Hospital Rankings Research Articles

Simplifying Hospital Quality Comparisons for Vascular Surgery Using Center-Level Frailty Burden Rather Than Comorbidities

Failure to rescue (FtR), or inpatient death following complication, is a publicly reported hospital quality measure. Previous work has demonstrated significant variation in the proportion of frail patients across hospitals. However, frailty is not incorporated into risk-adjustment algorithms for hospital quality comparisons and risk adjustment is made by comorbidity scores. Our aim was to assess the impact of frailty on FtR quality measurement and as a means of risk adjustment. Patients undergoing open or endovascular aneurysm repair or lower extremity bypass in the Vascular Quality Initiative (VQI) at centers performing ≥ 25 vascular procedures annually (2003-2019) were included. Multivariable logistic regression evaluated in-hospital death using scaled hierarchical modeling clustering at the center level. Center FtR observed/expected ratios were compared with expected values adjusted for either standard comorbidity profiles or frailty as measured by the VQI Risk Analysis Index. Centers were divided into quartiles using VQI-linked American Hospital Association data to describe the hospital characteristics of centers whose ranks changed. A total of 63,143 patients (213 centers) were included; 1,630 patients (2.58%) were classified as FtR. After accounting for center-level variability, frailty was associated with FtR [scaled odds ratio 1.9 (1.8-2.0), P<0.001]. The comorbidity-centric and frailty-based models performed similarly in predicting FtR with C-statistics of 0.85 (0.84-0.86) and 0.82 (0.82-0.84), respectively. Overall changes in ranking based on observed/expected ratios were not statistically significant (P=0.48). High and low performing centers had similar ranking using comorbidity-centric and frailty-based methods; however, centers in the middle of the performance spectrum saw more variability in ranking alterations. Forty nine (23%) of hospitals improved their ranking by five or more positions when using frailty versus comorbidity risk adjustment. The centers in Quartile 4, those who performed the highest number of vascular procedures annually, experience on average a significant improvement in hospital ranking when frailty was used for risk adjustment, whereas centers performing the fewest number of vascular procedures and the lowest proportion of vascular surgery cases annually (Quartile 1) saw a significant worsening of ranking position (all P<0.05). However, total number of surgical procedures annually, total hospital beds, for-profit status, and teaching hospital status were not significantly associated with changes in rank. A simple frailty-adjusted model has similar predictive abilities as a comorbidity-focused model for predicting a common quality metric that influences reimbursement. In addition to distilling the risk-adjustment algorithm to a few variables, frailty can be assessed preoperatively to develop quality improvement efforts for rescuing frail patients. Centers treating a greater proportion of frail patients and those who perform higher volumes of vascular surgery benefit from a risk adjustment strategy based on frailty.

Measuring broad-spectrum antibiotic use in hospitals with established versus new indicators.

The target of a 30% reduction in the use of broad-spectrum antibiotics in hospitals from 2012 to 2020 was not achieved, measured using the standard indicator of defined daily doses (DDD) per 100 bed days. We wished to investigate the reliability of the standard indicator and of selected alternative indicators for antibiotic use, and to determine the actual reduction in use. We included ten DDD-based indicators with adjustment for combinations of activity marker, admission category (inpatient vs. all admissions), and case mix, and evaluated these according to how each indicator correlated with antibiotic resistance in a self-developed model. We then calculated use of broad-spectrum antibiotics in hospitals for the period 2012-20 with indicators deemed valid, and compared these indicators with regard to change in use and ranking of hospitals according to use. We used consumption rate (DDD per 1000 inhabitants per day) as an activity-neutral reference indicator (national and regional). All the indicators for antibiotic use showed a strong correlation with resistance. For five indicators the correlation was statistically significant. Of these, the indicator that combined adjustment for the total number of admitted patients and case mix accorded best with the consumption rate (35.6%). The same indicator also showed the largest reduction in use (29.3%) and gave the most hospitals that achieved a reduction of at least 30% (13 of 22). Combined adjustment for number of admitted patients and case mix represents a new, robust indicator for antibiotic use that is suitable for hospitals at all levels. The indicator can be used in parallel with the consumption rate, and consideration should be given to introducing the latter as the new standard indicator at national and regional level.

Does Shorter Time to Treatment of Pediatric Supracondylar Humerus Fractures Impact Clinical Outcomes?

