Where do good outcomes come from?

A close look at one report and its accuracy

"America’s Best Hospitals" is an influential list published annually by U.S. News & World Report that assesses the quality of hospitals. But do patients admitted to hospitals ranked as tops in cardiology have lower short-term mortality from acute myocardial infarction (AMI) than those admitted to other hospitals, or can differences in mortality be explained by differing use of recommended therapies?

Using data from the Cooperative Cardiovascular Project, Yale University School of Medicine researchers looked at the progress of about 150,000 Medicare beneficiaries with AMI.1 They examined the care and outcomes of patients admitted to three types of hospitals: those ranked high in cardiology; those not in the top rank but which had on-site facilities for cardiac catheterization, coronary angioplasty, and bypass surgery; and those not similarly equipped.

The researchers compared these items:
• 30-day mortality;
• rates of use of aspirin, beta-blockers, and reperfusion;
• relation of differences in rates of therapy to short-term mortality.

Admission to a top-ranked hospital was associated with lower adjusted 30-day mortality. Among patients without contraindications to therapy, top-ranked hospitals had significantly higher rates of use of aspirin and beta-blockers but lower rates of reperfusion therapy. The survival advantage associated with admission to top-ranked hospitals was less strong after adjustment for factors including the use of aspirin and beta-blockers. The researchers concluded that a substantial portion of the survival advantage may be associated with those high-ranked hospitals’ greater rates of aspirin use and beta-blocker therapy.


1. Chen J, Radford MJ, Wang Y, et al. Do "America’s Best Hospitals" perform better for acute myocardial infarction? N Engl J Med 1999; 340:286-292.