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NORC AT THE
UNIVERSITY OF CHICAGO
The 2001 Index oJ Hospital
Quality
Colm OMuircheartaigh Diana Jergovic Whitney Moore
AsmaAli
The 2001 Index of Hospital Quality
I Introduction middot 3
II The Index ofHospital Quality
A Universe Definition 6
B Composite Measures of Structure9
C Process 13 f D Outcome18 l E The Calculation ofthe Index 22
III Directions for Future Releases 24
IV References25
V Appendices
A Technology indices by specialty
B Structural variable map
C Diagnosis-related group (DRG) groupings by specialty
D 2001 Sample physician questionnaire
E Predicted mortality APR-DRG methodology
F Index ofHospital Quality (IHQ) scores by specialty
G Reputational rankings for specialmiddotservice hospitals
H The 2001 Honor Roll
i
l
r
r l
NORC 6021
1 Introduction
l
f
L
Health care providers and consumers today face a dynamic and often puzzling array of
choices with few tools to inform their critical decisions about quality of care No single
standard measure of quality of care is available for the 6116 hospitals in the United States In
1993 the National Opinion Research Center at the University of Chicago (NORC) developed
such a measure This report card is supported and published annually by U S News amp World
Report in an issue entitled Americas Best Hospitals
In the NORC report card each hospital receives a score called the Index of Hospital
Quality (IHQ) that assesses hospital quality by taking into account the three fundamental
dimensions of health care delivery process structure and outcome None of these dimensions
by itself can completely and accurately represent quality of care all three must be assessed and
combined Care starts with the structural characteristics of an institution (such as the number of
patients served and the range of medical technology available) moves through the process of
delivering care and produces results or outcomes for the patients served To be most useful to
the consumer and provider of care the IHQ--our application of the Donabedian paradigml2 of
structure process and outcomes--combines robust and sensitive measures of each of these
dimensions for the universe of tertiary-care hospitals across a wide range ofmedical and surgical
practice specialties The IHQ draws from secondary sources such as the Annual Survey of
Hospitals by the Americ~ Hospital Association (AHA) for data about various quality
dimensions We continually try to improve the specificity and sensitivity of the measures we use
to rank hospitals and to identify the best possible sources ofdata
For the 2001 rankings we made the following changes bull Introduced new procedures allowing all hospitals that do not respond to the AHA
survey to be eligible for ranking bull Completed the transition to a revised calculation ofmortality ratios bull Refined the selection of Diagnosis-Related Groups (DRGs) for the heart and
orthopedic specialties bull Tested the impact on the response rate to the annual physician survey of either an
explicit reference in the survey letter or questionnaire to the Americas Best Hospitals issue of us News amp World Report or implicitly to the 12th Annual Survey ofPhysicians for US News amp World Report
bull Redesigned the appearance of the questionnaire bull Incorporated into this report a flow chart illustrating the analytical steps of the
methodology
3
(
L
We regularly examine the impact of hospital mergers on our rankings For this release
three mergers among hospitals previously ranked as independent entities appear on the lists
Albany Medical Center NY Evanston Northwestern Medical Center Evanston Ill and
Harper Hospital Detroit These hospitals responded as new corporate entities for the first time
in the 1999 AHA database The following sections define the universe of tertiary-care
hospitals for the purpose of this project describe and define the standardized mortality ratios
and the structural components and explain how process-related data is collected As a guide
the materials on which each of the components of the index is based are outlined below
I Reputation bull The reputational score is based on cumulative infonnation from three NORC
surveys of physicians carried out in 1999 2000 and 2001 the sample design is consistent across the three years
bull The sample for the 2001 survey consists of 2550 board-certified physicians selected from the American Medical Associations (AMA) Physician Masterfile of 811000 physicians
bull StratifYing by region and by specialty within region we selected a sample of 150 physicians from each of 17 specialty areas for a total of2550 physicians
bull The final sample includes both non-federal and federal medical and osteopathic physicians residing in the 50 states and the District ofColumbia
II Structure bull The structural score is based on data related to the structural characteristics of
each specialty within each hospital bull These elements represent volume of work technology and other elements of the
hospital environment bull Most of the data comes from the 1999 AHA Annual Survey bull The volume data comes from the Health Care Financing Administrations
(HeFA) MEDP ARS database which contains information on all Medicare discharges (primarily aged over 65) in each specialty
III ()utco~e
bull The outcome measure is based on HCFAs MEDP ARS database
bull An adjusted mortality rate is computed based on predicted mortality rates bull The data and the model were provided by Solucient Inc of Evanston Ill using
the All Patient Refined Diagnosis Related Group (APR-DRG) method designed by 3M Health Infonnation Systems
bull The APR-DRG adjusts expected deaths for severity of illness by means of principal diagnosis and categories of secondary diagnoses
bull This method is applied to the pooled 1997 1998 and 1999 data set of Medicare reimbursement claims made to HCF A by hospitals
4
In the final section we outline new directions anticipated for the index For a more
exhaustive review of the foundation as well as the development and use of the individual
measures and the composite index see ItBest Hospitals A Description of the Methodology for
the Index ofHospital Quality3
shy
J
r
5
IL The Index ofHospital Quality
A Universe Defmition
We have implemented a two-stage approach to defining eligible hospitals for each of the
IHQ specialty lists
First eligible hospitals must be considered tertiary-care centers To be identified as a
tertiary-care hospital a hospital must meet at least one of the following criteria
bull COTH membership or
bull medical school affiliation or
bull a score of9 or higher on our hospital-wide high-technology index
(Appendix A)
Using these criteria we identified 1878 tertiary-care hospitals that were eligible for any of the
thirteen IHQ-based rankings Once the eligible hospitals were identified data for these hospitals
were drawn from the 1999 AHA Annual Survey As with any data collection effort the AHA
Annual Survey database is incomplete due to nonresponding hospitals Although it did not affect
the analysis this year we have a procedure to allow eligible hospitals that are nonresponders to
the current AHA Annual Survey to remain in our database First for all previously ranked
hospitals that are nonresponders to the current survey we average the two prior years ofdata and
substitute the result for the missing data Two-year non-responders that lack data both from the
current survey and from the previous two surveys are ranked without any structure data
Although nonresponding hospitals need to be treated separately for the IHQ analysis it is
unnecessary to do so for the four reputation-only lists
We then created separate analytic universes for each of the 13 IHQ-driven specialties
using criteria such as specialty-specific technology or facilities and a minimum number of
discharges across appropriate DRGs (Figure 1) However hospitals with a non-zero reputational
score were deemed eligible for ranking even if they had insufficient volume (discharges) in a
specialty
The flow chart in Figure 2 illustrates the eligibility process
6
Figure 1 1999 Universe Definition by Specialty
~pec~~ltyi bull Number ()fllospit~ Imiddotimiddotf~~ifji~t~~f~frl~~~~~~~~~fmiddot ~~ bull~~ bullbull ~ f~middot~~~~ ~ ~~)~~~~ ~~~ Imiddotmiddot~ lt IA~~~~~ri1j~(~~tl = ~-~ ~~~~~f~~-~)~~lt-)-_~- ~~ ~ ~ v~_~ ~_~~ ~~
Cancer minimum of 380 discharges for relevant DRGs or 935 non-zero reputation score
Digestive disorders minimum of734 discharges for relevant DRGs or non- 1394 zero reputation score
Ear nose and minimum of37 discharges for relevant DRGs or non- 1371 throat zero reputation score
Geriatrics score of 1 or more on the geriatrics service index and 1412 minimum of 5947 discharges for all DRGs or nonshy
zero reputation score
Gynecology minimum of 52 discharges for relevant DRGs or non- 1356 zero reputation score
have a cardiac catheterization lab or Heart offer open heart surgery or 853
offer angioplasty and minimum of 245 surgical discharges for relevant
DRGs or non-zero reputation score
Hormonal Minimum of3615 discharges for relev 944 disorders non-zero reputation score
Kidney disease Minimum of 185 discharges for relev 1389 non-zero reputation score
Neurology and Minimum of464 discharges for rete 1408 Neurosurgery non-zero reputation score Orthopedics Minimum of392 discharges for relevant DRGs or 1406
non-zero reputation score Respiratory Minimum of881 discharges for relevant DRGs or 1409
disorders non-zero reputation score Rheumatology Minimum of22 discharges for relevant DRGs or non- 1376
zero reputation score Urology Minimum of 133 discharges for relevant DRGs or 1370
non-zero reputation score
7
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B Composite Measure of Structure
The structural dimension defines the tools and environment available to care providers in
treating patients It represents the possibilities of care for a patient and physician Healthcare
research overwhelmingly supports the use of a measure of structure in assessing quality of care
However no prior research has revealed a single indicator of quality that summarizes all others
or that adequately represents the structure construct on its own Thus the structural component
must be represented by a composite variable comprising different measures that are specialtyshy
specific and are weighted relative to each other
For the 2001 index all structural elements other than volume are derived from the 1999
AHA Annual Survey of Hospitals database and are described below For specific mapping of
variables to the AHA data elements see Appendix B
COTH membership This dichotomous variable indicates membership in the Council of
Teaching Hospitals
Technology indices In 2001 we added medical and surgical intensive care beds to
the list of nephrology elements All other technology elements for all other specialties are
unchanged A complete list of the technologies considered for each specialty can be found in
AppendixA
Since the 1996 version of the index we have allowed our technology indices to reflect
the real cost of high-technology services While providing a service inside the hospital is
convenient for patients the cost may be unacceptable to some hospitals Many hospitals
provide access to technology services through the hospitals health system a local community
network or a contractual arrangement or joint venture with another provider in the
community We have taken this into account by giving hospitals that provide a service such as
ultrasound on-site one full point for that element hospitals that provide the service locally
through a formal arrangement receive a half-point A hospital receives no more than one point
for each element of the index
Volume The volume measure reflects the total number of medical or surgical (or both
when appropriate) discharges in the appropriate specialty-specific ORO groupings submitted for
HCF A reimbursement In the heart specialty surgical discharges indicates volume Data from
