|
E-mail this page to a friend!
Senior Citizen Health & Medicine
Heart Attack Death Rates are Lower at ‘America’s
Best Hospitals’ Finds Study
Although study used ratings by U.S. News and World
Report, it is consistent with other professional studies
 July 9, 2007 - Individuals admitted for heart
attack to a hospital ranked as one of “America’s Best” by U.S. News &
World Report are less likely to die within 30 days than those admitted
to a non-ranked hospital, according to a report in the July 9 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals.
| |
Related Stories |
|
| |
Senior Citizens on Medicare Substantially Lower
Death Risk by Choosing 5-Star Hospitals
HealthGrades 2007 hospital-quality study looked a
40.6 million Medicare records
October 16, 2006
Quality Matters in Choosing a Hospital: Top-Rated
Have 28 Percent Less Deaths
HealthGrades says 'Quality Chasm' remains,
free list of best hospitals they found
January 29, 2007
Hospital Performance Guidelines for Heart Failure
are Failing Senior Citizens
Medicare & Medicaid pay-for-performance programs
may not work
January 2, 2007
Skyrocketing Hospital Medication Errors Can Be
Reduced 66%, Says New Study
Senior citizens most at risk as largest medication
consumers
June 27, 2007
Senior Citizens Can Now Learn More about Local
Hospital Services
Medicare improves Hospital Compare tools; adds
new information on cost of elective hospital procedures
June 21, 2007
Little Care Improvement by Hospitals in Medicare
Pay-for-Performance Program
Bonuses of $17.6 million were awarded to 238
hospitals in two years
June 6, 2007
Hospital Death Rates for Heart Attack, Failure in
Medicare Patients to be Published by CMS
Centers for Medicare & Medicaid Services provides
seniors 'Hospital Compare'
May 24, 2007
When Specialty Cardiac Hospitals Come to Town the
Rate of Heart Procedures Jumps
Questions raised about heart operations on marginal
patients
March 7, 2007
Read the latest news on Senior
Health & Medicine |
|
Using a methodology that is similar to the recently
released mortality measures that are publicly reported by the Centers
for Medicare and Medicaid Services (CMS), the study found that ranked
hospitals were also more likely to have lower-than-expected death
rates—however, many unranked hospitals did as well.
Senior citizens can lower their
death risk during a hospitalization by 69 percent by getting their
treatment at a top-rated hospital ("5-star") rather than a 1-star rated
hospital. This conclusion was released last October as part of the largest
annual study of hospital quality in America by HealthGrades. (See
sidebar for more.)
“Among the increasing number of academic, industry
and governmental profiling systems that evaluate and compare hospitals,
U.S. News & World Report’s annual issue of ‘America’s Best Hospitals’
for specialty and overall care is one of the most well known,” the
authors write as background information in the article.
“Despite their prominent role in the public arena,
the ability of the U.S. News & World Report rankings to identify
hospitals with excellent survival rates for common cardiovascular
conditions is not known.”
Oliver J. Wang, M.D., of Yale University School of
Medicine, New Haven, Conn., and colleagues assessed 30-day death rates
among 13,662 patients admitted to 50 hospitals ranked on the U.S. News
list as the best in “Heart and Heart Surgery” and among 254,907 patients
admitted to 3,813 unranked hospitals in 2003.
The researchers also compared the hospitals’
standardized mortality ratios, where a ratio of greater than one
indicates that the hospital had more deaths than expected and a ratio of
less than one means there were fewer deaths than expected.
After the researchers factored in patient
characteristics, the 30-day death rates were, on average, lower in
ranked hospitals vs. non-ranked hospitals (16 percent vs. 17.9 percent).
When the hospitals were divided into four groups based on these rates,
35 ranked hospitals (70 percent) were in the group with the fewest
deaths, 11 (22 percent) were in the middle two groups and four (8
percent) were in the worst-performing group.
Eleven ranked hospitals (22 percent) and 28
non-ranked hospitals (0.73 percent) had standardized mortality ratios
significantly less than one, meaning that although ranked hospitals were
more likely to have lower-than-expected death rates, non-ranked
hospitals with favorable ratios outnumbered ranked hospitals with
similar performance by nearly three to one.
“As a result, the U.S. News
& World Report ranking list does not include many hospitals that have
outstanding performances for the care of patients with acute myocardial
infarction,” or heart attack, the authors write.
One reason for this may be the reputation component
of the rankings, which accounts for one-third of the overall ranking
score and is based on cardiologists’ opinions of hospitals that provide
the best treatment, the authors speculate.
“Citations by cardiologists
likely favor tertiary centers with strong subspecialty care for the most
critically ill patients while not necessarily reflecting the perceived
care for the overwhelming majority of admissions for more common
diagnoses, which in turn have a more substantial impact on overall
hospital outcomes,” they continue.
“The U.S. News & World Report ranking, which
includes many of the nation’s most prestigious hospitals, did identify a
group of hospitals that was much more likely than non-ranked hospitals
to have superb performance on 30-day mortality after acute myocardial
infarction,” the authors conclude.
“However, our study also revealed
that not all ranked hospitals had outstanding performance and that many
non-ranked hospitals performed well. Consequently, although the U.S.
News & World Report rankings provide some guidance about the performance
on outcomes, they fall short of identifying all the top hospitals with
respect to 30-day survival after admission for acute myocardial
infarction and include a few hospitals that are actually in the lowest
quartile of performance.”
Editorial: Rankings Should Drive Quality Care
Although hospital rankings are now published by a
wide variety of governmental and non-governmental organizations, it is
unclear how useful they are to patients, write Sean Michael O’Brien,
Ph.D., and Eric D. Peterson, M.D., of Duke University, Durham, N.C, in
an accompanying editorial.
“A growing literature of methodological studies
presents a sobering picture for patients who would like to use available
quality information to identify hospitals with the best outcomes for a
particular condition,” they write.
“Most systems seem to do a reasonable
job at identifying groups of hospitals that perform well on average, yet
there is considerable uncertainty regarding the true performance of a
particular hospital. As noted, some truly exceptional hospitals will be
improperly rated as poor whereas some mediocre hospitals will be rated
as excellent.”
However, that does not mean that assessing hospital
quality has no role in medicine, they write. Hospitals ranked poorly
should take action, and those ranked highly should not boast or become
complacent.
“They need to understand the potential inconsistency and
fallibility of quality-ranking systems. And they need to realize that
regardless of their true rank, their goal should not be to merely beat
their peers in the ratings but to strive for optimum performance. In
this type of quality competition, the real winners are the patients,”
Drs. O’Brien and Peterson conclude.
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
