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Top-Ranked Hospitals Have Better Survival Rates

— U.S. News and World Report rankings not associated with fewer readmissions

Last Updated November 29, 2018
Ƶ MedicalToday

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Cardiology patients treated in hospitals at the top of U.S. News & World Report rankings had better survival rates, but not necessarily less risk of readmission, researchers found.

Thirty-day risk-standardized mortality rates were consistently lower among the top 50 U.S. hospitals in cardiology and heart surgery than at other centers, when looking at acute MI (11.9% vs 13.2%), heart failure (9.5% vs 11.9%), and coronary artery bypass grafting (2.3% vs 3.3%, all P<0.001).

However, top-ranked institutions didn't have better 30-day risk-standardized readmissions rates compared to other institutions that didn't rank in the top 50, reported Deepak Bhatt, MD, MPH, of Brigham and Women's Hospital Heart & Vascular Center in Boston, and colleagues, online in :

  • Acute MI: 16.7% versus 16.5% (P=0.64)
  • Heart failure: 21.0% versus 19.2% (P<0.001)
  • Coronary artery bypass grafting: 14.1% versus 13.7% (P=0.15)

"This disconnect between mortality rates and readmission outcomes at top-ranked hospitals, compared with nonranked hospitals highlight the ongoing uncertainty as to whether readmission rates are an adequate surrogate for quality of care, particularly for cardiovascular conditions, such as heart failure," Bhatt's group said.

"It is possible that top-ranked and nonranked hospitals have focused substantial resources on reducing readmissions rather than mortality rates, given the financial push of the Hospital Readmission Reduction Program, which resulted in generally similar readmission rates, but disparate mortality rates between these hospital groups," they suggested.

That program, HRRP, was intended to encourage hospitals to improve care quality for patients, even after discharge. But, the financial penalties it imposes have been criticized as leading hospitals to take shortcuts that actually increase mortality rates for conditions such as heart failure and pneumonia.

Defenders of the readmission penalties have argued that increasing post-discharge deaths in heart failure and pneumonia began well before the program was implemented between 2010-2012.

Bhatt's latest study included 3,552 U.S. hospitals, 50 of which were ranked by the U.S. News & World Report in 2017-2018.

Patient satisfaction was higher at these top-ranked hospitals, which averaged 3.9 out of 5 stars, which was rated by the Hospital Consumer Assessment of Healthcare Providers and Systems (based on publicly available Centers for Medicaid and Medicare Services [CMS] data from 2014 to 2018). This was in contrast with the mean 3.3 stars garnered by unranked hospitals (P<0.001).

Bhatt and colleagues acknowledged that the annual U.S. News & World Report rankings incorporate CMS data, which means that not all patients factor into these hospital rankings.

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    Nicole Lou is a reporter for Ƶ, where she covers cardiology news and other developments in medicine.

Disclosures

Bhatt reported grants from Amarin, AstraZeneca, Bristol-Myers Squibb, Roche, Eisai, Ethicon, Medtronic, Sanofi Aventis, Pfizer, Forest Laboratories/AstraZeneca, Ischemix, Amgen, Lilly, Chiesi, Ironwood, Abbott, Regeneron, PhaseBio, Idorsia, Synaptic, and The Medicines Company; unfunded research support from FlowCo, PLx Pharma, Novo Nordisk, Takeda, and Merck; serving on the advisory boards of Medscape Cardiology, Regado Biosciences, Cardax; serving on the board of directors of Boston VA Research Institute; being the deputy editor of Clinical Cardiology; working as a site coinvestigator for Biotronik, Boston Scientific, Svelte, and St Jude Medical (now Abbott); receiving honoraria from the American College of Cardiology; serving on clinical trial committees funded by Bayer and Boehringer Ingelheim; personal fees from Duke Clinical Research Institute, Mayo Clinic, Population Health Research Institute, Belvoir Publications, Slack Publications, WebMD, Elsevier, Society of Cardiovascular Patient Care, HMP Global, Harvard Clinical Research Institute (now Baim Institute for Clinical Research), Journal of the American College of Cardiology, Cleveland Clinic, Mount Sinai School of Medicine, and TobeSoft; nonfinancial support from American College of Cardiology, American Heart Association, and the Society of Cardiovascular Patient Care.

Primary Source

JAMA Cardiology

Wang DE, et al "Association of rankings with cardiovascular outcomes at top-ranked hospitals vs nonranked hospitals in the United States" JAMA Cardiol 2018; DOI: 10.1001/jamacardio.2018.3951.