the three most recent years is pooled The ORO groupings are shown in Appendix C
9
RNs to beds The number of beds is defined by the AHA as beds set up and staffed at
the end of the reporting period Only nurses who have graduated with RN degrees from
approved schools of nursing and who are currently registered by their state are considered
Nurses must be full-time (35 hoursweek or more) and on staff Private-duty nurses nursing
staff whose salary is financed entirely by outside sources (eg an agency or a research grant)
and LPNs are not counted Registered nurses more appropriately classified in other
occupational categories (eg supervisory nurses facility administrators) also are not counted
Trauma In 1992 the annual US News survey of board-certified physicians ranked the
presence of an emergency room and a hospitals trauma provider level high on a list of hospital
quality indicators Physicians in nine specialties ranked trauma as one of the top five indicators
of quality The indications of these specialists and resultant high factor loadings supported the
inclusion of this data for heart hormonal disorders digestive disorders gynecology kidney
disease neurology and neurosurgery orthopedics ear nose and throat respiratory disorders and
urology
The trauma indicator is dichotomous and reflects two variables from the AHA database
whether the hospital has a certified trauma center in the hospital and the level of the trauma
center To receive credit for trauma services hospitals must provide either Level 1 or Level 2
trauma services in-hospital (as opposed to providing trauma services only as part of a health
system network or joint venture) Levell trauma service is defined as a regional resource
trauma center which is capable of providing total care for every aspect of injury and plays a
leadership role in trauma research and education4 Level 2 is defined by the AHA as a
community trauma center which is capable ofproviding trauma care to all but the most severely
injured patients who require highly specialized care4
Discharge planning The three elements of discharge planning are patient-education
services case management services and patient representative services TA service must be
provided in-hospital to receive credit
Service mix This indicator ranges from 0 to 10 points and comprises alcoholdrug abuse
or dependency inpatient care hospice home health services social work services reproductive
health services psychiatric education services womens health centerservices and psychiatric
consultationlliaison services Services must be provided within the hospital We do not award a
half-point for items in this measure
10
L
Geriatric services This indicator ranges from 0 to 7 points and comprises arthritis
treatment centers adult day care programs patient representative services geriatric services
meals on wheels assisted living and transportation to health facilities Again to receive credit
for a service it must be provided in-hospital
Gynecology services This indicator was introduced in 19975 It provides a means to
better rate the quality of services a hospital provides for its gynecological and obstetric patients
High factor loadings provide support to this variables inclusion With a range of 0 to 4 the
services included are obstetric care reproductive health care birthing rooms and womens
health center The half-point scheme used for the technology indices was not employed for this
indicator
Medicalsurgical intensive care beds This indicator is new in 2001 it surfaced as an
important factor for the nephrology specialty The AHA database provides the number of
medical and surgical intensive care beds per facility To be counted beds must be physically
located within the hospital and set up and staffed at the end of the reporting period
To combine these structural variables we weight the elements to create a flnal
composite measure Using factor analysis we force a one-factor solution and use the resultant
loadings as weight values for each variable in the composite structural measure The
relative weight assigned to each element varies from specialty to specialty and from one release
to the next within specialty Figure 3 provides the factor weights assigned to each element for
the 2001 release
11
F
Fig
ure
3 F
acto
r Lo
adin
g by
Spe
cial
ty
CO
TH
Imiddot
Tec
hnic
al
V
olum
e R
Ns
lBed
s D
is-
Goomiddot
Inde
xes
chan
ze
Can
cer
73
59
70
70
Dig
esti
ve d
isor
ders
69
52
60
63
Ear
nos
e a
nd th
roat
72
54
64
63
Ger
iatr
ics
35
81
Gyn
ecol
ogy
61
71
I H
eart
72
62
65
61
I
56
Hor
mon
al d
isor
ders
71
53
56
65
I
63
Kid
ney
dise
ase
63
66
62
57
I 54
Neu
rolo
gy a
nd n
euro
surg
ery
68
54
62
66
62
Ort
hope
dics
69
46
54
66
63
Res
pira
tory
dis
orde
rs
50
73
31
51
58
Rhe
umat
olog
y 45
82
Uro
logy
73
49
C Process
The process dimension of the quality equation is the sum or net effect of physicians
clinical decision-making Physicians clinical choices about the use of medication or diagnostic
tests admission to the hospital or one ofits units and length ofstay account for a large fraction
of the outcomes experienced by patients However measurements ofprocess on a national scale
are extremely difficult to obtain In order to measure process we rely on an alternative measure
to act as a proxy for process We contend that when a qualified expert identifies a hospital as
one of the best he or she is in essence endorsing the process choices made at that hospital
Thus we use the nomination of a hospital by a board-certified specialist as a measure off process In order to collect these nominations we conduct an annual survey of board-certified
f - physicians As in past releases we have pooled nominations for the past three years [1999-2001] I to arrive at the process measure i
Survey sample The sample for the 2001 survey consists of 2550 board-certified
physicians selected from the American Medical Associations (AMA) Physician Masterfile of
811000 physicians From within the Masterfile we selected a target population of 194916
board-certified physicians who met the eligibility requirements listed in Figure 4 Stratifying by
region and by specialty within region we selected a probability (random) sample of 150
t l physicians from each of 17 specialty areas for a total of 2550 physicians The final sample
r includes both non-federal and federal medical and osteopathic physicians residing in the 50
states and the District ofColumbia Figure 4 displays the list of specialties surveyed in 2001
f Eligibility requirements We defined a probability sample of physicians who could
properly represent the 17 specialty groupings delineated by us News amp World Report We
used two rules of eligibility one related to a mapping between the 17 specialties and the AMAs
list of 85 self-designated specialties and the second related to a mapping between these 85
specialties and the 23 member boards of the American Boards ofMedical Specialties (ABMS)
Under the first rule we linked each of the 17 specialties to one or more relevant AMA
specialties from the list of AMA self-designated practice specialty codes Physicians who
designated a primary specialty in one of the 17 specialties were preliminarily eligible for the
survey Under the second rule the physicians must also be certified by the corresponding
member board of the ABMS Figure 4 displays the correspondence between the specialty [ specified for US News amp World Report AMA self-designated specialty and the corresponding
member board
13
Figure 4 Physician Sample Mapping
us NEWS SPECIALTY
Cancer
r Digestive disorders
Ear nose and throat
Eyes
Geriatrics
i
Gynecology L
Heart
Hormonal disorders
Kidney disease
Neurology and Neurosurgery
-l ~
Orthopedics
Pediatrics
Psychiatry
Rehabilitation
Respiratory disorders
Rheumatology
Urology
I AMAKEY CODE
HEMl22 ON24
GEl
OTO48
OPW46
FPG38 IMG38
GYN21 OBG42
CD08 CDS08
END14 DW12
NEP
N36 NS
ORS85
PO55 ADUOI
P63
PW62
PUD
RHU174
Ul91
AMASELF-middot DESIGNATED
Hematology Oncology
Gastroenterology
Otolaryngology
Ophthalmology
Geriatrics
Gynecology Obstetrics amp gynecology
Cardiovascular diseases Cardiovascular surgery
Endocrinology Diabetes
Nephrology
Neurology Neurological surgery
Orthopedic surgery
Pediatrics Adolescent medicine
Psychiatry
Physical medicine amp rehabilitation
Pulmonary diseases
Rheumatology
Urological surgery
14
AMERICAN BOARD OF
Internal medicine Internal medicine
almedicine
Otolaryngology
Ophthalmology
Internal medicine
Obstetrics amp gynecology Obstetrics amp gynecology
Internal medicine Surgery
Internal medicine Internal medicine
Internal Medicine
Psychiatry amp neurology
Orthopedic surgery
Pediatrics Pediatrics
Psychiatry amp neurology
Physical medicine amp rehabilitation
Internal medicine
I Internal medicine
Urology
r -
l
r
to
f -
1 bull
Stratification To compensate for the widely varying number of eligible physicians
across the targeted specialties we used different probabilities of selection for each grouping and
used proportionate stratification across the four United States Census regions (West Northeast
South and North Central) Within each of the 17 strata we achieved a sample that was also
geographically representative of the spread ofphysicians across the country
2001 physician survey Sampled physicians were mailed a three-page questionnaire (see
Appendix D) a cover letter and a prepaid return envelope We also included a token incentive
in the form of a two-dollar bilL One week after the initial survey mailing a reminder postcard
was sent to the sampled physicians Two weeks following the reminder mailing we sent a
second mailing to nonrespondents including the questionnaire a cover letter and a business reply
envelope Three weeks after the second mailing we re-sent the questionnaire to nonrespondents
This third mailing was sent by Federal Express and included the questionnaire a cover letter and
a business reply envelope
2001 questionnaire redesign In consultation with Dr Donald Dillman of Washington
State University a noted questionnaire designer we revised the physical layout of the project
questionnaire (Appendix D) so that respondents could read and complete it more easily We
believe that the redesign had appreciable impact on this years response rate (below and Figure
5)
Response rate Of the 2550 physicians surveyed for this years report 1377 physicians
returned a useable questionnaire a response rate of 547 percent (Response rate is calculated as
the ratio of completed questionnaires to the total eligible in accordance with standard practice
any member of the sample found to be ineligible was removed from the denominator of the
equation for calculation purposes) Figure 5 shows response rates by specialty for the three years
used for the 2001 index
2001 experiments NORC conducted two experiments as part of the physician survey
for 2001 Briefly the experiments were 1) a Web version of the survey permitting direct onshy
line response for physicians and 2) a comparison of explicit citations of the Americas Best
Hospitals project for US News amp World Report and implicit references to the 12th Annual
15
Survey of Physicians conducted for US News amp World Report Citations appeared on both the
cover letters and questionnaire cover As with last years experimental launching of the Web
version this years version was used successfully by a small number of respondents We plan to
evaluate the cost-effectiveness ofthis strategy before using it again next year With regard to the
project citation experiment half of the physicians in each specialty were told explicitly that their
responses would be used to rank hospitals in Americas Best Hospitals issue of US News amp
World Report and the other half were told that they were participating in an annual survey of
physicians for US News amp World Report Our comparison of the explicit and implicit project
citations indicated no difference in response rates The difference in the number of survey
