National Hospital Rankings
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The national rankings for hospitals are calculated using publicly reported data downloaded from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website (www.hospitalcompare.hhs.gov - last accessed 8/2/2017). The Hospital Compare data set contains hospital-specific performance data on more than 100 measures for over 4,500 hospitals nationwide. These quality measures include clinical process of care, patient outcomes and patient experience of care measures. The national rankings are based on hospitals' performance in four areas:
- Patient experience of care
- Health care associated infections
- Hospital readmissions
Hospitals are ranked based on their performance in each of these areas and the individual ranks are combined into an overall composite performance ranking, with the patient experience of care measures contributing 35 percent, the healthcare-associated infections 45 percent and mortality and readmissions 10 percent each to the composite rank.
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Patient Experience of Care Measures and Rankings
The patient experience of care measures are based on the results of a national, standardized survey of patients’ perspectives of hospital care known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The survey asks a random sample of discharged patients 25 questions about their recent hospital stay. For each participating hospital results on 11 measures (seven summary measures, two individual survey items and two global ratings) are publically reported on the Hospital Compare website2,3.
For the patient experience of care measures hospitals are ranked based on the percentage of survey respondents who give the most favorable response (the 'top-box' score) for each measure; for example the percentage of patients who report that their nurses always communicated well with them, or the percentage of patients who reported that they would definitely recommend the hospital to family or friends. The top-box scores for the eleven measures are averaged for each hospital to get a patient experience of care performance score. The hospitals are then ranked on this score and the ranks are converted to percentiles.
Health Care Associated Infections Measures and Rankings
The healthcare-associated infection (HAI) measures show how often patients in a particular hospital contract certain infections in the course of their medical treatment. These infections can often be prevented when healthcare facilities follow guidelines for safe care. The measures were developed by the Centers for Disease Control and Prevention (CDC) and collected from hospitals through the National Healthcare Safety Network (NHSN). Hospitals currently submit information on central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), MRSA Bacteremia, and C.difficile laboratory-identified events. Calculations for the HAI measures adjust for differences in the characteristics of hospitals and patients using a Standardized Infection Ratio (SIR), which is a summary measure that takes into account differences in the types of patients a hospital treats.
For the health care associated infections hospitals are ranked based on their reported SIRs for CLABSI, CAUTI, SSIs, MRSA and C. difficile. The SIRS are first standardized to make them comparable, and then hospitals are ranked based on their average standardized SIR and the ranks are converted to percentiles. Hospitals must have at least three reported SIRs to be ranked.
Mortality and Readmissions Measures and Rankings
The Hospital Compare data set also contains hospital-specific 30-day risk-standardized mortality and readmission measures for hospitalized patients. These measures are produced from Medicare claims and enrollment data using statistical techniques that adjust for patient-specific characteristics and differences between hospitals in patient populations (risk adjustment). CMS does not report data for a measure when the number of eligible cases is less than 25.
For mortality, hospitals are ranked based on their risk-adjusted, all-cause 30-day mortality rates for patients hospitalized for heart attack, heart failure, and pneumonia. All-cause mortality is defined as death from any cause within 30 days of discharge, regardless of whether the patient dies while still in the hospital or after discharge. For readmissions hospitals are ranked based on their risk-adjusted, 30-day unplanned readmissions for all discharged patients (hospital-wide readmissions).
The mortality ranks are based on hospitals’ risk-adjusted 30 day mortality rates for patients hospitalized for heart attack, heart failure and pneumonia. The rates are first standardized to make them comparable. Hospitals are then ranked based on their average standardized mortality rate and the ranks are converted to percentiles. Hospitals must have at least two reported mortality scores to be ranked. The readmissions ranks are based on hospitals’ standardized 30 day, hospital-wide readmissions.
Overall Performance Rank
The overall performance rank for hospitals is determined by first calculating the weighted average of the patient experience of care, health care associated infection, mortality and readmission ranks, with the patient experience of care rank contributing 35%, the HAI rank contributing 45%, and the mortality and readmissions ranks 10% each to the weighted average. The hospitals are then ranked on the weighted average, and the ranks are converted to percentiles.
All rankings displayed on this web site are presented as percentile ranks. A percentile is not equivalent to a success rate or performance measure rate. Percentiles are values that divide a set of observations into 100 equal parts, and the percentile rank is the percentage of values in a distribution that a specific value is greater than or equal to. For example, if a hospital has an average HCAHPS top-box score of 60% and this is greater than or equal to the average top-box scores of 80% of all hospitals, then that hospital will have a percentile rank of 80%. A ranking in the 100th percentile does not mean that hospitals in that percentile achieved perfect scores on all their measures; it indicates that their scores were better than all other hospitals except for those that are also in the 100th percentile. Similarly, a hospital with a rank in the 50th percentile did not achieve an average of 50% on their performance scores. They performed better than 50% of all the hospitals in the country. Also note that although for the HCAHPS higher performance scores are better, and lower performance scores are better for HAIs, mortality and readmissions, the percentile ranks are calculated so that higher is always better.
1 This currently includes data from the time period 10/1/2015 – 9/30/2016 for the patient experience of care measures, 1/1/2015 to 12/31/2015 for the health care associated infections, and 7/1/2013 – 6/30/2016 for the 30-day mortality measures and 7/1/2015 – 6/30/2017 for the readmission measure. To obtain a copy of the database, go to: Hospital Compare and click on "Download Database"
2 The HCAHPS Measures and the response levels reported by CMS are (most favorable responses are in bold):
- How often did nurses communicate well with patients? (Sometimes or Never; Usually; Always)
- How often did doctors communicate well with patients? (Sometimes or Never; Usually; Always)
- How often did patients receive help quickly from hospital staff? (Sometimes or Never; Usually; Always)
- How often was the patient's pain well controlled (Sometimes or Never; Usually; Always)
- How often did staff explain about medicines before giving them to patients? (Sometimes or Never; Usually; Always)
- Were patients given information about what to do during their recovery at home (No; Yes)
- How often were the patients' rooms and bathrooms kept clean? (Sometimes or Never; Usually; Always)
- How often was the area around the patient's rooms kept quiet at night? (Sometimes or Never; Usually; Always)
- How do patients rate the hospital overall? [on a scale of 1-10: 6 or lower (low); 7 or 8 (medium); 9 or 10 (high)]
- Would patients recommend the hospital to friends or family? (No, Probably; Definitely)