Report: A growing quality chasm’ for hospitals

Mortality rates are 27% lower

A new study from HealthGrades, a Golden, CO-based health care ratings company, names the top 5% of hospitals in the country — and also shows that this group has mortality rates that are 27% lower than other hospitals, with a 14% lower risk of complications. The researchers analyzed 39 million hospitalization records at 5,122 hospitals over a three-year period, for 26 medical procedures and diagnoses.

The findings are strong evidence of the growing "quality chasm" between the nation’s best hospitals and others, says Jeff Goldstein, MD, senior consultant with HealthGrades’ hospital quality assessment and improvement group. "We are seeing a widening gap between hospitals doing well and those hospitals who are not doing well," he says.

To qualify for the list, hospitals were required to meet minimum thresholds in terms of patient volumes, quality ratings, and range of services provided. Before comparing the mortality and complication rates of the nation’s hospitals, data were risk-adjusted so that hospitals that treated sicker patients would be on equal footing. Hospitals with risk-adjusted mortality and complication rates that scored in the top 5% or better nationally were then recognized as Distinguished Hospitals for Clinical Excellence.

"These are difficult goals to achieve because they require a big commitment from the hospital. There has to be a top-down solution, with a true leadership imperative. This can’t be done with one department or service line; it has to be system wide," says Goldstein.

As an example of this, Goldstein points to the RACE (Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments) consortium of North Carolina hospitals working to improve outcomes for patients with coronary disease throughout the continuum of care. "Patient care literally starts even before they walk in the door," he says.

Quality requires a significant amount of resources and is "more than just paint and plaster in the hallways," says Goldstein. "But this is an investment that any industry would have to make," he says.

Researchers concluded that 152,966 lives could have been saved, and 21,896 complications could have been avoided, if the quality of care at all hospitals matched the level of those in the top 5%. Armed with this type of information, consumers are playing a much bigger role in the health care decision-making process — not just patients but also their family members and employers, says Goldstein.

"People want to be certain they are getting the best possible outcome and the most value for their dollar," he says. "No one wants to go to a hospital that is not performing well. Any hospital administrator who is not sensitive to this fact is being very short-sighted. The more information the consumer has, the better off everyone will be." (To access the report, go to