Treatment of supracondylar humerus (SCH) fractures within 18 hours of presentation is a tracked quality metric for ranking of pediatric hospitals. This is in contrast with literature that shows time to treatment does not impact outcomes in SCH fractures. We aim to determine whether an 18-hour cutoff for pediatric supracondylar humerus fracture treatment is clinically significant by comparing the complication risks ofpatients on either side of this timepoint. Our hypothesis is that there will be no statistically significant differences based on time to treatment. A retrospective review of clinical outcomes was performed for 472 pediatric patients who underwent surgical management of isolated supracondylar humerus fractures between 1997 and 2022 at a single level I pediatric trauma hospital. The cohort was split based on time to surgery (within or ≥18h from Emergency Department admission). Surgical treatment occurred within 18 hours of arrival in 435 (92.2%) patients and after 18 hours in 37 (7.8%) patients. Mean age was 5.6±2.2 years and 51.5% of patients were female. Gartland fracture classification was type II [n=152 (32.3%)], type III [n=284 (60.3%)], type IV [n=13 (2.8%)], or flexion-type [n=18 (3.8%)]. There were no differences in demographic characteristics or fracture classification between cohorts. Fractures in the ≥18-hour cohort were treated more commonly with 2 pins (62.2% vs. 38.5%, P =0.04). There were no statistically significant differences in open versus closed reduction, utilization of medial pins, or postoperative immobilization between cohorts. We were unable to detect any differences in postoperative complications, including non-union, delayed union, stiffness, malunion, loss of reduction, iatrogenic nerve injury, or infection. This remained true when type II fractures were excluded. Using an arbitrary time cutoff of <18 hours does not influence clinical outcomes in the surgical treatment of SCH fractures. This held true when type II fractures were excluded. For this reason, we recommend modification to the USNWR guidelines to decrease emphasis on time-to-treatment of SCH fractures. Level III.

Selecting the Best Health Care Systems: An Approach Based on Opinion Mining and Simplified Neutrosophic Sets

Measuring what hospital offers the best services is very difficult, for that reason, the opinions from previous patients have become an essential tool for the new possible clients to decide which services they must select. Many online platforms deal with opinions to analyze their services/products, primarily, by means of aspect-based sentiment analysis techniques. These techniques are mainly based on the detection of features from services/products to model the feelings toward them. Most models primarily cope with positiveness, negativeness and neutrality; nevertheless, these do not reflect other situations in which there are positive and negative aspects, but the overall sentiment is not neutral, but indeterminate. To face this issue, simplified neutrosophic sets can be a useful tool. Therefore, this study presents a novel application of the simplified neutrosophic sets to hospital ranking. The application, first, detects the hospital features, second, models the feelings toward them using simplified neutrosophic sets, and finally, ranks the hospitals according to the patients’ preferences. It has been tested using opinions from a real website and compared against other fuzzy logic-based approaches. The achieved results outperform the ones obtained by other proposals, revealing that simplified neutrosophic sets can be an interesting solution to model feelings.

Determinants of Operative Time in Arthroscopic Rotator Cuff Repair

Arthroscopic rotator cuff repairs have been reported to take between 72 and 113 min to complete. This team has adopted its practice to reduce rotator cuff repair times. We aimed to determine (1) what factors reduced operative time, and (2) whether arthroscopic rotator cuff repairs could be performed in under 5 min. Consecutive rotator cuff repairs were filmed with the intent of capturing a <5-min repair. A retrospective analysis of prospectively collected data of 2232 patients who underwent primary arthroscopic rotator cuff repair by a single surgeon was performed using Spearman's correlations and multiple linear regression. Cohen's f2 values were calculated to quantify effect size. Video footage of a 4-min arthroscopic repair was captured on the 4th case. Backwards stepwise multivariate linear regression found that an undersurface repair technique (f2 = 0.08, p < 0.001), fewer surgical anchors (f2 = 0.06, p < 0.001), more recent case number (f2 = 0.01, p < 0.001), smaller tear size (f2 = 0.01, p < 0.001), increased assistant case number (f2 = 0.01, p < 0.001), female sex (f2 = 0.004, p < 0.001), higher repair quality ranking (f2 = 0.006, p < 0.001) and private hospital (f2 = 0.005, p < 0.001) were independently associated with a faster operative time. Use of the undersurface repair technique, reduced anchor number, smaller tear size, increased surgeon and assistant surgeon case number, performing repairs in a private hospital and female sex independently lowered operative time. A <5-min repair was captured.

The Utility of Smartphone-Based Thermal Imaging in the Management and Monitoring of Microvascular Flap Procedures: A Systematic Review and Meta-Analysis.

Smartphone-based thermal imaging (SBTI) has been reported in the literature to be an easy-to-use, contactless, cost-friendly alternative to standard imaging modalities in identifying flap perforators, monitoring flap perfusion, and detecting flap failure. Our systematic review and meta-analysis aimed to evaluate SBTI's accuracy in perforator identification and secondarily evaluate SBTI's utility in flap perfusion monitoring as well as ability to predict flap compromise, failure, and survival. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was performed using PubMed from inception to 2021. Articles were uploaded into Covidence and, following duplicate deletion, were initially screened for use of SBTI in flap procedures through title and abstract screening followed by full-text review. The following data points, if provided, were extracted from each included study: study design, number of patients, patient demographics, perforator number and location, flap number and location, room temperature, cooling method, imaging distance, time from cloth removal, primary (SBTI's accuracy in perforator identification), and secondary outcomes (prediction of flap compromise/failure/survival and cost analysis). Meta-analysis was performed using RevMan v.5. The initial search yielded 153 articles. Eleven applicable studies with a total of 430 flaps from 416 patients were ultimately included. The SBTI device assessed in all included studies was FLIR ONE. Four studies assessed the SBTI's perforated detection ability and were included in meta-analysis. Smartphone-based thermal imaging correctly identified 378 (93.3%; n = 405) perforators, and computed tomography angiography (CTA) correctly identified 402 (99.2%; n = 402), although in one study SBTI found additional perforators not detected on CTA. A random-effects model was used (I2 = 65%), and no significant difference in perforator detection ability was found between SBTI and CTA (P = 0.27). This systematic review and meta-analysis supports SBTI as user- and cost-friendly ($229.99), contactless imaging modality with perforator detection ability comparable to current criterion-standard CTA. Postoperatively, SBTI outperformed Doppler ultrasound in early detection of microvascular changes causing flap compromise, allowing for prompt tissue salvage. With a minimal learning curve, SBTI seems to be a promising method of postoperative flap perfusion monitoring able to be used by all hospital ranks. Smartphone-based thermal imaging could thus increase flap monitoring frequency and lower complication rates, although further study is warranted.

High-Volume Hospitals Have Lower Open Reduction Rates and Lower Cost of Care for Pediatric Supracondylar Humerus Fractures

Background: Open reduction and percutaneous pinning (ORPP) of pediatric supracondylar humerus (SCH) fractures is associated with increased morbidity compared to closed reduction. This investigation sought to assess variation in ORPP rates among U.S. children's hospitals by hospital treatment volume and ranking. Secondarily, we investigated costs associated with ORPP and closed reduction and percutaneous pinning (CRPP).Methods: The Pediatric Health Information System (PHIS), a database of U.S. children's hospitals, was queried for patients 3-10 years treated with ORPP or CRPP for closed SCH fractures from 2010-2014. Pediatric orthopaedic hospital rankings were collected from U.S. News and World Report. To account for differences in patient population, hospital ORPP rates were adjusted for patient characteristics. Analysis then assayed the effect of hospital treatment and ranking on cost of care and likelihood to treat with ORPP.Results: 28,100 patients were treated at 42 pediatric hospitals. 26,465 (94.2%) SCH fractures underwent CRPP and 1,635 (5.8%) underwent ORPP. Unadjusted ORPP rates varied from 1.9%-12.8%. Adjusted for patient characteristics, ORPP rates ranged from 4.2%–15.0%. Analysis demonstrated significant variation in cost and ORPP rates between hospitals (p<0.001). Patients treated at high-volume centers were less likely to undergo ORPP than patients at lower-volume centers (5.1% vs. 6.7%; Odds Ratio 0.70, 95% CI: 0.54-0.90). There was no difference in ORPP rates based on the USNWR ranking. Cost of care was also significantly lower at high-volume centers (p<0.001).Conclusions: At hospitals with low surgical volumes, children with SCH fractures are more likely to undergo ORPP and have a significantly higher cost of care.Level of Evidence: Therapeutic Level IIIKey Concepts•There is variability in operative pediatric supracondylar humerus (SCH) fracture care with some patients receiving less invasive closed reduction and percutaneous pinning (CRPP) and some receiving more morbid open reduction and percutaneous pinning (ORPP).•Patients treated at high-volume hospitals are 30% less likely to receive ORPP compared to patients treated at low-volume centers.•Cost of care was significantly less expensive at high-volume hospitals.

One in Three Chance of Finding A Plastic Surgeon on Major Hospital Websites.

The website search engines for the top 20 US medical centers according to the US News and World Report's Hospital Rankings from 2020 to 2021 were queried for search terms pertaining to breast reconstruction. Information collected for search results included gender, if they were a physician, medical specialty, medical school and residency attended, and each individual's position within the search results. Across 80 distinct search attempts, 27 searches (34%) produced no results. The search term "breast reconstruction" yielded the most plastic surgeon search results, with plastic surgeons composing 39% of all search results. The search term "mastectomy" generated the least number of plastic surgeon results, with a 16% representation of plastic surgeons. Nearly two-thirds of physicians identified were nonplastic surgeons (67%). Other surgeons represented 47% of search results and obstetricians/gynecologists, 2%. Nonsurgeons represented 18% of queries. On average, plastic surgeons appeared higher on search lists than nonplastic surgeons, 13th to 39th, respectively (P < 0.001). Plastic surgeons composed only a third of physicians identified, and a third of searches produced no results. Patients interested in breast reconstruction may encounter difficulty finding an appropriate plastic surgeon. Inadequate search engines on hospital websites introduce inefficiencies for the entire health care systems and may negatively impact hospital and physician bottom line.

Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric.

The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China. This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment. A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7-15%. The child's global health status and the respondent being the child's mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall's τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00. Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China. Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings. Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients' experience measures in a Chinese population. This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China.

The reliability of revision rates following primary shoulder arthroplasty as a quality indicator to rank hospital performance: a national registry analysis including 13,104 shoulders and 87 hospitals.

To assess the extent of between-hospital variation in revision following primary shoulder arthroplasty (SA), both overall and for specific revision indications to guide quality improvement initiatives, and to assess whether revision rates are suitable as quality indicators to reliably rank hospital performance. All primary SAs performed between 2014 and 2018 were included from the Dutch Arthroplasty Register to examine 1-year revision and all primary SAs performed between 2014 and 2016 for 1- and 3-year revisions. For each hospital, the observed number (O) of revisions was compared with that expected (E) based on case-mix and depicted in funnel plots with 95% control limits to identify outlier hospitals. The rankability (ie, the reliability of ranking hospitals) was calculated as the percentage of total hospital variation due to true between-hospital differences rather than chance and categorized as low (<50%), moderate (50%-75%), and high (>75%). A total of 13,104 primary SAs (87 hospitals) in 2014-2018 were included, of which 7213 were performed between 2014 and 2016. Considerable between-hospital variation was found in 1-year revision in 2014-2016 (median 1.6%, interquartile range 0.0%-3.1%), identifying 3 outlier hospitals having overall significantly more revisions than expected (O/E range 1.9-2.3) and for specific indications (cuff pathology and infection). Results for 2014-2018 were similar. For 3-year revision, 3 outlier hospitals were identified (O/E range 1.7-3.3). Rankabilities for all outcomes were low. Considerable between-hospital variation was observed for 1- and 3-year revision rates following primary SA, where outlier hospitals could be identified based on large differences in revision for specific indications to direct quality improvement initiatives. However, rankabilities were low, meaning that much of the other (smaller) variation in performance could not be detected, rendering revisions unsuitable to rank hospital performances following primary SA.

935. Antibiotic Use (AU) Adjustment by Infection-Related Patient Volume Across a Health System

Abstract Background Benchmarking AU is important to identify opportunities and allocate resources within a health system. Patient level factors such as infection diagnosis codes further refine risk adjustments but have not been more widely adopted because of the burden of accurately collecting and submitting granular data. The goal of this study was to evaluate a novel metric to estimate facility-level infection burden as a potential factor to use in adjustment of AU. Methods We conducted a retrospective analysis of hospital administrative data (for calendar year 2020) from 8 hospitals in a single health system using a common electronic health record and coding department. We identified inpatient encounters with an infection-related primary ICD-10 code (I-PDX), based on the health system’s coding department determination and extracted the length of stay (LOS) for each encounter. For any encounter with an I-PDX, the entire LOS was classified as infection-related patient days (IPD). Overall AU in days of therapy (DOT) was adjusted using two novel infection diagnoses denominators. The first was based on proportion of total patient days (PD) attributable to I-PDX encounters (% I-PDX x PD). Since LOS tends to be longer in I-PDX, we also calculated DOT with adjustment for actual extracted IPDs. We then rank ordered study hospitals based on standard DOT / 1,000 PD, NHSN SAAR metrics, and our novel DOT / (% I-PDX x PD) and DOT / 1,000 IPD metrics. Results The proportion of I-PDX was highly variable among hospitals, with a system-wide median of 37.27% (range 23.48 - 43.32) (Figure 1). Using DOT / 1,000 patient days for 1 year, Hospital A was the lowest in the system and hospital H was the highest (Figure 2). However, after adjusting for the proportion of patients with I-PDX encounters and IPDs, hospital rank changed considerably, i.e. Hospital H and C respectively ranked lowest and Hospital A was highest. Conclusion These novel infection diagnoses PD denominators more closely associated facility level infection burden with AU, for a more refined rank order within the health system. These metrics provide an example of a parsimonious adjustment using patient level data that is already collected at any facility. Next steps might include indirect standardization using PDX categories and other patient level factors readily collected. Disclosures Melissa D. Johnson, PharmD, Charles River Laboratories: Grant/Research Support|Entasis: Honoraria|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Scynexis: Grant/Research Support|Theratechnologies: Grant/Research Support|UpToDate: Honoraria Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties Angelina Davis, PharmD, M.S., Merck &amp; Co.: Honoraria.

Hospital selection framework for remote MCD patients based on fuzzy q-rung orthopair environment.

This research proposes a novel mobile health-based hospital selection framework for remote patients with multi-chronic diseases based on wearable body medical sensors that use the Internet of Things. The proposed framework uses two powerful multi-criteria decision-making (MCDM) methods, namely fuzzy-weighted zero-inconsistency and fuzzy decision by opinion score method for criteria weighting and hospital ranking. The development of both methods is based on a Q-rung orthopair fuzzy environment to address the uncertainty issues associated with the case study in this research. The other MCDM issues of multiple criteria, various levels of significance and data variation are also addressed. The proposed framework comprises two main phases, namely identification and development. The first phase discusses the telemedicine architecture selected, patient dataset used and decision matrix integrated. The development phase discusses criteria weighting by q-ROFWZIC and hospital ranking by q-ROFDOSM and their sub-associated processes. Weighting results by q-ROFWZIC indicate that the time of arrival criterion is the most significant across all experimental scenarios with (0.1837, 0.183, 0.230, 0.276, 0.335) for (q = 1, 3, 5, 7, 10), respectively. Ranking results indicate that Hospital (H-4) is the best-ranked hospital in all experimental scenarios. Both methods were evaluated based on systematic ranking and sensitivity analysis, thereby confirming the validity of the proposed framework.

Campaign Reform for US News and World Report Rankings

This Viewpoint discusses the perceived importance of US News and World Report hospital rankings and concerns with using specialty voting to dominate the assessment of process.

Categorization of Patient Reviews in a Hematology Clinic

Introduction: Patient reviews of physicians and hospitals are frequently collected after patient visits. This information is used in a multitude of ways, including ranking provider services, national hospital rankings, informing other patients of expectations, hospital improvements, etc. Often, the ranking of a physician is reflective of the entire patient experience rather than the provider as an individual. We opted to look at recent rankings from our outpatient hematology department to help determine where patients were identifying specific issues. Methods: Using 174 patient comments as collected by NRC Health ® on an outpatient hematology unit focused on both malignant and benign hematology in a hybrid academic/community practice in Orlando Florida, we divided patient comments into different sections. These included comments directed toward:Individual providerClinic or front office staffTime based concerns (time to get roomed to see physician, time for check out, time for results of tests, etc.)Financial concernsScheduling concernsConcerns related to emergency rooms or inpatient saysOther (medication refills, intake paperwork, parking issues) Every patient comment for reviews that were less than "five stars" were reviewed and categorized into the above categories. If telehealth was used, we separately looked at comments related to these visits. Results: Of 174 returned comments, there were 46 (26%) returned comments were less than "five stars". The concerns were directed toward:Individual provider: 4 timesHospital staff: 11 timesTime based concerns: 14 timesFinancial concerns: 2 timesScheduling concerns: 5 timesConcerns related to emergency rooms or inpatient says: 4 timesOther: 6 times When a visit was telehealth based, 14/15 patients left a positive review. The one negative review was a patient having a difficult time with the specific virtual platform used for the visit. Conclusion: Of 174 patient surveys being returned, 46 left a comment identifying a grievance or a point for improvement. Rarely (8%) was the individual provider the point of concern. Much more often, time based concerns or staff related concerns were highlighted as areas for improvement. When telehealth was used, these problems were never mentioned, perhaps highlighting a benefit for these platforms.

Hospital Rankings and Health Equity

This Viewpoint examines US News &amp;amp;amp; World Report’s approach to evaluating and publicly reporting hospital performance in various aspects of health equity as well as describes several novel equity measures published as part of its “Best Hospitals” rankings program.

Positive association between research competitiveness of Chinese academic hospitals and the scale of their biobanks: A national survey.

Biobanks are important research infrastructure developed rapidly by Chinese hospitals. The objective of this study is to investigate the association between the comprehensive research competitiveness of hospitals and the development of hospital biobanks. In 2018, we conducted a national survey among Chinese biobank managers and directors. An online questionnaire was used to collect data of biobank characteristics. Of the 70 academic hospital biobanks responded to our survey, 49 of their hospitals were listed in the Science and Technology Evaluation Metrics (STEM) and 46 of their hospitals were listed in the Fudan Hospital Rankings, respectively, in 2018. Hospital scores from the STEM and Fudan Hospital Rankings were identified from their official websites. Multivariate linear regression analyses were used to assess the associations of STEM scores and Fudan Hospital Rankings with the scale of biobanks. The overall STEM score, Scientific and Technological Output, and Academic Impact in hospitals with large-scale biobanks were 48.35%, 55.16%, and 58.65% higher than those with small-scale biobanks, respectively. The scale of biobanks was positively associated with STEM score (β=0.367, p=0.009), Scientific and Technological Output (β=0.441, p=0.001), and Academic Impact (β=0.304, p=0.044) after adjustment for potential confounders. For Fudan Hospital Rankings, the comprehensive score and sustainable development ability score were higher in hospitals with large-scale biobanks. Further analyses showed that the scale of the biobanks was positively associated with a higher comprehensive score (β=0.313, p=0.037) and a sustainable development ability score (β=0.463, p < 0.001). The scale of hospital biobanks was positively associated with the research competitiveness of Chinese hospitals.

Limitations to Health Care Quality Measurement: Assessing Hospital Variation in Risk of Cardiac Events After Noncardiac Surgery.

Limited sample size, incomplete measures, and inadequate risk adjustment adversely influence accurate health care quality measurements, surgical quality measurements, and accurate comparisons among hospitals. Since these measures are linked to resources for quality improvement and reimbursement, improving the accuracy of measurement has substantial implications for patients, clinicians, hospital administrators, insurers, and purchasers. The team examined risk-adjusted differences of postoperative cardiac events among 20 geographically dispersed, community-based medical centers within an integrated health care system and compared it with the National Surgical Quality Improvement Program (NSQIP) hospital-specific differences. The exposure included the hospital at which patients received noncardiac surgical care, with stratification of patients by the acuity of surgery (elective vs. urgent/emergent). Among 157,075 surgery patients, the unadjusted risk of cardiac event per 1000 ranged among hospitals from 2.1 to 6.9 for elective surgery and from 10.3 to 44.5 for urgent/emergent surgery. Across the 20 hospitals, hospital rankings estimated in the present analysis differed significantly from ranking reported by NSQIP (P for difference: elective, P = 0.0001; urgent/emergent, P < 0.0001) with significantly and substantially lower variation after risk adjustment. Current surgical quality measures may not adequately account for limitations of sample size, data capture, adequate risk adjustment, and surgical acuity in a given hospital, particularly for rare outcomes. These differences have implications for quality reporting and may introduce bias into hospital comparisons, particularly for hospitals with incomplete capture of their patients' baseline risk and acuity.

"The reputation premium": does hospital ranking improvement lead to a higher healthcare spending?