questionnaires returned by each group within each specialty ranged from 1 to 8 Figure 5 [
details the total number of surveys returned for each specialty
16
r
~
r-
lt
ance
r ig
esti
ve d
isor
ders
orm
onal
dis
orde
rs
idne
y di
seas
e
euro
logy
and
esp
irat
ory
diso
rder
s gy
Fig
ure
5 R
espo
nse
Rat
e b
y Y
ear
(150
sam
pled
phy
sici
ans
per
spe
cial
ty p
erye
ar)
n 70
71
82
75
84
70
62
68
62
78
r
Weighting Weighting was carried out in two steps First weights were assigned to
physicians that reflected the probabilities of selection within specialty groups and the overall
rates ofresponse within these groups Second the weights from the first step were poststratified
using the two-dimensional contingency table of specialty (17 categories) by census region
(Northeast Midwest South and West) To check the weights we ~nfinned that the sum across
the sample of the weights in each cell of the classifications (specialty x region) equaled the
population size
D Outcome
Many healthcare professionals have decried the use of mortality rates because of
limitations in the methods used to adjust for risk Nonetheless research strongly suggests a
positive correlation between a risk-adjusted mortality rate that is better than average and overall
quality8-17 Based on these findings we used adjusted mortality rate as the outcome measure for
our quality of care model All predicted mortality rates were provided by Solucient Inc of
Evanston Ill using the All Patient Refined Diagnosis Related Group (APR-DRG) method
designed by 3M Health Information Systems The APR-DRG adjusts expected deaths for
severity of illness by means of principle diagnosis and categories of secondary diagnoses A
detailed description of the full APR-DRG methodology is provided in Appendix E Solucient
applied this method to the pooled 1997 1998 and 1999 data set of reimbursement claims made to
HCF A by hospitals These complete data sets were the most current available
2001 DRG refmements We annually review the DRG-groupings for every specialty In 2001
we chose to conduct a thorough examination of the DRG groupings in heart and orthopedics
Because we anticipated likely changes as a result we conducted two independent reviews
Solucient conducted a review of each specialty and an independent consultant shy
a cardiologist and an orthopedic surgeon--conducted a review in his specialty Where the two
reviews agreed as they did in each of the two specialties we implemented the recommended
changes Revisions for each specialty are detailed below
18
Heart DRGs Three DRGs were added
109 = Coronary bypass wlo cardiac cath
124 =Circulatory disorders except AMI w cardiac cath and complex diag
125 =Circulatory disorders except AMI w cardiac cath and wlo complex diag
Orthopedic DRGs Two DRGs were deleted and six were added
DeletedDRGs
214 =Back amp neck procedures wI CC
215 =Back amp neck procedures wlo CC
AddedDRGs
496 =Combined anteriorlposterior spinal fusion
497 = Spinal fusion wI CC r 498 = Spinal fusion wlo CC 501 =Knee proc wI pdx ofinfection wi CC
502 =Knee proc wI pdx ofinfection wlo CC
503 =Knee proc wlo pdx ofinfection
As in previous years we used an all-cases mortality rate for four specialties (geriatrics
gynecology ear nose and throat and rheumatology) rather than a specialty-specific rate either
because the number of hospitals with sufficient discharges in the particular DRG-grouping was
too low or because the DRG groupings proved to be less robust than was desired Appendix C r -
lists the DRGs for each specialty
In 2000 we modified the construction of the outcome measure The IRQ is the final
score for each hospital in the specialty rankings It gives equal weight to process (represented by
reputation) outcome (mortality) and structure (volume technology and other elements of the
hospital environment) The numbers produced for each of these three measures however differ
greatly in magnitude and in range or variability Without correcting for that the final score
even when the three measures are weighted equally would be distorted
19
Pre-2000 solution For each specialty prior to 2000 the calculated mortality ratio for each
hospital was inverted--the ratio of actual to expected deaths was divided into 1 so that as with
other measures higher meant better For example a better-than-expected mortality ratio of 08
would produce an inverted result of 125 a worse-than-expected ratio of 12 would produce an
inverted result of 083 (The published rankings continued to display the ratio of actual to
expected deaths) Then the scores for reputation mortality and structure were standardized or
adjusted so that the degree ofvariability in each measure was the same
A difficulty with this approach was that inverting caused very low mortality ratios to
distort the outcome (Inverted a mortality ratio of 025 produces a score of 4 a ratio of 005
produces a score of 20 and a ratio of 001 produces a score of 100) If instead of being divided
into 1 the mortality ratio is subtracted from I-this could be called reverse scoring-such extremes r
are eliminated Using reverse scoring a mortality ratio of 025 produces a score of 075 a ratio
of 005 produces a score of 095 and a ratio of 001 produces a mortality score of 99 This
maintains the magnitudes of the differences and avoids extreme values Accordingly the new
rankingsreflect reverse scoring in mortality To dampen the effect of year-to-year fluctuations
mortality scores will be averaged over three years
Finally scores at the extremes in mortality and in certain structural measures were
trimmed to eliminate the influence ofvery wide variation Figure 6 gives the percentile at which
each of the mortality distributions was trimmed
Lj Figure 6 Percentile at Which Each Mortality Distribution Was Trimmed
Specialty
Cancer
Digestive disorders
Ear nose and throat
Geriatrics
Gynecology
Heart
Hormonal disorders l ~
Percentile
95
99
95
99
99
95
95
Specialty Percentile
Kidney disease 99
Neurology and neurosurgery 99
Orthopedics 95
Respiratory disorders 99
Rheumatology 99
Urology 90
20
l
A second round of standardizing also was added in 2000 after trimming extremes
Previously this second standardization was not perfonned resulting in trimmed measures having
less influence on the final score than other measures did Restandardizing restores the balance so
that trimmed and untrimmed measures have the same influence
Phase-in The changes described affect the final scores so they are phased in over two
years For 2000 each hospitalts final score averaged pre-2000 and current methodologies As
before the top hospital in each specialty received a score of 100 with other hospitals scaled
down from that figure
In 2001 the phase-in is complete with the 2001 mortality ratios fully reflecting the
revised methodology
J
--
21
E Calculation of the Index
i
The calculation of the IRQ for each hospital (other than in specialties ranked solely on
reputation) considers equally the three dimensions of quality of care structure process and
outcome Although all three measures represent a specific aspect of quality a single score not
only provides an easier-to-use result but yields a more accurate portrayal of overall quality than
would the three aspects individually
Therefore in computing the final scores for a particular specialty the reputational score
mortality scores and the collective set of structural indicators receive arithmetically equivalent
importance
The total fonnula for calculation of the specialty-specific IHQs is
where
IHQi = Index for Hospital Quality for specialty i
Sl-n = Structural indicators (STRUCTURE)
F = Factor loading
P = Nomination score (PROCESS)
M = Standardized mortality ratio (OUTCOME)
The general fonnula for deriving the index scores for tertiary-level hospitals is the same
as it began in 1993 Each of the three components--structure process and outcomes--is
considered equally in determining the final overall score For presentation purposes we
standardized raw scores then equated the raw IRQ scores as computed above to a 100-point
scale where the top hospital in each specialty received a score of 100
The mean and standard deviation of each of the 17 specialties are listed in Figure 7
Note that for the four reputation-only rankings mean and standard deviation of the reputational
score are presented This data further illustrates that the spread of IRQ scores produces a very
small number of hospitals two and three standard deviations above the mean Horizontal lines
in each of the 17 specialty lists in Appendices F and G indicate the cutoff points of two and
three standard deviations above the mean
22
We could not calculate scores for hospitals that provide care in eyes pediatrics
psychiatry or rehabilitation because data for robust and meaningful structural and outcomes
measures are not available for these specialties Thus as shown in Appendix G we rank
hospitals in these specialties solely by reputation Although the four reputation-only specialties
are ranked without the Index of Hospital Quality standard deviations of the reputational scores
are still useful in identifying truly superior hospitals (in terms of statistically relevant nomination
scores)
Figure 7 Mean and Standard Deviations ofIHQ and Reputational Scores
Mean Standard deviation 1 SD above Z SDs above 3 SDs above the mean the mean the mean
~- IHQScore
Cancer 2390 652 3042 3694 4346
Digestive disorders 1514 538 2052 2590 3128
Ear nose and throat 2064 647 2711 3358 4005
Geriatrics 2049 588 2637 3225 3813 Gynecology 1857 598 2455 3053 3651
Heart 2079 674 2753 3427 4101 Hormonal disorders 2545 574 3119 3693 4267 Kidney disease 2600 758 3358 4116 4874
Neurology and 1781 562 2343 2905 3467 neurosurgery Orthopedicsmiddot 1960 539 2499 3038 3577I Respiratory disorders 1665 569 I 2234 2805 3372 Rheumatology 3768 454 4222 4676 5130 Urology 1930 502 2432 2934 3436
Reputational Score
lEyes 455 1272 1727 2999 4271 [pediatrics 299 659 958 1617 2276 psychiatry 252 524 776 1300 1824 Rehabilitation 287 777 1064 1841 2618
23
III Directions for Future Releases
The US News Index has since its inception used the most rigorous methodology
available to define measure and combine the components of quality incorporated in its
construction Over the next few years we plan to subject each of the components (process
outcome and structure) to a searching re-examination We are aware that the skewed
distribution of the reputation scores can appear to give an inappropriate advantage to hospitals
that obtain a high percentage ofnominations and we will continue to examine the way in which
the reputation scores are used to define the process score We intend to test and evaluate
different transformations of the raw scores to see whether a transformation would produce a
bull i superior measure With regard to outcome the refinement of definitions of non-fatal outcomesshy
particularly in some specialties-suggests incorporating some of these measures into outcome
scores We will continue to refine and develop our measures of technology for the structural
component Finally we will re-examine the way in which the three components are combined
into the IHQ There may be ways to maintain the principle of equal weight for the three
components while improving the method ofcombining them
We will also examine the possibility of extending the evaluation of the four specialties
that are currently ranked only on reputation to incorporate appropriate structure and outcome
measures
As in years past we welcome input from users of the index in charting new directions
Readers and users are encouraged to contact the authors with suggestions and questions
j bull
24
l
lmiddot
References 1 Donabedian A Evaluating the quality of medical care The Milbank Memorial Fund Quarterly
1966 44166-203
2 Donabedian A Promoting quality through evaluating the process of patient care Med Care 1968 6181
