Hospital Quality Metrics: "America's Best Hospitals" and Outcomes After Ischemic Stroke
Hospital Quality Metrics: "America's Best Hospitals" and Outcomes After Ischemic Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2018.10.022
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发表时间：
2019-02-01
影响因子：
2.5
通讯作者：
Goldstein, Larry B.
中科院分区：
文献类型：
--
作者：
Lichtman, Judith H.;Leifheit, Erica C.;Goldstein, Larry B.
背景：制定质量指标来评估医院级别的护理和结果在美国越来越受欢迎。 《美国新闻与世界报道》的“美国最佳医院”排名是现有的、流行的医院分析系统，但尚不清楚其报告中排名靠前的医院是否根据其他医院质量指标（例如医疗保险和医疗补助服务中心 (CMS) 公开报告的 30 天中风测量结果）获得更好的结果。方法：分析基于 2015-2016 年《美国新闻与世界报道》对神经内科和神经外科顶级 50 家医院的排名以及 2012-2014 年 CMS 医院比较数据。我们使用根据医院特征调整并按医院规模加权的混合模型来比较顶级医院和其他医院之间的 30 天风险标准化死亡率和再入院率。在 50 家排名靠前的医院中，我们确定排名顺序是否与 CMS 结果相关。结果：与其他 2737 家医院相比，排名前 50 的医院的 30 天死亡率较低（14.8% vs 15.3%），但再入院率较高（14.5% vs 13.3%）。这些模式在调整后的分析中仍然存在，顶级医院的死亡率降低了 0.72%（95% 置信区间 [CI] -1.09%，-.34%），再入院率提高了 41%（95% CI 0.16%，0.67%）。在顶级医院中，排名顺序与死亡率（每个排名死亡率下降0.05%，95% CI -.10%,.01%）或再入院（增加0.02%；95% CI -.03%，.06%）无关。结论：入住顶级医院的神经内科或神经外科与较低的 30 天风险标准化死亡率相关，但缺血性卒中后的再入院率较高。 50 家顶级医院之间的结果存在异质性。
Background: Developing quality metrics to assess hospital-level care and outcomes is increasingly popular in the United States. The U.S. News & World Report ranking of "America's Best Hospitals" is an existing, popular hospital-profiling system, but it is unknown whether top-ranked hospitals in their report have better outcomes according to other hospital quality metrics such as the Centers for Medicare and Medicaid Services (CMS) publicly reported 30-day stroke measures. Methods: The analysis was based on the 2015-2016 U.S. News & World Report ranking of the 50 top-rated hospitals for neurology and neurosurgery and 2012-2014 CMS Hospital Compare Data. We used mixed models adjusted for hospital characteristics and weighted by hospital volume to compare 30-day risk-standardized mortality and readmission between top-ranked and other hospitals. Among the 50 top-ranked hospitals, we determined whether ranking order was associated with the CMS outcomes. Results: Compared with 2737 other hospitals, the 50 top-ranked hospitals had lower 30-day mortality (14.8% versus 15.3%) but higher readmission (14.5% versus 13.3%). These patterns persisted in adjusted analyses with top-ranked hospitals having .72% (95% confidence interval [CI] -1.09%, -.34%) lower mortality and.41% (95% CI .16%, .67%) higher readmission. Among top-ranked hospitals, rank order was not associated with mortality (.05% decrease in mortality with each rank, 95% CI -.10%,.01%) or readmission (.02% increase; 95% CI -.03%, .06%). Conclusion: Admission to a top-ranked hospital for neurology or neurosurgery was associated with lower 30-day risk-standardized mortality but higher readmission after ischemic stroke. There was heterogeneity in outcomes among the 50 top-ranked hospitals.