BACKGROUND: Ranking of hospitals by lay media has attracted widespread attention but may not accurately reflect quality. Acute myocardial infarction (AMI) mortality is a straightforward measure of clinical outcome frequently used by ranking algorithms. AIMS: Our aim was to assess whether ranking among top hospitals correlated with lower in-hospital risk-adjusted mortality following admission for AMI. METHODS: Using a hierarchical regression model and the comprehensive nationwide database of hospital AMI admissions from 2004 to 2007 in France, we analysed crude and risk-adjusted hospital mortality rates in the ranked ('best') hospitals versus non-ranked hospitals. We subsequently restricted the comparison to non-ranked hospitals with matching on-site facilities. RESULTS: We analysed 192,372 admissions in 439 hospitals, 43 of which were in the ranked group. Patients admitted to the 396 non-ranked hospitals tended to be older with more comorbidities and underwent fewer revascularization procedures than patients admitted to ranked hospitals. Between hospital differences accounted for 10% of differences in mortality. Crude mortality was lower in ranked versus non-ranked hospitals (7.5% vs. 11.9%; P<0.001). The survival advantage associated with admission to ranked hospitals was reduced after adjustment for age and sex (5.7% vs. 6.4%; P=0.087) and comorbidities (4.9% vs. 5.5%; P=0.102). CONCLUSIONS: Ranked hospitals have similar adjusted AMI mortality rates to those not ranked and patient characteristics rather than hospital differences account for the variation in outcomes.
BACKGROUND: Ranking of hospitals by lay media has attracted widespread attention but may not accurately reflect quality. Acute myocardial infarction (AMI) mortality is a straightforward measure of clinical outcome frequently used by ranking algorithms. AIMS: Our aim was to assess whether ranking among top hospitals correlated with lower in-hospital risk-adjusted mortality following admission for AMI. METHODS: Using a hierarchical regression model and the comprehensive nationwide database of hospital AMI admissions from 2004 to 2007 in France, we analysed crude and risk-adjusted hospital mortality rates in the ranked ('best') hospitals versus non-ranked hospitals. We subsequently restricted the comparison to non-ranked hospitals with matching on-site facilities. RESULTS: We analysed 192,372 admissions in 439 hospitals, 43 of which were in the ranked group. Patients admitted to the 396 non-ranked hospitals tended to be older with more comorbidities and underwent fewer revascularization procedures than patients admitted to ranked hospitals. Between hospital differences accounted for 10% of differences in mortality. Crude mortality was lower in ranked versus non-ranked hospitals (7.5% vs. 11.9%; P<0.001). The survival advantage associated with admission to ranked hospitals was reduced after adjustment for age and sex (5.7% vs. 6.4%; P=0.087) and comorbidities (4.9% vs. 5.5%; P=0.102). CONCLUSIONS: Ranked hospitals have similar adjusted AMI mortality rates to those not ranked and patient characteristics rather than hospital differences account for the variation in outcomes.