3 Hill CA Winfrey KL Rudolph BA Best Hospitals A description of the methodology for the index ofhospital quality Inquiry 1997 34(1)80-90
4 American Hospital Association 1996 Annual Survey of Hospitals Data Base Documentation Manual
5 Ehrlich RH Hill CA Winfrey KL 1997 Survey oBest Hospitals Chicago NORC 1997
6 Hill CA Winfrey KL1995 Survey on Best Hospitals Chicago NORC 1995
7 Palella FJ Jr Delaney KM Moorman AC Loveless MO Fuhrer J Satten GA Aschman DJ Holmberg SD Declining Morbidity and Mortality Among Patients With Advanced Human Immunodeficiency Virus Infection N Engl J Med 1998 338853-860
8 United States Department of Health and Human Services Medicare hospital mortality information HCFA publication 01-002 Report prepared by Otis R Bowen and William L Roper Washington DCUSGPO 1987
9 Blumberg MS Comments on HCFA hospital death rate statistical outliers HSR Health Services Research 1987 21715-40
10 Dubois RW Brook RH Rogers WH Adjusted hospital death rates a potential screen or the quality ofmedical care MPH 1987 771162-6
11 Gillis KD Hixson JS Efficacy of statistical outlier analysis for monitoring quality of care Journal oBusiness and Economic Statistics 1991 9241-52
12 Green J Wintfield N Sharkey P Passman LJ The importance of severity of illness in assessing hospital mortality JAMA 1990 263241-6
13 Green J Passman LJ Wintfield N Analyzing hospital mortality the consequences ofdiversity in patient mix JAMA 1991 2651849-53
14 Greenfield S Aronow HU ElashoffRM Watanabe D Flaws in mortality data the hazards of ignoring comorbid disease JAMA 1988 2602253-7
15 Rosen HM Green BA The HCFA excess mortality lists a methodological critique Hospital and Health Services Administration 1987 2119-24
16 Flood AB Scott WR Conceptual and methodological issues in measuring the quality of care in hospitals In Hospital structure and performance Baltimore Johns Hopkins University Press 1987
17 Iezzoni LI Ash AS Coffinan GA Moskowitz MA Predicting in-hospital mortality a comparison of severity measurement approaches Med Care 1992 30347-59
25
Appendix A
Technology Indices by Specialty t
1
All Hospital Index
17 elements (used to define eligible hospitals)
r
Cancer
7 Elements
AnRioplasty Cardiac Catheterization Lab
Cardiac Intensive Care Beds
Computed Tomography Scanner
Diagnostic Radioisotope Facility
Diagnostic Mammography Services
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
MedicaVSurgical Intensive Care
Neonatal Intensive Care Beds
Open Heart Surgery
Pediatric Intensive Care Beds
Positron Emission Tomography Scanner
ReprQductive Health
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraphy Scanner Magnetic Resonance Imaging
Oncology Services
Pediatric Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
I Digestive disorders
8 Elements Computed Tomography Scanner Diagnostic Radioisotope Facility
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound i
X-ray Radiation Therapy
Ear Nose and Throat
5 Elements Comouted Tomorrraohv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
Heart
9 Elements Angioplasty Cardiac Catheterization Lab
Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Open Heart Surgery
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
j
Hormonal disorders
7 Elements
Geriatrics
8 Elements
Gynecology
8 Elements
Computed TomoRraphv Scanner Diagnostic Radioisotope Facility
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Cardiac Catheterization Lab Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraDhv Scanner Diagnostic Mammography Services
Magnetic Resonance Imaging
Neonatal Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Kidney disease
5 Elements
Neurology and f Neurosurgery t j
7 Elements
t
l
Orthopedics
5 Elements I t
Respiratory disorders 4 Elements
Extracorporeal Shock Wave Lithiotripter Ultrasound
Computed Tomography Scanner
Diagnostic Radioisotope FacUity
Transplant Services
Computed Tomography Scanner Diagnostic Radioisotope FacUity
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed Tomolraphv Scanner Magnetic Resonance Imaging
Positron Emissions Tomography Scanner
Single Photon Emissions Computed Tomography
Ultrasound
Computed Tomographv Scanner Diagnostic Radioisotope FacUity
Radiation Therapy
Ultrasound
Rheumatology
5 Elements Computed TomoJraphv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
Urology
8 Elements Extracorporeal Shock Wave Lithiotripter X-ray Radiation Therapy
Computed Tomography Scanner
Diagnostic Radioisotope Facility
i Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
(
i
AppendixB
Structural Variable Map
f
L
r
t bull
r
tJ
L
The following variables used to construct structural elements of the 2001 IHQ were taken from the 1999 Annual Survey of Hospitals Data Base published by the American Hospital Association
ALL HOSP~TAL ~NDBX - used to define hospital eligibility 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ~GIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICBDHOS=l half point if CICBDSYS CICBDNET or CICBDVEN=l 1 point if CTS CNHOS=1 half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if MSICHOS=l half point if MSICSYS MSICNET or MSICVEN=l 1 point if NICBDHOS=l half point if NICBDSYS NICBDNET or NICBDVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PEDBDHOS=l half point if PEDBDSYS PEDBDNET or PEDBDVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if REPROHOS=l half point if REPROSYS REPRONET or REPROVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Cancer Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if ONCOLHOS=l half point if ONCOLSYS ONCOLNET or ONCOLVEN=l 1 point if PEDICHOS=l half point if PEDICSYS PEDICNET or PEDICVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
Digestive Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Ear I Nose and Throat Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRIVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
1
Heart Technology Index 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ANGIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNETor CICVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Hormonal Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRlHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Geriatrics Technology Index 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNET or ClCVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETROS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Gynecology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if NICHOS=l half point if NICSYS NICNET or NlCVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Kidney Disease Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=lhalf point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if TPLNTHOS=l half point if TPLNTSYS TPLNTNET or TPLNTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Neurology and Neurosurgery Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Orthopedics TeChn610gy ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Respiratory Disorders Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Rheumatology Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Urology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
r
I
Discharge Planning COTH ] point if CMNGTHOS=] Yes if MAPP8=1 ] point if PATEDHOS=] 1 point if PATRPHOS=l RN I s to Beds
Full-time Registered Nurses Geriatric Services (FTRNTF) divided by Total Hospital 1 point if ADULTHOS=l Beds (HOSPBD) ] point if ARTHCHOS=l 1 point if ASSTLHOS=l Trauma ] point if GERSVHOS=l Yes if TRAUML90=] or 2 and 1 point if MEALSHOS=l TRAUMHOS=l 1 point if PATRPHOS=l 1 point if TPORTHOS=l
Gynecology Services 1 point if BROOMHOS=l 1 point if OBLEV=2 or 3 and OBHOS=] 1 point if REPROHOS=l
l ~
1 point if WOMHCHOS=l r ~
Service Mix ] point if ALCHHOS=l ] point if COUTRHOS=l 1 point if HOMEHHOS=l ] point if HOSPCHOS=l ] point if PSYEDHOS=] 1 point if PSYLSHOS=] 1 point if REPROHOS=l ] point if SOCWKHOS=] ] point if WOMHCHOS=]
l
i
1
[ l
AppendixC
Diagnosis-Related Group (DRG) Groupings l by Specialty
r 1
DRG10 DRGll DRG64 DRG82 DRGl72 DRG173 DRG199 DRG203 DRG239
DRG257 DRG258 DRG259 DRG260 DRG274
r 1 DRG275 DRG338 DRG344 DRG346 DRG347 DRG354 DRG355 DRG357 DRG366 DRG367 DRG400 DRG401 DRG402 DRG403 DRG404 DRG405 DRG409 DRG410 DRG411 DRG412 DRG413 DRG414
r 1 DRG473 DRG492
1
U
I 1
LJ
Cancer
NERVOUS SYSTEM NEOPLASMS W CC NERVOUS SYSTEM NEOPLASMS WIO CC EAR NOSE MOUTH amp TIIROAT MALIGNANCY RESPIRATORY NEOPLASMS DIGESTIVE MALIGNANCY W CC DIGESTIVE MALIGNANCY WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS PAlHOLOGICAL FRACTURES amp MUSCULOSKELETAL amp CONN TISS MALIGNANCY TOTAL MASTECTOMY FOR MALIGNANCY W CC TOTAL MASTECTOMY FOR MALIGNANCY WIO CC SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC SUBTOTAL MASTECTOMY FOR MALIGNANCY WIO CC MALIGNANT BREAST DISORDERS W CC MALIGNANT BREAST DISORDERS WIO CC TESTES PROCEDURES FOR MALIGNANCY OTHER MALE REPRODUCTIVE SYSTEM OR PROCEDURES FOR MALIGNANCY MALIGNANCY MALE REPRODUCTIVE SYSTEM W CC MALIGNANCY MALE REPRODUCTIVE SYSTEM WIO CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG W CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG WIO CC UTERINE amp ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY MALIGNANCY FEMALE REPRODUCTIVE SYSTEM W CC_ MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WIO CC LYMPHOMA amp LEUKEMIA W MAJOR OR PROCEDURE LYMPHOMA amp NONmiddotACUTE LEUKEMIA W OTHER OR PROC W CC LYMPHOMA amp NON-ACUTE LEUKEMIA W OTHER OR PROC WIO CC LYMPHOMA amp NON-ACUTE LEUKEMIA W CC LYMPHOMA amp NON-ACUTE LEUKEMIA WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGE 0-17 RADIOlHERAPY CHEMOTHERAPY WIO ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS HISTORY OF MALIGNANCY WIO ENDOSCOPY HISTORY OF MALIGNANCY W ENDOSCOPY OlHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGEgt17 CHEMOTHERAPY W ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS
DRG146 DRG147 DRG148 DRG149 DRG150 DRG151 DRG152 DRG153 DRG154 DRG155 DRG156 DRG170
l i DRG171 DRG174 DRG175
L DRG176 DRG177 DRG178 DRG179 DRG180 DRG181 DRG182 DRG183 DRG184 DRG188
l DRG189 DRG190 DRG191
i J DRG192 DRG193 DRG194 DRG195 DRG196 DRG197
t
LeJ DRG198 DRG200 DRG201 DRG202 DRG204 DRG205 DRG206 DRG207 DRG208 DRG493 DRG494
Digestive Disorders
RECTAL RESECTION W CC RECTAL RESECTION WIO CC MAJOR SMALL amp LARGE BOWEL PROCEDURES W CC MAJOR SMALL amp LARGE BOWEL PROCEDURES WIO CC PERITONEAL ADHESIOLYSIS W CC PERITONEAL ADHESIOLYSIS WIO CC MINOR SMALL amp LARGE BOWEL PROCEDURES W CC MINOR SMALL amp LARGE BOWEL PROCEDURES WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE gt17 W CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGEgt17 WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE 0-17 OTHER DIGESTIVE SYSTEM OR PROCEDURES W CC OTHER DIGESTIVE SYSTEM OR PROCEDURES WO CC G HEMORRHAGE W CC GJ HEMORRHAGE WIO CC COMPLICATED PEPTIC ULCER UNCOMPLICATED PEPTIC ULCER W CC UNCOMPLICATED PEPTIC ULCER WIO CC INFLAMMATORY BOWEL DISEASE GI OBSTRUCTION W CC GI OBSTRUCTIONWO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 W CC ESOPHAGmS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 WIO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGE 0-17 OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 W CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 WIO CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0-17 PANCREAS LIVER amp SHUNT PROCEDURES W CC PANCREAS LIVER amp SHUNT PROCEDURES W 10 CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE W CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE WIO CC CHOLECYSTECTOMY W CDE W CC CHOLECYSTECTOMY W CDE WIO CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE W CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY OTHER HEPATOBILIARY OR PANCREAS OR PROCEDURES CIRRHOSIS amp ALCOHOLIC HEPATITIS DISORDERS OF PANCREAS EXCEPT MALIGNANCY DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEP A W CC DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEPA WIO CC DISORDERS OF THE BILIARY TRACT W CC DISORDERS OF THE BILIARY TRACT WO CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE W CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE WO CC
