Performance of the '100 top hospitals': What does the report card report?

Health Affairs

Volumn 18, Issue 4, 1999, Pages 53-68

  Chen, Jersey ^a   Radford, Martha J ^a   Wang, Yun ^a   Marciniak, Thomas A ^a   Krumholz, Harlan M ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; FEMALE; GOVERNMENT; HEALTH CARE QUALITY; HEART INFARCTION; HOSPITAL COST; HUMAN; LEGAL ASPECT; LENGTH OF STAY; MALE; MORTALITY; QUALITY CONTROL; TREATMENT OUTCOME; UNITED STATES;

AGED; BENCHMARKING; FEMALE; HOSPITAL COSTS; HOSPITAL MORTALITY; HUMANS; LENGTH OF STAY; MALE; MYOCARDIAL INFARCTION; OUTCOME AND PROCESS ASSESSMENT (HEALTH CARE); QUALITY ASSURANCE, HEALTH CARE; UNITED STATES; UNITED STATES CENTERS FOR MEDICARE AND MEDICAID SERVICES;

EID: 0033160666     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.4.53     Document Type: Article

References (53)

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2. Health Care Report Cards, 1998-1999, 4th ed. (Washington: Atlantic Information Services, Inc., 1998); America's Best Hospitals (Washington: U.S. News and World Report, October 1995); J. Green and N. Wintfeld, "Report Cards on Cardiac Surgeons: Assessing New York State's Approach," New England Journal of Medicine 332, no. 18 (1995): 1229-1232; and Health Plan Employer Data and Information Set (HEDIS) 3.0 (Washington: National Committee for Quality Assurance, 1997).
3. Health Care Report Cards, 1998-1999, 4th ed. (Washington: Atlantic Information Services, Inc., 1998); America's Best Hospitals (Washington: U.S. News and World Report, October 1995); J. Green and N. Wintfeld, "Report Cards on Cardiac Surgeons: Assessing New York State's Approach," New England Journal of Medicine 332, no. 18 (1995): 1229-1232; and Health Plan Employer Data and Information Set (HEDIS) 3.0 (Washington: National Committee for Quality Assurance, 1997).
4. Health Care Report Cards, 1998-1999, 4th ed. (Washington: Atlantic Information Services, Inc., 1998); America's Best Hospitals (Washington: U.S. News and World Report, October 1995); J. Green and N. Wintfeld, "Report Cards on Cardiac Surgeons: Assessing New York State's Approach," New England Journal of Medicine 332, no. 18 (1995): 1229-1232; and Health Plan Employer Data and Information Set (HEDIS) 3.0 (Washington: National Committee for Quality Assurance, 1997).
5. 100 Top Hospitals: Benchmarks for Success (Baltimore: HCIA, Inc., and New York: William M. Mercer, Inc., 1997).
6. Financial management: total operating expense per discharge; long-term debt to total assets, or financial leverage; cash-flow margin, or profitability; change in equity; and return on capital assets. Operations: average length-of-stay; investment in capital assets; charge per discharge; and index of outpatient revenues. Clinical practices: risk-adjusted in-hospital mortality; and risk-adjusted complication rate. See ibid.; and J. Morrissey, "Top 100 Hospitals Set New Success Standards," Modern Healthcare (14 November 1994): 74-76, 84; J. Morrissey, "Top 100 Hospitals: The Best-Run Hospitals; For-Profits Spur Efficiency," Modern Healthcare (4 December 1995): 54-56; and J. Morrissey, "Reaching for the Clouds: High Standards, Efficient Management Spur Success for Top 100 Hospitals," Modern Healthcare (9 December 1996): 53-60.
7. Financial management: total operating expense per discharge; long-term debt to total assets, or financial leverage; cash-flow margin, or profitability; change in equity; and return on capital assets. Operations: average length-of-stay; investment in capital assets; charge per discharge; and index of outpatient revenues. Clinical practices: risk-adjusted in-hospital mortality; and risk-adjusted complication rate. See ibid.; and J. Morrissey, "Top 100 Hospitals Set New Success Standards," Modern Healthcare (14 November 1994): 74-76, 84; J. Morrissey, "Top 100 Hospitals: The Best-Run Hospitals; For-Profits Spur Efficiency," Modern Healthcare (4 December 1995): 54-56; and J. Morrissey, "Reaching for the Clouds: High Standards, Efficient Management Spur Success for Top 100 Hospitals," Modern Healthcare (9 December 1996): 53-60.
8. Financial management: total operating expense per discharge; long-term debt to total assets, or financial leverage; cash-flow margin, or profitability; change in equity; and return on capital assets. Operations: average length-of-stay; investment in capital assets; charge per discharge; and index of outpatient revenues. Clinical practices: risk-adjusted in-hospital mortality; and risk-adjusted complication rate. See ibid.; and J. Morrissey, "Top 100 Hospitals Set New Success Standards," Modern Healthcare (14 November 1994): 74-76, 84; J. Morrissey, "Top 100 Hospitals: The Best-Run Hospitals; For-Profits Spur Efficiency," Modern Healthcare (4 December 1995): 54-56; and J. Morrissey, "Reaching for the Clouds: High Standards, Efficient Management Spur Success for Top 100 Hospitals," Modern Healthcare (9 December 1996): 53-60.
9. Financial management: total operating expense per discharge; long-term debt to total assets, or financial leverage; cash-flow margin, or profitability; change in equity; and return on capital assets. Operations: average length-of-stay; investment in capital assets; charge per discharge; and index of outpatient revenues. Clinical practices: risk-adjusted in-hospital mortality; and risk-adjusted complication rate. See ibid.; and J. Morrissey, "Top 100 Hospitals Set New Success Standards," Modern Healthcare (14 November 1994): 74-76, 84; J. Morrissey, "Top 100 Hospitals: The Best-Run Hospitals; For-Profits Spur Efficiency," Modern Healthcare (4 December 1995): 54-56; and J. Morrissey, "Reaching for the Clouds: High Standards, Efficient Management Spur Success for Top 100 Hospitals," Modern Healthcare (9 December 1996): 53-60.
10. Ibid.
11. 100 Top Hospitals.
12. J. Burns, "HCIA Recognition Is a PR Bonanza for Top Hospitals," Modern Healtkare (7 February 1994): 42.
13. Morrissey, "Reaching for the Clouds;" "HCIA, Mercer Name Top 100 Hospitals, Update Benchmark Practice Patterns," Health Care Strategic Management (February 1998): 4-5; "Hagerstown Hospital Makes Top 100' List," Baltimore Sun, 6 January 1998, 1C; "Hospital Named One of Nation's Top 100," Los Angeles Times, 31 December 1996, D8; "Four Bay State Hospitals Make List of Top Performers," Boston Globe, 10 December 1996, C2; and "100 Top Hospitals List Is a Hot Benchmark Source," Healthcare Benchmarks 4, no. 6 (1997): 85-89.
14. Morrissey, "Reaching for the Clouds;" "HCIA, Mercer Name Top 100 Hospitals, Update Benchmark Practice Patterns," Health Care Strategic Management (February 1998): 4-5; "Hagerstown Hospital Makes Top 100' List," Baltimore Sun, 6 January 1998, 1C; "Hospital Named One of Nation's Top 100," Los Angeles Times, 31 December 1996, D8; "Four Bay State Hospitals Make List of Top Performers," Boston Globe, 10 December 1996, C2; and "100 Top Hospitals List Is a Hot Benchmark Source," Healthcare Benchmarks 4, no. 6 (1997): 85-89.
15. Morrissey, "Reaching for the Clouds;" "HCIA, Mercer Name Top 100 Hospitals, Update Benchmark Practice Patterns," Health Care Strategic Management (February 1998): 4-5; "Hagerstown Hospital Makes Top 100' List," Baltimore Sun, 6 January 1998, 1C; "Hospital Named One of Nation's Top 100," Los Angeles Times, 31 December 1996, D8; "Four Bay State Hospitals Make List of Top Performers," Boston Globe, 10 December 1996, C2; and "100 Top Hospitals List Is a Hot Benchmark Source," Healthcare Benchmarks 4, no. 6 (1997): 85-89.
16. Morrissey, "Reaching for the Clouds;" "HCIA, Mercer Name Top 100 Hospitals, Update Benchmark Practice Patterns," Health Care Strategic Management (February 1998): 4-5; "Hagerstown Hospital Makes Top 100' List," Baltimore Sun, 6 January 1998, 1C; "Hospital Named One of Nation's Top 100," Los Angeles Times, 31 December 1996, D8; "Four Bay State Hospitals Make List of Top Performers," Boston Globe, 10 December 1996, C2; and "100 Top Hospitals List Is a Hot Benchmark Source," Healthcare Benchmarks 4, no. 6 (1997): 85-89.
