Performance of top-ranked heart care hospitals on evidence-based process measures.

Abstract

Despite the increasing availability of evidence-based clinical performance measure data that compares the performances of US hospitals, the general public continues to rely on more popular resources such as the US News & World Report annual publication of "America's Best Hospitals" for information on hospital quality. This study evaluated how well hospitals ranked on the US News & World Report list of top heart and heart surgery hospitals performed on acute myocardial infarction and heart failure measures derived from American College of Cardiology and American Heart Association clinical treatment guidelines. This study identified 774 hospitals, including 41 of the US News & World Report top 50 heart and heart surgery hospitals. To compare hospitals, 10 rate-based performance measures (6 addressing processes of acute myocardial infarction care and 4 addressing heart failure care), were aggregated into a cardiovascular composite measure. As a group, the US News & World Report hospitals performed statistically better than their peers (mean, 86% versus 83%; P < 0.05). Individually, however, only 23 of the US News & World Report hospitals achieved statistically better-than-average performance compared with the population average, whereas 9 performed significantly worse (P < 0.05). One hundred sixty-seven hospitals in this study routinely implemented evidenced-based heart care > or = 90% of the time. A number of the US News & World Report top hospitals fell short in regularly applying evidenced-based care for their heart patients. At the same time, many lesser known hospitals routinely provided cardiovascular care that was consistent with nationally established guidelines.