DRG49 DRG50 DRG51 DRG55 DRG57 DRG58 DRG61 DRG62 DRG63 DRG65 DRG66 DRG67
DRG68
DRG69 DRG70 DRG71 DRG72 DRG73 DRG74
DRG353 DRG356 DRG358 DRG359 DRG360 DRG361 DRG362 DRG363 DRG364 DRG365 DRG368 DRG369
Ear Nose and Throat
MAJOR HEAD amp NECK PROCEDURES SIALOADENECTOMY SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY MISCELLANEOUS EAR NOSE MOUTH amp TIiROAT PROCEDURES TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGEgt17 TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGE 0-17 MYRINGOTOMY W TUBE INSERTION AGE gt17 MYRINGOTOMY W TUBE INSERTION AGE 0-17 OTHER EAR NOSE MOUTH amp TIiROAT OR PROCEDURES DYSEQUILIBRIUM EPISTAXIS EPIGLOTTITIS
OTITIS MEDIA amp URI AGEgt17 W CC OTITIS MEDIA amp URI AGEgt17 WIO CC OTITIS MEDIA amp URI AGE 0-17 LARYNGOTRACHEITIS NASAL TRAUMA amp DEFORMITY OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE gt17 OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE 0-17
Geriatrics ALL CASES
Gynecology
PELVIC EVISCERATION RADICAL HYSTERECTOMY amp RADICAL VULVECTOMY FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY W CC UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY WIO CC VAGINA CERVIX amp VULVA PROCEDURES LAP AROSCOPY amp INCISIONAL TUBAL INTERRUPTION ENDOSCOPIC TUBAL INTERRUPTION DampC CONIZATION amp RADIO-IMPLANT FOR MALIGNANCY DampC CONIZATION EXCEPT FOR MALIGNANCY OrnER FEMALE REPRODUCTIVE SYSTEM OR PROCEDURES INFECTIONS FEMALE REPRODUCTIVE SYSTEM MENSTRUAL amp OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
DRG103 DRGl04 DRG105 DRG106 DRG107 DRG108 DRG109
DRG1l0 DRG1l1 DRG112 DRG115 DRG1l6 DRG117 DRG118 DRG121 DRG122 DRG123 DRG124 DRG125 DRG126 DRG127 DRG128 DRG129 DRG130 DRG131 DRG132 DRG133 DRG135 DRG136 DRG137 DRG138 DRG139 DRG140 DRG141middot DRG142 DRG 144 DRG145
r i
f ~
Heart
HEART TRANSPLANT CARDIAC VALVE PROCEDURES W CARDIAC CATH CARDIAC VALVE PROCEDURES WIO CARDIAC CATH CORONARY BYPASS W CARDIAC CATH CORONARY BYPASS WIO CARDIAC CATH OTHER CARDIOTHORACIC PROCEDURES CORONARY BYPASS WIO CARDIAC CATH
MAJOR CARDIOVASCULAR PROCEDURES W CC MAJOR CARDIOVASCULAR PROCEDURES WIO CC PERCUTANEOUS CARDIOVASCULAR PROCEDURES PERM CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK OTH PERM CARDIAC PACEMAKER IMPLANT OR AICD LEAD OR GENERATOR PRO
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT CARDIAC PACEMAKER DEVICE REPLACEMENT CIRCULATORY DISORDERS W AMI amp CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI WIO CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI EXPIRED CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH AND CMPLX DIAG CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH WIO CMPLX DIAG ACUTE amp SUBACUTE ENDOCARDmS HEART FAILURE amp SHOCK DEEP VEIN THROMBOPHLEBITIS CARDIAC ARREST UNEXPLAINED PERIPHERAL VASCULAR DISORDERS W CC PERIPHERAL VASCULAR DISORDERS WIO CC ATHEROSCLEROSIS W CC ATHEROSCLEROSIS WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 W CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGE 0-17 CARDIAC ARRHYTIIMIA amp CONDUCTION DISORDERS W CC CARDIAC ARRHYTHMIA amp CONDUCTION DISORDERS WIO CC ANGINA PECTORIS SYNCOPE amp COLLAPSE W CC SYNCOPE amp COLLAPSE WIO CC OTHER CIRCULATORY SYSTEM DIAGNOSES W CC OTHER CIRCULATORY SYSTEM DIAGNOSES WIO CC
1
DRG286 DRG287 DRG288 DRG289 DRG290 DRG292 DRG293 DRG294 DRG295 DRG296 DRG297
t DRG298 DRG299
DRG300 DRG301
~- --j
DRG316 DRG317 DRG320 DRG321 DRG322 DRG325 DRG326 DRG327 DRG 331 DRG332 DRG333
f
Hormonal Disorders
ADRENAL amp PITUITARY PROCEDURES SKIN GRAFTS amp WOUND DEBRID FOR ENDOC NUTRlT amp METAB DISORDERS OR PROCEDURES FOR OBESITY P ARA1HYROID PROCEDURES 1HYROIDPROCEDURES OrnER ENDOCRINE NUTRIT amp METAB OR PROC W CC 01HER ENDOCRINE NUTRIT amp METAB OR PROC WIO CC DIABETES AGE gt35 DIABETES AGE 0-35 NUTRlTIONAL amp MISC METABOLIC DISORDERS AGEgt17 W CC NUTRITIONAL amp MISC METABOLIC DISORDERS AGE gt17 WIO CC NUTRlTIONAL amp MISC METABOLIC DISORDERS AGE 0-17 INBORN ERRORS OF METABOLISM ENDOCRINE DISORDERS W CC ENDOCRINE DISORDERS WIO CC
Kidney Disease
RENAL FAILURE ADMIT FOR RENAL DISEASE KIDNEY amp URINARY TRACT INFECTIONS AGE gt17 W CC KIDNEY amp URINARY TRACT INFECTIONS AGEgt17 WIO CC KIDNEY amp URINARY TRACT INFECTIONS AGE 0-17 KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 W CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 WIO CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMS AGE 0-17 01HERKIDNEY amp URINARY TRACT DIAGNOSES AGE gt17 W CC 01HER KIDNEY amp URINARY TRACT DIAGNOSESgt 17 WIO CC 01HER KIDNEY amp URINARY TRACT DIAGNOSES AGE 0-17
Neurology and Neurosurgery
DRGl CRANIOTOMY AGE gt17 EXCEPT FOR TRAUMA DRG2 CRANIOTOMY FOR TRAUMA AGEgt17 DRG3 CRANIOTOMY AGE 0-17 DRG4 SPINAL PROCEDURES DRG5 EXTRACRANIAL VASCULAR PROCEDURES DRG6 CARPAL TUNNEL RELEASE DRG7 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC W CC DRG8 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC WIO CC DRG9 SPINAL DISORDERS amp INJURIES DRG12 DEGENERATIVE NERVOUS SYSTEM DISORDERS
j DRG13 MULTIPLE SCLEROSIS amp CEREBELLAR ATAXIA DRG14 SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA DRG15 TRANSIENT ISCHEMIC ArrACK amp PRECEREBRAL OCCLUSIONS DRG16 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC DRG17 NONSPECIFIC CEREBROVASCULAR DISORDERS WIO CC DRG18 CRANIAL amp PERIPHERAL NERVE DISORDERS W CC DRG19 CRANIAL amp PERIPHERAL NERVE DISORDERS WIO CC DRG20 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGmS DRG21 VIRAL MENlNGITIS DRG22 HYPERTENSIVE ENCEPHALOPATHY DRG23 NONTRAUMATICSTUPORampCOMA DRG24 SEIZURE amp HEADACHE AGEgt17 W CC DRG25 SEIZURE amp HEADACHE AGEgt17 WIO CC DRG26 SEIZURE amp HEADACHE AGE 0-17 DRG27 TRAUMATIC STUPOR amp COMA COMA gt1 HR DRG28 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGEgt17 W CC DRG29 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE gt17 WIO CC
imiddot DRG30 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE 0-17 DRG31 CONCUSSION AGEgt17 W CC DRG32 CONCUSSION AGEgt17 WIO CC DRG33 CONCUSSION AGE 0-17 DRG34 OTHER DISORDERS OF NERVOUS SYSTEM W CC DRG35 OTHER DISORDERS OF NERVOUS SYSTEM WIO CC
(
DRG209 DRG210 DRG211 DRG212 DRG213 DRG216 DRG217 DRG218 DRG219 DRG220 DRG221 DRG222 DRG223 DRG224 DRG225 DRG226 DRG227 DRG228 DRG229 DRG230 DRG231 DRG232 DRG233 DRG234 DRG235
j DRG236 DRG237 DRG238 DRG240 DRG241 DRG471 DRG485
DRG491 DRG496 DRG497 DRG498
f DRG501 DRG502 DRG503
Orthopedics
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 W CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 WIO CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0-17 AMPUTATION FOR MUSCULOSKELETAL SYSTEM amp CONN TISSUE DISORDERS BIOPSIES OF MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE WND DEBRID amp SKN GRFT EXCEPT HANDFOR MUSCSKELET amp CONN TISS DIS LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 W CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 WIO CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGE 0-17 KNEE PROCEDURES W CC KNEE PROCEDURES WO CC MAJOR SHOULDERIELBOW PROC OR OTHER UPPER EXTREMITY PROC W CC SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC WIO CC FOOT PROCEDURES SOFT TISSUE PROCEDURES W CC SOFT TISSUE PROCEDURES WIO CC MAJOR THUMB OR JOINT PROCOR OTH HAND OR WRIST PROC W CC HAND OR WRIST PROC EXCEPT MAJOR JOINT PROC WIO CC LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES OF HIP amp FEMUR LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES EXCEPT HIP amp FEMUR ARTHROSCOPY OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC W CC OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC WIO CC FRACTURES OF FEMUR FRACTURES OF HIP amp PELVIS SPRAINS STRAINS amp DISLOCATIONS OF HIP PELVIS amp THIGH OSTEOMYELmS CONNECTIVE TISSUE DISORDERS W CC CONNECTIVE TISSUE DISORDERS WIO CC BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY LIMB REATTACHMENT HIP AND FEMUR PROC FOR MULT SIGNIFICANT
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY COMBINED ANTERIORIPOSTERIOR SPINAL FUSION SPINAL FUSION WI CC SPINAL FUSION WIO CC KNEE PROC WI PDX OF INFECTION WI CC KNEE PROC WI PDX OF INFECTION WOCC KNEE PROC WOPDX OF INFECTION WI CC
~ t L ~
l
DRG76 DRG77 DRG78 DRG79 DRG80 DRG81 DRG85 DRG86 DRG87 DRG88 DRG89 DRG90 DRG91 DRG92 DRG93 DRG94 DRG95 DRG96 DRG97 DRG98 DRG99 DRG100 DRG101 DRG102 DRG475
DRG242 DRG244 DRG245 DRG246 DRG247 DRG256
i_J
Respiratory Disorders
OTHER RESP SYSTEM OR PROCEDURES W CC OTHER RESP SYSTEM OR PROCEDURES WO CC PULMONARYEMBOUSM RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 W CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 WO CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGE 0-17 PLEURAL EFFUSION W CC PLEURAL EFFUSION WO CC PULMONARY EDEMA amp RESPIRATORY F AlLURE CHRONIC OBSTRUCTIVE PULMONARY DISEASE SIMPLE PNEUMONIA amp PLEURISY AGEgt17 W CC SIMPLE PNEUMONIA amp PLEURISY AGEgt17 WO CC SIMPLE PNEUMONIA amp PLEURISY AGE 0-17 INTERSTITIAL LUNG DISEASE W CC INTERSTITIAL LUNG DISEASE W 10 CC PNEUMOTIIORAX W CC PNEUMOTIIORAX WO CC BRONCHmS amp ASTIIMA AGEgt17 W CC BRONCHmS amp ASTIIMA AGEgt17 WO CC BRONCIDTIS amp ASTIIMA AGE 0-17 RESPIRATORY SIGNS amp SYMPTOMS W CC RESPIRATORY SIGNS amp SYMPTOMS WO CC OTHER RESPIRATORY SYSTEM DIAGNOSES W CC OTHER RESPIRATORY SYSTEM DIAGNOSES WO CC RESPIRATORY SYSTEM DIAGNOSIS WITII VENTILATOR SUPPORT
Rheumatology
SEPTIC ARTHRITIS BONE DISEASES amp SPECIFIC ARTHROPATIIIES W CC BONE DISEASES amp SPECIFIC ARTHROPATIDES WO CC NON-SPECIFIC ARTHROPATHIES SIGNS amp SYMPTOMS OF MUSCULOSKELETAL SYSTEM amp CONN TISSUE OTIIER MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE DIAGNOSES
DRG302 DRG303 DRG304 DRG305 DRG306 DRG307 DRG308 DRG309 DRG31O DRG311 DRG312 DRG313 DRG314
DRG315 DRG323 DRG324 DRG328 DRG329 DRG330 DRG334 DRG335 DRG336 DRG337 DRG339 DRG340 DRG341 DRG342 DRG343 DRG348 DRG349 DRG350 DRG351 DRG352
Urology
KIDNEY TRANSPLANT KIDNEYURETER amp MAJOR BLADDER PROCEDURES FOR NEOPLASM KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL W CC KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL WIO CC PROSTATECTOMY W CC PROSTATECTOMY WIO CC MINOR BLADDER PROCEDURES W CC MINOR BLADDER PROCEDURES WIO CC TRANSURETHRAL PROCEDURES W CC TRANSURETHRAL PROCEDURES WIO CC URETHRAL PROCEDURES AGE gt17 W CC URETHRAL PROCEDURES AGEgt17 WIO CC URETHRAL PROCEDURES AGE 0-17 OTHER KIDNEY amp URINARY TRACT OR PROCEDURES URINARY STONES W CC amplOR ESW LTIHOTRIPSY URINARY STONES WIO CC URETHRAL STRICTURE AGEgt17 W CC URETHRAL STRICTURE AGE gt17 WIO CC URETHRAL STRICTURE AGE 0-17 MAJOR MALE PELVIC PROCEDURES W CC MAJOR MALE PELVIC PROCEDURES WIO CC TRANSURETHRAL PROSTATECTOMY W CC TRANSURETHRAL PROSTATECTOMY WIO CC TESTES PROCEDURES NON-MALIGNANCY AGEgt17 TESTES PROCEDURES NON-MALIGNANCY AGE 0-17 PENIS PROCEDURES CIRCUMCISION AGEgt17 CIRCUMCISION AGE 0-17 BENIGN PROSTATIC HYPERTROPHY W CC BENIGN PROSTATIC HYPERTROPHY WIO CC INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM STERILIZATION MALE OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES
AppendixD
f 2001 Sample Physician Questionnaire
( Americas Best Hospitals)
This survey of physicians judgments provides the
basis for the reputation component of the annual
ranking of hospitals for U S News amp World Report
c
Conducted by the National Opinion Research Center at the University of Ctlicago 1155 East 60th Street Chicago IL 60637
( THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with rehabilitation regardless of location or expense (weve provided space for both hospital andlor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
l L Answers to these questions will help Have your patients been helped ormiddot
us to understand the impact of the hindered by the information they have Internet on medica practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions
D Neith~imiddoto Yes
D BothONo D Does notapply
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
D Helped
D Hindered
D Neither
D Both
D I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D A day or two a week
l D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical L company web sites
DYes D No
D Does not apply
Do you ever access medical association web sites
DYes D No
ri D Does not apply L
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet isbullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes D No
Do you allow your patients to communicate with you via electronic mail
DYes o No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes D No
D Does not apply
Thank you again for your participation
r I
l~
National Opinion Research Center at the University of Chicago 1155 East 60th Street Chicago IL 60637
Jbullbullbull
(12th Annual Survey of PhysiciansJ Direct input from physicians is
crucial in evaluating hospital quality_ f
Conducted by the National Opinion Research Center at the University of Chicago 1155 East 60th Street Chica9o IL 60637
l J
(THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with cancer regardless of location or expense (weve provided space for both hospital andor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
Answers to these questions will help Have your patients been helped or us to understand the Impact of the hindered by the information they have Internet on medical practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions o NeitherOmiddotYes o BothD No o Does not apply
-Continued
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
HelpedD HinderedD NeitherD BothD
0 I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D Aday or two a week
D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical company web sites
DYes
D No
D Does not apply
Do you ever access medical association web sites
DYes
D No
D Does not apply
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet is bullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes
D No
Do you allow your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Thank you again for your participation
r
r
1 National Opinion Research Center at th~ University of Chicagobull 0 __ bull bull
1155 East 60th Street Chicago IL 60637
AppendixE
Predicted Mortality APR-DRG Methodology
r
shyi
Introduction to DRGs
The All Patient Refined Diagnosis Related Groups (APR-DRGs) were developed by 3M Health
Information Systems (3M-HIS) in conjunction with the National Association of Childrens Hospitals and
Related Institutions (NACHRI) APR-DRGs expand the basic diagnosis-related group (DRG) structure to
address patient severity of illness risk ofmorta1ity and resource intensity The APR-DRG Version 140
uses the Health Care Financing Administration (HCFA) Version 140 DRG methodology Because APRshy
DRGs are based on DRGs and All Patient DRGs (AP-DRGs) a brief explanation of both structures will
be useful
Current HCFA DRG Structure
Created from Adjacent Diagnosis Related Groups (ADGs) which combine patients into groups
with common characteristics DRGs were developed by Yale University in the 1970s to relate a
hospitals case mix index to the resource demands and associated costs experienced by the hospital
ADGs were created by subdividing an MDC1 into two groups based on the presence or absence of
an operating room procedure Surgical patients identified as those having an operating room procedure
were then classified by type ofprocedure to form surgical ADGs Patients with multiple procedures were
assigned to the highest surgical class Medical patients were divided into smaller groups based on their
principal diagnosis to form medical ADGs
DRGs use ADGs as a base and then further classify patients into selected disease and procedure
categories based on whether or not they have substantial comorbidities or complications (CC)
Approximately 3000 diagnosis codes have been designated by HCFA as substantial CCs (defined by a
list of additional diagnosis codes that a panel of physicians felt would increase the length of stay by at
least one day for 75 percent of the patients) This list covers a broad range of disease conditions and no
differentiation in severity or complexity level was made among the additional diagnoses The patients
age and discharge status were sometimes used in the definition ofDRGs
r
1 Major Diagnostic Categories (MDCs) are broad medical and surgical categories one step hierarchically higher than DRGs (several DRGs roll-up into an MDC) MDCs are divided by body systems such as nervous ear nose and throat and respiratory
Current AP-DRG Structure
In 1987 the New York State Department of Health entered into an agreement with 3M-HIS to
evaluate the applicability of DRGs to a non-Medicare population with a specific focus on neonates and
patients with Human Immunodeficiency Virus (HIV) infections The DRG definitions developed by this
relationship are referred to as the AP-DRGs
The AP-DRGs are modeled after the HCF A DRGs and attempt to improve the DRGs in an effort
to more accurately predict a hospitals resource demands and associated costs for all acute care patients
In the creation ofAP-DRGs the modifications made to the DRG structure can be summarized as follows
bull Except for neonates who die or are transferred within the first few days of life AP-DRGs define six ranges ofbirth weight that represent distinct demands on hospital resources Within each birth weight range neonates are then subdivided based on the presence of a significant operating room procedure and then further subdivided based on presence ofmultiple major minor or other problems
bull Assignment to neonatal MDC is based on age Specifically the AP-DRGs assign a patient to the neonatal MDC when the age of the patient is less than 29 days at admission regardless of the principal diagnosis
bull MDC 25 was created to account for the highly specialized treatment of multiple trauma patients Patients assigned to MDC 25 have at least two significant trauma diagnoses from different body sites
bull MDC 20 for alcohol and substance abuse was restructured to differentiate patients based on the substance being abused
bull Across all MDCs patient with a tracheostomy were put into either of two tracheostomy AP-DRGs tracheostomy performed for therapeutic reasons and tracheostomy representing long-term ventilation
bull All liver bone marrow heart kidney and lung transplant patients were assigned to an AP-DRG independent of the MDC ofthe principal diagnosis
bull For several MDCs a single major comorbidity and complication (CC) AP-DRG was formed across all surgical patients within an MDC and a single major CC AP-DRG was formed across all medical patients within an MDC
I I The AP-DRGs introduced changes to the HCF A DRGs in an attempt tomiddot depart from using the
LJ principal diagnosis as the initial variable for assignment The AP-DRGs were designed to more
accurately group patients into like groups that provide an operational means of defining and measuring a
hospitals case mix complexity
r
All Patient Refined DRGs
APR-DRG Objectives
The primary objective of the RCF A DRG and AP-DRG patient classification systems was to
relate the type ofpatients treated to the hospital resources they consumed This limited focus on resource
intensity does not allow providers to classify patients into other groups for meaningful analysis The
APR-DRG patient classification system goes beyond traditional resource intensity measures and was
designed with the ability to address the following needs
bull Compare hospitals across a wide range ofresource and outcome measures
bull Evaluate differences in inpatient mortality rates
bull Implement and support critical pathways
bull Identify continuous quality improvement initiatives
bull Support internal management and planning systems
bull Manage capitated payment arrangements
To meet these needs the APR-DRG system classifies patients according to severity of illness risk
of mortality and resource intensity Therefore in the APR-DRG classification system a patient is
assigned three distinct descriptors base APR-DRG severity of illness subclass and risk of mortality
subclass
Severity of illness can be defined as the extent of physiologic decompensation or organ system
loss of function experienced by the patient In contrast risk of mortality is defined as the patients
likelihood ofdying
For analyses such as evaluating resource intensity or patient care outcomes the base APR-DRGs
in conjunction with the severity of illness subclass is used For evaluating patient mortality the base
APR-DRGs in conjunction with the risk ofmortality subclass is used
Development of the APR-DRGs
The AP-DRGs were used as the base DRGs in the development of the APR-DRGs because they
were representative of the entire inpatient population and accounted for populations not included in DRGs
at the time of development Several consolidations additions and modifications were made to the APshy
DRGs to form the list of APR-DRGs used in the severity of illness and risk of mortality subclass
assignments
The following list summarizes the revisions made to the AP-DRGs in the creation ofthe APR-DRGs
bull All age CC and major CC splits were consolidated
bull Splits based on discharge status or death were consolidated
bull Definitions based on the presence or absence ofa complicated principal diagnosis were consolidated
bull Additional APR-DRGs were created for pediatric patients
bull APR-DRGs for newborns were completely restructured to create medical and surgical hierarchies within each birth weight range
bull Low volume APR-DRGs were consolidated into other related APR-DRGs
bull APR-DRGs that could be explained by the severity of illness subclasses were consolidated into one APR-DRG
bull Due to risk ofmortality subclasses several APR-DRGs were split to account for significant differences in mortality between patient groups
APR-DRG Severity oflllness Subclass Assignment
With the exception of neonatal patients after a patient has been given an APR-DRG code a
Severity of Illness Subclass is assigned based on the level of the secondary diagnoses presence of certain
non-OR procedures and the interaction among secondary diagnoses age APR-DRG and principal
diagnosis Neonatal patients have their own hierarchical method for determining severity of illness and
will be discussed later The four severity ofillness subclasses are
t l
~~~~~i~~ 1 Minor (Includes non CC)
2 Moderate
3 Major
i L 4 Extreme
The severity of illness subclass is used in conjunction with the patients base APR-DRG for
analysis such as evaluating resource intensity or patient care outcomes A patients severity of illness
subclass should not be used with their DRG because several DRGs may form one APR-DRG Therefore
since severity of illness subclasses correspond to the APR-DRG number and not the DRG it is important
to use the APR-DRG number to accurately interpret data
The process for assigning a patient a severity of illness subclass is a three phase process and is
summarized as follows
Phase
bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further analysis
bull Remaining secondary diagnoses are assigned one of four distinct Standard Severity of lllness Levels Figure 1 presents examples of secondary diagnoses in each severity ofillness leveL
Figure 1 Examples of Secondary Diagnoses by Severity of Illness Level
Minor Benign hypertension acute bronchitis lumbago
Moderate Chronic renal failure viral pneumonia diverticulitis
Major Diabetic ketoacidosis chronic heart failure acute cholecystitis
Extreme Septicemia acute myocardial infarction cerebral vascular accident
bull The Standard Severity of Illness Level is modified for some secondary diagnoses based on age APRshyDRG and presence of non-OR procedures Figure 2 displays an example of modifications to the standard severity ofillness level based on the APR-DRG
Bronchitis and asthma Minor
Chronic renal failure Moderate Diabetes Major LJ
Cardiomegaly Moderate Chronic heart failure Minor
Uncomplicated Minor Vaginal delivery Moderate LJ diabetes
f
f
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Severity of Illness Level is retained This prevents double counting clinically similar diagnoses
bull The Base Severity of Illness Subclass of the patient is set to the highest Standard Severity of lllness Level ofany of the secondary diagnoses
bull Patients with a Base Severity of Illness Subclass of major (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Standard Severity of Illness Level Figure 3 displays the requirements for keeping a severity of illness subclass ofmajor or extreme
Major
Extreme Two or more secondary diagnoses that are extreme or one secondary diagnosis that is extreme and at least two second dia oses that are maor
Phase III bull A minimum Severity of Illness Subclass is established based on the patients principal diagnosis This
accounts for patients assigned to codes that contain both the underlying disease and an associated manifestation of the disease (ie diabetes with hyperosmolar coma) but is only assigned to the APRshyDRG that accounts for the underlying disease
bull A minimum Severity of Illness Subclass is established based on combinations of principal diagnosis and age for specific APR-DRGs
bull A minimum Severity of Illness Subclass is established for some APR-DRGs with certain APR-DRG and non-OR procedure combinations as well as principal diagnosis and non-OR procedure combinations
bull A minimum Severity of Illness Subclass is established based on the presence of certain combinations ofsecondary diagnoses Figure 4 shows the combination of secondary diagnoses necessary to increase the severity of illness subclass to a minimum severity of illness level For example a type 1 combination would be a major bacterial infection with pleural effusion If a diagnosis from both of these categories is present plus at least one other secondary diagnosis that is at least a major severity of illness level then the minimum patient severity of illness subclass will be extreme
Figure 4 Minimum Severity of Illness Requirements
maor second dia osis 2 At least one additional Major
moderate secondary dia osis
3 Specified combinations of At least one additional Major a moderate and a minor moderate secondary cate 0 dia osis
4 Specified combinations of At least two additional Moderate r--1 Two minor cate ories minor second i Ii 5 Specified combinations of
Two moderate cate ories None Major
bull The final patient Severity of Illness Subclass is selected based on the maximum of the Phase II Base Patient Severity of Illness Subclass and the Phase III minimum Severity of Illness Subclass
Both medical and surgical patients are assigned a severity of illness level of 1-4 based on the
assignment process outlined previously
f
r-
I
l
r f
~
l
r 1
APR-DRG Risk of Mortality Subclass Assignment
Similar to the Severity ofIllness Subclass assignment the Risk ofMortality Subclass assignment
is based on the level ofthe secondary diagnoses and the interaction among secondary diagnoses age
APR-DRG and principal diagnosis In general the patients Risk ofMortality Level and Subclass will be
lower than the Severity ofIllness Level and Subclass respectively Neonatal patients have their own
hierarchical method for determining risk ofmortality and will be discussed later The four severity of
illness subclasses are
~~~~~~~G~~pound~) bull~~~~~~~~S~rs~~2bullbullmiddott~ 1 Minor (includes non CC)
2 Moderate
3 Major
4 Extreme
The risk ofmortality subclass is used in conjunction with the patients base APR-DRG for
evaluating patient mortality Like the severity of illness subclass a patients risk ofmortality subclass
should not be used with their DRG because several DRGs may form one APR-DRG Therefore since
risk ofmortality subclasses correspond to the APR-DRG number and not the DRG it is important to use
the APR-DRG number to accurately interpret data
The process for assigning a patient a risk ofmortality subclass is a three phase process and is
summarized as follows
Phase I bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further
analysis
bull Remaining secondary diagnoses are assigned one of four distinct Risk ofMortality Levels
bull The Risk ofMortality Level is modified for some secondary diagnosis based on the patients age and APR-DRG
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Risk ofMortality Level is retained This prevents double counting clinically-similar diagnoses
bull The Base Risk ofMortality Subclass of the patient is set to the highest Risk ofMortality Level ofany of the secondary diagnoses
bull Patients with a Base Risk ofMortality Subclass ofmajor (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Risk ofMortality Level
Phase III
bull A minimum Risk ofMortality Subclass is established based on the patients principal diagnosis This accounts for specific APR-DRGs that have a principal diagnosis indicative of a higher risk ofmortality relative to the other principal diagnoses in the APR-DRG r
i
l ~ bull A minimum Risk ofMortality Subclass is established based on the presence ofcertain combinations of secondary diagnoses
bull The final patient Risk ofMortality Subclass is selected based on the maximum ofthe Phase II Base l
Risk ofMortality Subclass and the Phase III minimum Risk ofMortality Subclass
J
r
AppendixF
f Index of Hospital Quality (lHQ) Scores by Specialty
i
i L
F-~
f laquo
2001
C
ance
r B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
con
sc
ore
R
N s
R
ank
Ho
spit
al
10
0
sco
re
rate
M
embe
r (o
f 7
) D
isch
arg
es
to b
eds
Mem
oria
l S
loan
-Ket
teri
ng
can
cer
Cen
ter
N
ew Y
ork
10
00
7
18
0
93
Y
es
60
51
67
21
2
2 U
niv
ersi
ty 0
1 T
exas
M
D
A
nder
son
Cen
cer
Cen
ter
H
oust
on
98
2
68
5
07
7
Yes
5
0
5103
2
68
3
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
78
3
59
0
69
Y
es
70
15
78
14
2
4 D
ana-
farb
er C
ance
r In
stit
ute
B
osto
n 6
37
3
88
0
81
No
60
21
8 2
27
5
May
o C
lin
ic
Ro
ches
ter
M
inn
5
81
2
50
0
60
Y
es
70
37
11
13
1
(+3
SO)
6 UC
LA M
edic
al C
ente
r
los
Ang
eles
41
0
79
0
56
Y
es
70
12
19
10
8 7
Un
iver
sity
01
Chi
cago
Ho
spit
als
40
6
65
0
66
Y
es
70
14
69
19
4
8 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
401
7
1
07
5
Yes
7
0
3494
1
81
9
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
40
0
91
0
82
Y
es
60
18
44
16
1
10
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
38
5
10
7
09
2
Yes
4
0
1105
1
61
11
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r
Ann
Arb
or
38
4
31
0
42
Y
es
70
16
56
17
9
12
Un
iver
sity
01
was
hing
ton
Med
ical
Cen
ter
S
eatt
le
38
3
79
0
66
Y
es
60
92
6 1
10
13
M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 3
80
8
8
09
5
Yes
7
0
2022
1
38
14
C
lari
an H
ealt
h P
art
ners
In
dia
nap
oli
s 3
78
5
2
07
5
Yes
7
0
2149
1
67
15
U
niv
ersi
ty o
f P
ittS
bu
rgh
Med
ical
Cen
ter
37
4
26
0
56
Y
es
65
23
10
16
7
(+2
SO)
16
Cle
vel
and
Cli
nic
3
62
3
1
07
4
Yes
7
0
2018
1
94
17
R
osw
ell
Par
k C
ance
r In
stit
ute
B
uff
alo
36
1
55
0
85
Y
es
50
16
76
28
7
18
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
35
5
37
0
73
Y
es
60
14
15
14
3
19
Un
iver
sity
of
Ken
tuck
y H
osp
ital
le
xin
gto
n
351
0
5
05
6
Yes
7
0
1047
2
20
20
fo
x C
hase
can
cer
Cen
ter
P
hil
adel
ph
ia
35
0
56
0
83
Y
es
50
10
46
15
8
21
H
lee M
off
itt
can
oer
Cen
ter
T
ampa
F
la
35
0
15
0
65
Y
es
60
16
44
16
8lt
22
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
Cen
ter
Ch
arl
ott
esv
ille
3
49
0
5
061
Y
es
60
13
48
22
7
23
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
34
8
17
0
67
Y
es
70
99
9 2
40
24
S
hand
s H
osp
ital
at
the
Un
iver
sity
of
flo
rid
a
Gei
nes
vil
le
34
7
14
0
46
Y
es
60
10
23
15
7
25
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
34
6
00
0
57
Y
es
60
12
22
191
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
34
4
17
0
67
Y
es
80
16
15
151
27
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
34
3
15
0
66
Y
es
55
14
14
15
8
28
Un
iver
sity
Ho
spit
al o
f A
rkan
sas
li
ttle
Roc
k 3
43
0
5
06
3
Yes
5
5
1287
2
54
29
U
niv
ersi
ty H
osp
ital
D
enve
r 3
42
2
7
05
7
Yes
5
0
431
24
0
30
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
34
2
23
0
49
Y
es
60
44
8 1
72
lt
31
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
34
2
00
0
61
Y
es
70
15
55
15
3
32
Art
hu
r G
Ja
mes
Can
cer
Ho
spit
al
Col
umbu
s
Ohi
o 3
41
0
0
04
8
Yes
5
5
2147
1
56
33
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
34
0
19
0
69
Y
es
70
11
42
13
6
34
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
33
9
00
0
50
Y
es
55
14
81
14
9
35
New
Yor
k P
resb
yte
rian
HO
spit
al
33
7
34
0
86
Y
es
70
31
03
13
2
36
Un
iver
sity
of
cali
forn
ia
San
Fra
nci
soo
Med
ical
Cen
ter
33
5
30
0
71
Yes
6
0
573
17
5
37
fG
M
cGaw
Ho
spit
al a
t lo
yo
la U
niv
ersi
ty
May
woo
d
Ill
3
33
1
6
07
0
Yes
6
0
1023
1
62
38
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
33
3
00
0
62
Y
es
60
12
79
15
2
39
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
-Sal
em
33
3
19
0
84
Y
es
70
20
21
181
40
fa
irv
iew
-Un
iver
sity
Med
ical
Cen
ter
M
inn
eap
oli
s 3
32
0
4
06
2
Yes
5
0
1248
1
56
41
G
reat
er B
alti
mo
re M
edic
al C
ente
r B
alti
mo
re
33
2
00
0
58
Y
es
35
12
39
20
0
42
Un
iver
sity
Ho
spit
als
of
Cle
vel
and
3
30
0
0
06
4
YampS
70
19
71
12
1
43
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
lo
we
Cit
y
32
9
04
0
70
Y
es
70
13
05
13
4
44
St
Jo
hn
S H
osp
ital
S
pri
ng
fiel
d
Ill
3
29
0
0
05
5
Yes
6
0
996
13
3
45
Hen
ry F
ord
Ho
spit
al
Detr
oit
3
27
0
0
07
6
Yes
6
5
1473
1
92
46
B
arn
es-J
ewis
h H
osp
ital
S
t
lou
is
32
6
05
0
74
Y
es
85
27
56
14
9
47
luth
era
n G
ener
al H
ealt
hSys
tem
P
ark
Rid
ge
Ill
3
26
0
0
06
2
Ves
6
0
1420
1
14
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
3
24
0
5
05
0
Yes
7
0
776
10
9
49
Coo
k C
ount
y H
osp
ital
C
hica
go
32
3
04
0
49
Y
es
50
49
1 2
10
50
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
32
2
09
0
90
Y
es
50
13
24
19
2
1
2001
D
iges
tiv
e D
iso
rder
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N
s
Tra
uma
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 8
) D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
59
8
05
9
Yes
8
0
7660
1
31
Yes
2
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
82
3
50
0
63
Y
es
75
31
28
14
2
Yes
3
Cle
vel
and
Cli
nic
6
27
3
05
0
57
Y
es
80
44
75
19
4 N
o 4
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
58
9
29
9
08
7
Yes
8
0
4403
1
38
Y
es
5 M
ount
Sin
ai
Med
ical
Cen
ter
N
ew Y
ork
49
5
23
2
09
8
Yes
8
0
5220
1
57
Y
es
6 UC
LA M
edic
al C
ente
r
Los
A
ngel
es
44
5
18
5
081
Y
es
80
25
40
10
8
Yes
7
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
39
7
14
3
09
0
Yes
8
0
3787
1
81
Yes
8
un
ivers
ity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
37
9
13
2
07
0
Yes
7
0
1596
1
75
N
o 9
Un
iver
sity
of
Chi
oago
Ho
spit
als
37
0
131
0
93
Y
es
80
19
84
19
4
Yes
(+
3 SO
) 10
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
30
6
57
0
61
Y
es
80
91
3 1
98
Y
es
11
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 2
99
5
2
07
5
Yes
8
0
4048
1
67
Y
es
12
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
2
95
7
7
09
9
Yes
8
0
2348
1
61
Yes
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
29
2
47
0
72
Y
es
80
56
89
14
9
Yes
14
U
niv
ersi
ty o
f M
iohi
gan
Med
ical
Cen
ter
Ann
Arb
or
291
3
8
06
8
Yes
8_
0 28
16
17
9
Yes
15
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 2
90
4
9
07
4
Yes
8
0
2636
1
43
Y
es
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
28
0
50
0
74
Y
es
50
20
34
161
Y
es
17
Cla
rian
Hea
lth
part
ners
In
dia
nap
oli
s 2
78
5
2
09
2
Yes
8
0
5286
1
67
Y
es
18
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
27
6
45
0
84
Y
es
80
28
28
15
3
Yes
19
B
eth
Isra
el
Dea
cone
ss M
edio
al C
ente
r
Bos
ton
21
4
34
0
73
Y
es
70
45
27
15
8
Yes
20
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
27
1
30
0
45
Y
es
80
99
2 1
09
Y
es
21
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
N
ew Y
ork
26
5
16
0
49
Y
es
70
26
18
21
2
No
22
New
Yor
k P
resb
yte
rian
Ho
spit
al
26
2
52
1
01
Yes
8
0
4884
