hospital differences accounted for 10% of differences in mortality. Crude mortality was lower in ranked versus non-ranked hospitals (7.5% vs. 11.9%; P<0.001). The survival advantage associated with admission to ranked hospitals was reduced after adjustment for age and sex (5.7% vs. 6.4%; P=0.087) and comorbidities (4.9% vs. 5.5%; P=0.102).


CONCLUSIONS
Ranked hospitals have similar adjusted AMI mortality rates to those not ranked and patient characteristics rather than hospital differences account for the variation in outcomes.
AP-HP, URC Eco and UPEC EA 4393, Paris, France.
Karine
K
Chevreul
Amélie
A
Prigent
Isabelle
I
Durand-Zaleski
Philippe Gabriel
PG
Steg
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008402:Mass Media / Q000639:trends*; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D010343:Patient Admission / Q000639:trends; D011379:Prognosis; D019984:Quality Indicators, Health Care / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors