麻豆传媒

Cardiology patients treated in hospitals at the top of U.S. News & World Report rankings had better survival rates, but not necessarily less risk of readmission, researchers found.

Thirty-day risk-standardized mortality rates were consistently lower among the top 50 U.S. hospitals in cardiology and heart surgery than at other centers, when looking at acute MI (11.9% vs 13.2%), heart failure (9.5% vs 11.9%), and coronary artery bypass grafting (2.3% vs 3.3%, all P<0.001).

However, top-ranked institutions didn't have better 30-day risk-standardized readmissions rates compared to other institutions that didn't rank in the top 50, reported Deepak Bhatt, MD, MPH, of Brigham and Women's Hospital Heart & Vascular Center in Boston, and colleagues, online in :

• Acute MI: 16.7% versus 16.5% (P=0.64)
• Heart failure: 21.0% versus 19.2% (P<0.001)
• Coronary artery bypass grafting: 14.1% versus 13.7% (P=0.15)

"This disconnect between mortality rates and readmission outcomes at top-ranked hospitals, compared with nonranked hospitals highlight the ongoing uncertainty as to whether readmission rates are an adequate surrogate for quality of care, particularly for cardiovascular conditions, such as heart failure," Bhatt's group said.

"It is possible that top-ranked and nonranked hospitals have focused substantial resources on reducing readmissions rather than mortality rates, given the financial push of the Hospital Readmission Reduction Program, which resulted in generally similar readmission rates, but disparate mortality rates between these hospital groups," they suggested.

That program, HRRP, was intended to encourage hospitals to improve care quality for patients, even after discharge. But, the financial penalties it imposes have been criticized as leading hospitals to take shortcuts that actually increase mortality rates for conditions such as heart failure and pneumonia.

Defenders of the readmission penalties have argued that increasing post-discharge deaths in heart failure and pneumonia began well before the program was implemented between 2010-2012.

Bhatt's latest study included 3,552 U.S. hospitals, 50 of which were ranked by the U.S. News & World Report in 2017-2018.

Patient satisfaction was higher at these top-ranked hospitals, which averaged 3.9 out of 5 stars, which was rated by the Hospital Consumer Assessment of Healthcare Providers and Systems (based on publicly available Centers for Medicaid and Medicare Services [CMS] data from 2014 to 2018). This was in contrast with the mean 3.3 stars garnered by unranked hospitals (P<0.001).

Bhatt and colleagues acknowledged that the annual U.S. News & World Report rankings incorporate CMS data, which means that not all patients factor into these hospital rankings.

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