Circulation: U.S. News & World Report hospital rankings may need overhaul
The 50 hospitals ranked by U.S. News & World Report as “America’s Best Hospitals” in “Heart & Heart Surgery” are more likely than non-ranked hospitals to have a significantly lower than expected 30-day mortality rate for the treatment of heart failure, but there was much overlap in performance. The readmission rates for patients with heart failure were similar in ranked and nonranked hospitals, which suggests that the hospital factors that produce better mortality rates may not be the ones that are important for readmission, according to a study published Sept. 1 in Circulation: Cardiovascular Quality and Outcomes.

“Heart failure is the most common reason that people are admitted to the hospital for cardiovascular care,” said senior author Harlan M. Krumholz, MD, professor of medicine and outcomes researcher at Yale University School of Medicine in New Haven, Conn. “We conducted this study to determine whether the annually reported U.S. News & World Report list provides information that is similar or different than hospital national performance measures published by the Centers for Medicare & Medicaid Services [CMS].”

The researchers compared heart failure mortality and readmission rates at 50 ranked hospitals on the U.S. News list to outcomes of heart failure patients at about 4,700 nonranked U.S. hospitals using CMS’ 30-day outcomes report on heart failure.

Ranked hospitals, as a group, were more likely than nonranked hospitals to have low 30-day mortality rates after heart failure -- 10.1 percent versus 11.2 percent, respectively. However, these rates varied widely for both ranked and nonranked institutions, ranging from 7.9 percent to 12.4 percent for ranked hospitals and from 7.1 percent to 17.5 percent for nonranked hospitals.

“With this list, you’re identifying a group that on average does better, but some that are not better than average,” Krumholz said. “But none of the hospitals on the U.S. News & World Report list had below average quality measures when it came to heart failure mortality.”

However, those on the best hospitals list did not fare as well on readmission rates.

Average 30-day heart failure readmission rates were no different between ranked and nonranked hospitals in the study. The 30-day readmission rates ranged from 18.7 percent to 29.3 percent for ranked hospitals and from 19.2 percent to 29.8 percent for nonranked hospitals.

The readmission rate is another indicator of quality of care and an important consideration for heart failure patients because one in four heart failure patients is readmitted to the hospital within 30 days of discharge, according to Krumholz.

“The ways in which these hospitals are excelling in mortality do not seem to be transferring to excellence in transitioning people from being in the hospital to staying out of the hospital,” he said. “People referring to the list, for the most part, want to know about individual hospitals – not how hospitals have done as a group.

“The message from this study is that if you really want to know how a hospital compares in the areas of heart failure mortality and readmission, you should look directly at government statistics for those measures and not assume that only the hospitals on the list are the best in the care of heart failure patients.”

In fact, hospitals that are not routinely ranked and don’t have well-earned reputations can also achieve high quality of care, according to Clyde W. Yancy, MD, president of the American Heart Association (AHA) and medical director at Baylor Heart and Vascular Institute in Dallas. “We believe hospitals that use proven quality improvement initiatives, such as the AHA’s Get With The Guidelines program, which increases quality via adherence to evidence-based therapy, can achieve quality outcomes that rival any facility in the country.”