17. Morrissey, "Reaching for the Clouds;" "HCIA, Mercer Name Top 100 Hospitals, Update Benchmark Practice Patterns," Health Care Strategic Management (February 1998): 4-5; "Hagerstown Hospital Makes Top 100' List," Baltimore Sun, 6 January 1998, 1C; "Hospital Named One of Nation's Top 100," Los Angeles Times, 31 December 1996, D8; "Four Bay State Hospitals Make List of Top Performers," Boston Globe, 10 December 1996, C2; and "100 Top Hospitals List Is a Hot Benchmark Source," Healthcare Benchmarks 4, no. 6 (1997): 85-89.
18. Morrissey, "Reaching for the Clouds;" "HCIA, Mercer Name Top 100 Hospitals, Update Benchmark Practice Patterns," Health Care Strategic Management (February 1998): 4-5; "Hagerstown Hospital Makes Top 100' List," Baltimore Sun, 6 January 1998, 1C; "Hospital Named One of Nation's Top 100," Los Angeles Times, 31 December 1996, D8; "Four Bay State Hospitals Make List of Top Performers," Boston Globe, 10 December 1996, C2; and "100 Top Hospitals List Is a Hot Benchmark Source," Healthcare Benchmarks 4, no. 6 (1997): 85-89.
19. A. Phan, "Cost-Based List of Hospitals Snubs 'Mecca': Only Four from Massachusetts Make Mercer's Lineup of 100 Best," Boston Globe, 5 December 1995, 42; and R. Kaiser, "Johns Hopkins Fails to Make Top 100 Hospitals List," Washington Business Journal, 2 February 1998, 38.
20. A. Phan, "Cost-Based List of Hospitals Snubs 'Mecca': Only Four from Massachusetts Make Mercer's Lineup of 100 Best," Boston Globe, 5 December 1995, 42; and R. Kaiser, "Johns Hopkins Fails to Make Top 100 Hospitals List," Washington Business Journal, 2 February 1998, 38.
21. R. Kuttner, "Columbia/HCA and the Resurgence of the For-Profit Hospital Business," New England Journal of Medicine 335, no. 5 (1996): 362-367.
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23. Burns, "HCIA Recognition."
24. T.J. Ryan et al., "ACC/AHA Guidelines for the Management of Patients with Acute Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction)," Journal of the American College of Cardiology 28, no. 5 (1996): 1328-1428.
25. T.A. Marciniak et al., "Improving the Quality of Care for Medicare Patients with Acute Myocardial Infarction: Results from the Cooperative Cardiovascular Project," Journal of the American Medical Association 279, no. 17 (1998): 1351-1357.
26. Ibid.; and E.F. Ellerbeck et al., "Quality of Care for Medicare Patients with Acute Myocardial Infarction: A Four-State Pilot Study from the Cooperative Cardiovascular Project," Journal of the American Medical Association 273, no. 19 (1995): 1509-1514.
27. Ibid.; and E.F. Ellerbeck et al., "Quality of Care for Medicare Patients with Acute Myocardial Infarction: A Four-State Pilot Study from the Cooperative Cardiovascular Project," Journal of the American Medical Association 273, no. 19 (1995): 1509-1514.
28. E.D. Huff, "Comprehensive Reliability Assessment and Comparison of Quality Indicators and Their Components," Journal of Clinical Epidemiology 50, no. 12 (1997): 1395-1404.
29. 2, or two of the following: chest pain, twofold elevation of the creatine kinase level, or a new AMI on the official electrocardiogram report.
30. The Annual Survey of Hospitals Database: Documentation for 1994 Data (Chicago: American Hospital Association, 1994).
31. Bureau of the Census, State and Metropolitan Area Data Book (Washington: U.S. Government Printing Office, 1991).
32. J.G. Jollis et al., "Outcome of Acute Myocardial Infarction According to the Specialty of the Admitting Physician," New England Journal of Medicine 335, no. 25 (1996): 1880-1887.
