http://www.pubmedcentral.nih.gov/art...?artid=1114830
Heart attack patients do better in America's “best” hospitals
Scott Gottlieb
New York
Elderly patients who have a myocardial infarction in the United States are more likely to survive if they are admitted to a hospital identified by a popular American magazine as “one of America's best hospitals,” according to a study assessing the veracity of the annual ranking (New England Journal of Medicine 1999;340:286-99, 309-10).
The study looked at 60 US hospitals that had each been identified at least once in the past three years as one of the top 40 hospitals in cardiology, based on an annual survey published in US News and World Report. All 60 of these hospitals were teaching hospitals. The study found that these hospitals had lower death rates than other hospitals for patients admitted with a myocardial infarction. It attributed the decreased mortality at these hospitals to a more liberal and timely use of aspirin and β blockers.
Much of the annual survey by the news magazine is based on a questionnaire sent to doctors. The doctors are asked to nominate the five “best” hospitals in their own specialties. Although the survey traditionally contains many hospitals that are commonly reputed to provide excellent care, the current study is the first to objectively measure the clinical accuracy of its rankings.
The researchers examined Medicare data for 149177 patients who had had a myocardial infarction; the patients had been treated in 4672 hospitals. Results showed that admission to a top ranked hospital was associated with lower risk adjusted 30 day mortality: 15.6%for the “best hospitals” compared with 18.3%for similarly equipped hospitals not given this ranking. Among patients without contraindications to treatment, significantly more were treated with aspirin (96.2%v 88.6%) and β blockers (75.0%v 61.8%) at the top ranked hospitals.
“We were not sure why hospitals with the best reputations were more likely to deliver a certain therapy,” said Jersey Chan, lead author of the study and a fourth year medical student at Yale University School of Medicine.
Dr Valentin Fuster, president of the American Heart Association, cautioned that other factors that may help explain differences in mortality might not have been detected by the study.
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