Global health systems have often disclosed hospital quality and performance information via hospital ranking or rating programs over the last 20years. This study aims to examine the relationship between hospital ranking and healthcare spending. Using the Basic Medical Insurance claims data from a big city in central China and the hospital ranking data from the Fudan Chinese Hospital League Table from 2016 to 2018, this study exploits the variation of hospital reputable ranking across hospitals and periods to employ the difference-in-differences (DiD) design. To alleviate the self-selection bias emerging from inpatients' selection of hospitals and the extrapolation bias emerging from the potential mis-specification of our linear model, we combine the DiD design with the 3-to-1 optimal Mahalanobis metric matching method. This study finds that ceteris paribus one hospital ascending from the Regional Famous Hospital Group to the National Famous Hospital Group significantly increases inpatients' total healthcare costs, reimbursement costs, and out-of-pocket costs by 5.9%, 6.2%, and 4.0%, respectively. Mechanism analysis reveals that it should be attributed more to physician moral hazard than patient willingness-to-pay. Leads and lags (event study) analysis validates our DiD identification framework and shows that the impact materializes slowly but significantly. In the robustness check, we transfer the outcome variables from the log value to the level value and control five digits of ICD-10 for the disease fixed-effects. The results are highly robust.

Ranking Hospital Hoteling Services from Patients’ Perspective Using Importance-Performance Analysis

Background: While the ultimate goal of health care is to maintain or improve the health status, features of care, including the quality of hotel services, are important to enhance the quality of health care services. Due to the limited resources of the health system, it is important to recognize the strengths and weaknesses of health service providers for policy-making and allocating resources in line with customers’ expectations. Objectives: The current study aimed at ranking the dimensions of hospital hoteling services from patients’ perspectives using the importance-performance analysis (IPA) method in Tehran, Iran. Methods: In this cross-sectional study, 440 patients were enrolled through multi-stage random sampling. The data collection tool was a questionnaire consisting of 44 items in six dimensions. Its internal reliability was determined based on Cronbach’s alpha coefficient (α = 0.97). The IPA method was used to prioritize the dimensions. Data were analyzed using descriptive statistics and the paired t-test at a significance level of &lt; 0.05. Results: In all aspects of hoteling, there was a significant difference between the performance of hospitals and the expectations of patients. The highest and lowest gaps between performance and expectation were related to the economic-financial and performance-process factors, respectively (P &lt; 0.05). Based on the IPA matrix, the "physical-structural" and "economic-financial" factors were the major weaknesses, and the "need to allocate more resources" and "human-behavioral" factors were recognized as the most strong points. Considering that the dimensions of "cultural-religious” and "safety-security" were located in the third quadrant of the IPA matrix, these dimensions did not require additional resources. Conclusions: The existence of a gap between hospital performance and patient expectation in all the hoteling dimensions indicated that the performance of hospitals in providing hoteling services was not proportional to the importance of these factors from the viewpoints of patients. The "physical-structural" and "economic-financial" factors were the major weaknesses of the hospitals studied. Therefore, it is necessary to pay more attention and allocate resources to these dimensions. Efforts should be continued to maintain and upgrade the status quo regarding the human-behavioral factors to boost patient satisfaction and improve the quality of hoteling services.

Comparing Consumer-Directed Hospital Rankings With STS Adult Cardiac Surgery Database Outcomes

BackgroundPublic interest in stratifying hospital performance has led to the proliferation of commercial, consumer-oriented hospital rankings. In cardiac surgery, little is known about how these rankings correlate with clinical registry quality ratings. MethodsThe Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for isolated coronary artery bypass grafting or coronary artery bypass grafting/valve patients at hospitals among the top 100 U.S. News & World Report (USNWR) Cardiology & Heart Surgery rankings from 2016 to 2020. Hospitals were grouped into deciles by risk-adjusted observed/expected (O/E) ratios for morbidity and mortality using the STS 2018 risk models. Agreement between STS Adult Cardiac Surgery Database and USNWR ranked deciles was calculated by Bowker symmetry test. The association between each center’s annual change in STS O/E ratio and change in USNWR ranking was modeled in repeated measures regression analysis. ResultsInclusion criteria were met by 524 393 patients from 149 hospitals that ranked in USNWR top 100 at least once during the study period. There was no agreement between USNWR ranking and STS major morbidity and mortality O/E ratio (P > .50 for all years). Analysis of patients undergoing surgery at the 65 hospitals that were consistently ranked in the top 100 during the study period demonstrated no association between annual change in hospital ranking and change in O/E ratio (P all > .3). ConclusionsThere was no agreement between annual USNWR hospital ranking and corresponding risk-adjusted STS morbidity or mortality. Furthermore, annual changes in USNWR rankings could not be accounted for using clinical outcomes. These findings suggest that factors unrelated to key surgical outcomes may be driving consumer-directed rankings.