Background "America's Best Hospitals," an influential list publishedannually by U.S. News & World Report, assesses the qualityof hospitals. It is not known whether patients admitted to hospitalsranked at the top in cardiology have lower short-term mortalityfrom acute myocardial infarction than those admitted to otherhospitals or whether differences in mortality are explainedby differential use of recommended therapies.
Methods Using data from the Cooperative Cardiovascular Projecton 149,177 elderly Medicare beneficiaries with acute myocardialinfarction in 1994 or 1995, we examined the care and outcomesof patients admitted to three types of hospitals: those rankedhigh in cardiology (top-ranked hospitals); hospitals not inthe top rank that had on-site facilities for cardiac catheterization,coronary angioplasty, and bypass surgery (similarly equippedhospitals); and the remaining hospitals (non–similarlyequipped hospitals). We compared 30-day mortality; the ratesof use of aspirin, beta-blockers, and reperfusion; and the relationof differences in rates of therapy to short-term mortality.
Results Admission to a top-ranked hospital was associated withlower adjusted 30-day mortality (odds ratio, 0.87; 95 percentconfidence interval, 0.76 to 1.00; P=0.05 for top-ranked hospitalsvs. the others). Among patients without contraindications totherapy, top-ranked hospitals had significantly higher ratesof use of aspirin (96.2 percent, as compared with 88.6 percentfor similarly equipped hospitals and 83.4 percent for non–similarlyequipped hospitals; P<0.01) and beta-blockers (75.0 percentvs. 61.8 percent and 58.7 percent, P<0.01), but lower ratesof reperfusion therapy (61.0 percent vs. 70.7 percent and 65.6percent, P=0.03). The survival advantage associated with admissionto top-ranked hospitals was less strong after we adjusted forfactors including the use of aspirin and beta-blockers (oddsratio, 0.94; 95 percent confidence interval, 0.82 to 1.08; P=0.38).
Conclusions Admission to a hospital ranked high on the listof "America's Best Hospitals" was associated with lower 30-daymortality among elderly patients with acute myocardial infarction.A substantial portion of the survival advantage may be associatedwith these hospitals' higher rates of use of aspirin and beta-blockertherapy.
Source Information
From the Section of Cardiovascular Medicine, Department of Medicine (J.C., H.M.K.), and the Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health (H.M.K.), Yale University School of Medicine, New Haven, Conn.; the Yale–New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn. (H.M.K., M.J.R.); Qualidigm, Middletown, Conn. (H.M.K., M.J.R., Y.W.); and the Health Care Financing Administration, Baltimore (T.A.M.).
Address reprint requests to Dr. Krumholz at Yale University School of Medicine, 333 Cedar St., P.O. Box 208025, New Haven, CT 06520-8025.
Comparing Hospitals
Hartz A., Graber M., Doebbeling B., Lane W. L., Otten J., Hollander R. M., Chen J., Krumholz H. M., Radford M. J., Kassirer J. P.
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N Engl J Med 1999;
340:2006-2007, Jun 24, 1999.
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[Full Text]
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[Abstract][Full Text]
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[Full Text]
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318: 1419-1419
[Full Text]
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[Full Text]
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[Full Text]
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