33. We excluded 357 patients with unverified dates of death recorded as the last day of the month. See S.T. Normand et al., "Using Admission Characteristics to Predict Short-Term Mortality from Myocardial Infarction in Elderly Patients," journal of the American Medical Association 275, no. 17 (1996): 1322-1328.
34. For descriptions of quality indicator construction, see Ellerbeck et al., "Quality of Care." Validation of the quality indicators has been reviewed in D.A. Lambert-Huber et al., "Quality of Care Indicators for Patients with Acute Myocardial Infarction: Pilot Validation of the Indicators," Clinical Performance and Quality Health Care 2, no. 4 (1994): 219-222.
35. For descriptions of quality indicator construction, see Ellerbeck et al., "Quality of Care." Validation of the quality indicators has been reviewed in D.A. Lambert-Huber et al., "Quality of Care Indicators for Patients with Acute Myocardial Infarction: Pilot Validation of the Indicators," Clinical Performance and Quality Health Care 2, no. 4 (1994): 219-222.
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38. H.A. White, "A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity," Econometrica 48, no. 4 (1980): 817-838; and P. Huber, "The Behavior of Maximum Likelihood Estimates under Non-Standard Conditions," Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability (Berkeley: University of California Press, 1967), 221-233.
39. J. Daley et al., "Predicting Hospital-Associated Mortality for Medicare Patients: A Method for Patients with Stroke, Pneumonia, Acute Myocardial Infarction, and Congestive Heart Failure," Journal of the American Medical Association 260, no. 24 (1988): 3617-3624. MMPS variables for AMI include APACHE II score (see W.A. Knaus et al., "APACHE II: A Severity of Disease Classification System," Critical Care Medicine 13, no. 10 [1985]: 818-829), age, ability to ambulate, do-not-resuscitate order on admission, blood urea nitrogen, mean arterial pressure, subendocardial infarction, congestive heart failure on roentgenogram, and heart rate. Our version of the MMPS did not include values for serum potassium in the APACHE II score (which were not abstracted for the CCP) and metastatic cancer (an exclusion criterion).
40. J. Daley et al., "Predicting Hospital-Associated Mortality for Medicare Patients: A Method for Patients with Stroke, Pneumonia, Acute Myocardial Infarction, and Congestive Heart Failure," Journal of the American Medical Association 260, no. 24 (1988): 3617-3624. MMPS variables for AMI include APACHE II score (see W.A. Knaus et al., "APACHE II: A Severity of Disease Classification System," Critical Care Medicine 13, no. 10 [1985]: 818-829), age, ability to ambulate, do-not-resuscitate order on admission, blood urea nitrogen, mean arterial pressure, subendocardial infarction, congestive heart failure on roentgenogram, and heart rate. Our version of the MMPS did not include values for serum potassium in the APACHE II score (which were not abstracted for the CCP) and metastatic cancer (an exclusion criterion).
41. "HCIA, Mercer Name Top 100 Hospitals."
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45. Hospital Statistics 1997-1998 (Chicago: Healthcare InfoSource, Inc., a subsidiary of the American Hospital Association, 1998), Table 1.
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48. Morrissey, "Reaching for the Clouds;" "Hagerstown Hospital;" and J. Morrissey, "A Formula for Shipshape Management: Top 100 U.S. Hospitals Find Quickest, Best Care Routes," Modern Healthcare (5 January 1998): 40-47.
49. Morrissey, "Reaching for the Clouds;" "Hagerstown Hospital;" and J. Morrissey, "A Formula for Shipshape Management: Top 100 U.S. Hospitals Find Quickest, Best Care Routes," Modern Healthcare (5 January 1998): 40-47.
50. Morrissey, "Reaching for the Clouds;" "Hagerstown Hospital;" and J. Morrissey, "A Formula for Shipshape Management: Top 100 U.S. Hospitals Find Quickest, Best Care Routes," Modern Healthcare (5 January 1998): 40-47.
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