Wang Oliver J, Wang Yun, Lichtman Judith H, Bradley Elizabeth H, Normand Sharon-Lise T, Krumholz Harlan M
Department of Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208088, New Haven, CT 06520, USA.
Arch Intern Med. 2007 Jul 9;167(13):1345-51. doi: 10.1001/archinte.167.13.1345.
The ranking of "America's Best Hospitals" by U.S. News & World Report for "Heart and Heart Surgery" is a popular hospital profiling system, but it is not known if hospitals ranked by the magazine vs nonranked hospitals have lower risk-standardized, 30-day mortality rates (RSMRs) for patients with acute myocardial infarction (AMI).
Using a hierarchical regression model based on 2003 Medicare administrative data, we calculated RSMRs for ranked and nonranked hospitals in the treatment of AMI. We identified ranked and nonranked hospitals with standardized mortality ratios (SMRs) significantly less than the mean expected for all hospitals in the study.
We compared 13 662 patients in 50 ranked hospitals with 254 907 patients in 3813 nonranked hospitals. The RSMRs were lower in ranked vs nonranked hospitals (16.0% vs 17.9%, P<.001). The RSMR range for ranked vs nonranked hospitals overlapped (11.4%-20.0% vs 13.1%-23.3%, respectively). In an RSMR quartile distribution of all hospitals, 35 ranked hospitals (70%) were in the lowest RSMR or best performing quartile, 11 (22%) were in the middle 2 quartiles, and 4 (8%) were in the highest RSMR or worst performing quartile. There were 11 ranked hospitals (22%) and 28 nonranked hospitals (0.73%) that each had an SMR significantly less than 1 (defined by a 95% confidence interval with an upper limit of <1.0).
On average, admission to a ranked hospital for AMI was associated with a lower risk of 30-day mortality, although about one-third of the ranked hospitals fell outside the best performing quartile based on RSMR. Although ranked hospitals were much more likely to have an SMR significantly less than 1, many more nonranked hospitals had this distinction.
《美国新闻与世界报道》发布的“美国最佳医院”中“心脏与心脏外科”排名是一种广为人知的医院评估体系，但尚不清楚该杂志排名的医院与未排名的医院相比，急性心肌梗死（AMI）患者的风险标准化30天死亡率（RSMR）是否更低。
基于2003年医疗保险行政数据，使用分层回归模型，我们计算了排名医院和未排名医院治疗AMI的RSMR。我们确定了标准化死亡率（SMR）显著低于研究中所有医院平均预期的排名医院和未排名医院。
我们将50家排名医院的13662例患者与3813家未排名医院的254907例患者进行了比较。排名医院的RSMR低于未排名医院（16.0%对17.9%，P<0.001）。排名医院与未排名医院的RSMR范围有重叠（分别为11.4%-20.0%对13.1%-23.3%）。在所有医院的RSMR四分位数分布中，35家排名医院（70%）处于最低RSMR或表现最佳的四分位数，11家（22%）处于中间两个四分位数，4家（8%）处于最高RSMR或表现最差的四分位数。有11家排名医院（22%）和28家未排名医院（0.73%）的SMR均显著低于1（定义为95%置信区间上限<1.0）。
平均而言，AMI患者入住排名医院与30天死亡风险较低相关，尽管约三分之一的排名医院基于RSMR未处于表现最佳的四分位数。虽然排名医院的SMR显著低于1的可能性要大得多，但有更多未排名医院也有此特征。