1
32
Yes
23
U
niv
ers
ttv o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
26
0
20
0
65
Y
es
80
21
84
13
6 Y
es
(+2
SOI
24
Med
ical
Un
iver
sity
of
Sou
th C
aro
lin
a C
har
lest
on
2
58
6
9
12
0
Yes
7
0
2202
2
09
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
25
1 2
2
07
5
Yes
6
5
2472
1
57
Y
es
26
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
oak
M
ich
2
50
0
8
07
0
Yes
8
0
5809
1
88
Y
es
27
8ay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
49
2
6
07
8
Yes
6
0
4673
1
22
y
es
28
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
24
8
00
0
60
Y
es
70
26
48
191
Y
es
29
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
42
1
4
06
9
Yes
7
5
1677
1
47
Y
es
30
Los
A
ngel
es C
ount
y-U
Sc
Med
ical
Cen
ter
24
2
08
0
37
Y
es
60
39
5 1
67
Y
es
31
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
24
0
18
0
79
Y
es
70
18
25
24
0
Yes
32
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
24
0
39
0
78
y
es
80
11
34
11
0
No
33
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Il
l
23
8
00
0
59
Y
es
60
31
21
11
4
Yes
34
U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
oer
Cen
ter
H
oust
on
23
7
33
0
80
Y
es
60
13
61
26
8
No
35
Lah
ey H
itch
coo
k C
lin
io
Bu
rlin
gto
n
Mas
s
23
6
00
0
67
Y
es
70
26
77
15
2
Yes
36
C
edar
s-S
inai
Med
ical
Cen
ter
L
os A
ngel
es
23
4
27
0
94
Y
es
80
47
95
10
6
Yes
37
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
Sit
y
May
woo
d
Ill
2
34
0
0
06
6
Yes
7
0
2180
1
62
Y
es
38
Mar
y H
itch
coo
k M
emor
ial
Ho
sp
ital
le
ban
on
N
H
23
4
04
0
68
Y
es
70
15
58
19
4
Yes
39
U
niv
ersi
ty o
f C
ali
forn
ie
Dav
is M
edio
al C
ente
r
Sac
ram
ento
2
33
0
0
06
8
Yes
8
0
1751
2
79
Y
es
40
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
iCS
Io
wa
Cit
y
23
3
13
0
77
Y
es
80
19
31
13
4
Yes
41
N
ew E
ngla
nd M
edic
al C
ente
r
Bos
ton
23
3
20
0
82
Y
es
10
11
88
24
2
Yes
42
F
roed
tert
Mem
oria
l L
uth
eran
Ho
spit
al
Mil
wau
kee
23
2
00
0
63
Y
es
70
19
29
14
6
Yes
43
T
hom
as J
eff
ers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
32
0
8
07
6
Yes
1
0
3206
1
23
Y
es
44
Tem
ple
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
30
1
7
01
0
Yes
7
5
1450
1
46
N
o 45
G
reat
er B
alti
mo
re M
edic
al C
ente
r
Bal
tim
ore
2
30
1
2
071
Y
es
SO
24
95
20
0
No
46
Hen
ry F
ord
Ho
spit
al
Detr
oit
2
29
0
8
08
6
Yes
7
5
3475
1
82
Y
es
47
Un
iver
sity
Of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pal
Hil
l 2
29
1
0
081
Y
es
60
29
86
15
2
Yes
48
O
chsn
er F
ou
nd
atio
n H
osp
1ta
l
New
Orl
ean
s 2
28
1
5
07
4
Yes
6
5
2465
1
40
N
o 49
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
F
la
22
S
00
0
62
14
0 7
0
5778
1
67
Y
es
SO
Un
iVer
sity
Ho
spit
al
Den
ver
22
7
11
0
81
Yes
6
0
1151
2
40
Y
es
L r
middotmiddot
2001
E
ar
Nos
e
and
Thr
oat
Bes
t H
osp
ital
Lis
t
Hos
pita
lwid
e T
echn
olog
y R
eput
atio
nal
mo
rtal
ity
C
OTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
sc
ore
rate
M
embe
r (o
f 5)
D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
40
2
08
2
Ves
5
0
26
4
14
2
Yes
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
8S
4
32
4
08
6
Yes
5
0
219
13
4
Ves
3
Mas
saoh
uset
ts E
ye
and
Ear
In
firm
ary
B
osto
n 7
66
2
71
0
11
No
3
0
26
8
18
7
Ves
4
May
o C
lin
io
Roo
hest
er
Min
n
68
2
21
0
07
2
Ves
5
0
502
13
1
Ves
5
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
6
39
1
90
0
82
Y
es
50
28
3 1
79
Y
es
6 U
niv
ersi
ty o
f P
itts
bUrg
h M
edic
al C
ente
r 6
23
1
85
0
84
V
es
50
36
3 1
67
Y
es
7 UC
LA M
edic
al C
ente
r
los
Ang
eles
6
21
1
89
0
83
Y
es
50
2
88
1
08
Y
es
8 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
cano
er C
ente
r H
oust
on
51
6
14
7
08
9
Ves
4
0
124
26
8
No
9 H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
5
05
1
36
1
02
Y
es
50
26
7 1
61
Y
es
10
Cle
vela
nd C
lin
ic
49
5
10
6
06
7
Yes
5
0
23
6
19
4
No
11
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nio
N
ashv
ille
4
64
9
3
09
4
Yes
5
0
28
4
24
0
Yes
12
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
caU
f
46
1
10
8
08
6
Yes
3
0
13
4
16
1
Yes
1
3
Bar
nesmiddot
Jew
ish
Ho
spit
al
St
lo
uis
4
68
9
0
08
2
Yes
5
0
39B
1
49
Y
es
14
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
42
6
10
1
0middot8
7 Y
es
50
8
6
11
0
No
15
M
etho
dist
Ho
spit
al
Hou
ston
4
09
1
02
1
07
Y
es
40
2
30
1
33
No
(+
3 SO
l 16
M
emor
ial
Slo
anmiddotK
ette
rin
g e
ence
r C
ente
r
New
Vor
k 3
91
5
4
07
9
Yes
5
0
24
9
21
2
No
17
Mou
nt S
lnai
Med
ioal
Cen
ter
New
Vor
k 3
86
7
8
11
1
Yes
5
0
31
2
15
7
Yes
18
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
37
9
45
0
79
Y
es
50
16
6 1
57
Y
es
19
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
oo M
edio
al C
ente
r 3
78
6
3
08
5
Ves
4
0
131
17
5
No
20
Duk
e U
niv
ersi
ty M
edio
al C
ente
r D
urha
m
NC
3
50
4
3
09
3
Yes
5
0
15
3
18
1
Ves
21
U
niv
ersi
ty o
f W
isoo
nsin
Ho
spit
al a
nd C
lin
ios
Med
ison
3
40
1
9
07
7
Yes
5
0
23
2
13
6
Yes
22
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
enoe
s C
ente
r C
har
lott
esv
ille
3
39
3
0
08
1
Ves
4
0
195
22
7
No
23
un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 3
37
2
2
07
9
Ves
4
0
18
9
15
2
Yes
(+
2 SO
l 2
4
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
33
4
26
0
77
V
es
50
4
4
19
8
Ves
2
5
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty O
f F
lori
da
Gai
nes
vil
le
33
3
18
0
76
V
es
40
16
7 1
57
Y
es
26
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middot Sal
em
33
1
26
0
92
Y
es
50
2
43
1
61
Y
es
27
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
33
0
29
0
76
Y
es
35
11
2 1
01
V
es
28
H
enry
For
d H
osp
ital
D
etro
it
32
9
05
0
73
Y
es
45
2
14
1
82
V
es
29
st
lo
uis
Un
iver
sity
Ho
spit
al
32
5
12
0
71
Y
es
50
1
13
1
47
Y
es
30
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
w
ashi
ngto
n
DC
3
24
1
7
05
3
Ves
5
0
89
1
0
9middot
Yes
31
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hioa
go
32
3
26
0
92
V
es
40
18
4 1
70
ve
s 32
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
C
hica
go
32
3
20
0
70
V
es
50
14
5 1
14
No
3
3
Fai
rvie
w-U
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
32
3
23
0
79
Y
es
30
3
57
1
56
No
3
4
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
25
0
90
Y
es
50
1
00
1
94
Y
es
35
Un
iver
sity
Ho
spit
al
Den
ver
31
7
15
0
74
Y
es
40
52
2
40
Y
es
36
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
3
17
1
9
08
5
Yes
4
0
19
9
12
3
Yes
3
7
Sum
ma
Hea
lth
syst
em
Akr
on
Ohi
o 3
16
0
0
06
9
Ves
4
0
28
7
14
9
Yes
3
8
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
sa
cram
ento
3
15
0
5
07
6
Ves
5
0
14
3
27
9
Ves
3
9
lOS
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
31
2
13
0
20
Y
es
35
42
1
67
Y
es
40
Val
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
31
2
16
0
92
Y
es
50
2
43
1
53
V
es
41
Un
iver
sity
of
Tex
as M
edio
al B
rano
h H
osp
ital
s
Gal
vest
on
31
1
27
0
91
Yes
4
0
118
15
3
Yes
4
2
Lut
hera
n G
ener
al H
ealt
hsys
tem
P
ark
Rid
ge
Ill
3
09
0
0
07
0
Yes
4
0
212
11
4
Yes
4
3
Un
iver
sity
of
Illi
no
is
Ho
spit
al a
nd C
lin
iCs
Chi
cago
3
06
1
2
06
6
Yes
2
5
87
1
29
Y
es
44
lah
ey H
itoh
oook
Cli
nic
B
url
ing
ton
M
ass
3
05
0
5
07
6
Yes
4
0
138
15
2
Yes
4
5
Art
hur
G
Jam
es C
anoe
I H
osp
ital
C
olum
bus
O
hio
30
4
00
0
57
V
es
40
13
1 1
56
Y
es
46
w
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
30
3
05
0
86
Y
es
40
2
16
1
92
V
es
47
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 3
02
0
4
08
7
Yes
5
0
35
5
16
7
Ves
4
8
wil
liam
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
3
02
0
0
08
5
Yes
5
0
29
6
18
8
Yes
4
9
New
Vor
k Ey
e an
d E
ar
Infi
rmar
y
New
Yor
k 3
02
1
7
00
0
No
35
50
2
63
Y
es
50
F
G
McG
aw H
osp
ital
at
lOll
ola
Un
iver
sity
M
ayw
ood
Il
l
30
0
10
0
87
Y
es
40
16
6 1
62
Y
es
L L
2001
G
eria
tric
s B
est
Ho
spit
al L
ist
Hos
ptta
lwid
e T
echn
olog
y D
isch
arge
S
erv
ice
Ger
iatr
ic
Rep
utat
iona
l m
ort
alit
y
COTH
sc
ore
R
N
s
plan
ning
m
ix
serv
ices
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 8
) to
bed
s (o
f 3
) (o
f 1
0)
(of
7)
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
10
00
3
97
0
83
Y
es
80
1
08
3
6 5
2 JO
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
89
5
33
6
08
2
Yes
8
0
14
2
3 9
4 3
Mou
nt
Sin
ai M
edic
al C
ente
r N
ew Y
ork
73
3
27
6
11
1
Yes
8
0
15
7
3 8
4 4
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
6
11
1
98
0
93
Y
es
80
1
81
3
7 3
5 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
59
4
18
5
09
3
Yes
8
0
13
8
3 8
4 6
May
o C
11ni
c
Roo
hest
er
Min
n
51
1
11
2
07
2
Yes
8
0
13
1
3 1
0
8 7
St
L
ouis
Un
iver
sity
Ho
spit
al
45
2
95
0
71
Y
es
80
1
47
3
4 3
8 Y
alemiddot
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
4
33
1
00
0
92
Y
es
80
1
53
3
1 3
9 C
leve
land
lt1
1nio
4
28
7
0
06
7
Yes
8
0
19
4
3 8
4 10
U
niv
ersi
ty o
f M
ichI
gan
Med
ical
Cen
ter
Ann
Arb
or
42
2
79
0
82
Y
es
80
1
79
3
9 4
11
Bet
h Is
rael
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
11
7
7
08
4
Yes
7
0
15
8
3 9
4 (+
3 SO
) 12
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
68
7
3
08
7
Yes
7
0
11
0
2 6
2 1
3
Un
iver
sity
01
Chi
cago
Ho
spit
als
35
4
50
0
90
Y
es
80
1
94
3
8 4
14
B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
33
6
32
0
82
Y
es
80
1
49
3
9 4
15
U
niv
ersi
ty H
osp
ital
D
enve
r 3
34
2
5
07
4
Yes
7
0
24
0
3 8
5 16
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
28
3
0
08
1
Yes
8
0
14
3
3 7
4 17
R
ush
middotPre
sby
teri
anmiddotS
t L
uke
s M
edic
al C
ente
r C
hica
go
32
5
14
0
70
Y
es
80
1
14
3
9 5
19
u
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co l
led
ical
Cen
ter
32
5
36
0
85
Y
es
70
1
75
3
6 4
(+2
SO)
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
0
34
0
86
Y
es
60
1
61
3
9 3
20
Ho
spit
al o
f th
e U
niv
ersi
ty o
f pe
nnsy
lvan
ia
Ph
ilad
elp
hia
3
16
4
4
10
2
Yes
8
0
16
1
I 8
3 21
U
niv
ersi
ty H
osp
ital
s o
f C
leve
land
3
13
2
5
07
9
Yes
8
0
12
1
2 8
4 2
2
Par
klan
d ll
emor
ial
Ho
spit
al
Dal
las
31
3
1S
0
77
Y
es
80
1
98
3
7 4
23
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middotSai
em
31
1
20
0
92
Y
es
80
1
61
3
10
6
24
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
30
8
05
0
53
Y
es
70
1
09
3
8 4
25
U
niv
ersi
ty o
f Il
lin
Ois
Ho
spit
al a
nd C
lin
ios
C
hioa
go
30
7
11
0
66
Y
es
55
1
29
3
7 4
26
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 3
04
4
1
10
5
Yes
8
0
11
8
3 1
4 2
7
Fai
rvie
wmiddotu
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
30
4
14
0
19
Y
es
60
1
56
3
9 5
28
Sos
ton
Med
ioal
Cen
ter
30
4
16
0
75
Y
es
60
2
10
3
7 4
29
Fra
nci
s S
cott
Key
Med
ical
Cen
ter
Bal
tim
ore
30
4
18
0
80
Y
es
70
0
79
3
8 5
30
S
parr
ow H
osp
ital
and
Hea
lth
Sys
tem
L
anS
ing
M
ich
3
04
0
0
06
5
No
70
1
13
3
10
6
31
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
02
0
8
08
4
Yes
8
0
16
7
3 9
7 3
2
Los
Ang
eles
cou
ntymiddot
uSC
lle
dica
l C
ente
r 3
01
0
3
02
0
Yes
6
5
16
7
3 8
3 3
3
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
98
2
3
09
2
Yes
7
0
17
0
3 9
4 3
4
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
29
7
03
0
68
Y
es
70
1
49
3 9
3 3
5
Coo
k C
ount
y H
osp
ital
C
hica
go
28
6
00
0
55
Y
es
60
2
10
3
7 4
36
U
niv
ersi
ty o
f C
onne
ctic
ut H
ealt
h C
ente
r
Far
min
gton
2
94
4
6
10
0
Yes
6
0
26
0
3 3
2 3
7
Ho
spit
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 2
91
0
0
01
0
Yes
6
0
15
1
3 5
4 3
8
Un
iver
sity
Med
ioal
Cen
ter
Tuc
son
A
riz
2
90
0
0
06
6
Yes
7
0
17
2
3 7
3 3
9
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
28
9
07
0
79
Y
es
70
1
52
3
10
3
40
Thom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
28
9
13
0
85
Y
es
70
1
23
3
9 4
41
Hen
nepi
n C
ount
y M
edic
al C
ente
r
Min
neap
olis
2
89
0
0
06
1
Yes
6
5
10
5
3 7
3 4
2
St
L
uk
es
Ho
spit
al
Ch
este
rfie
ld
Mo
2
88
0
0
06
7
No
70
1
06
3
8 8
43
Aug
usta
Hea
lth
Car
e
Fis
her
svil
le
Va
2
87
0
0
06
5
No
50
1
35
3
8 5
44
John
D
Arc
hbol
d M
emor
ial
Ho
spit
al
Tho
maS
Vil
le
Ga
2
86
0
0
06
3
No
70
0
93
3
7 4
45
F
G
McG
aw H
osp
ital
at
Loy
ola
un
iver
sity
M
ayw
ood
Il
l
28
5
14
0
87
Y
es
70
1
62
3
9 3
46
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
Sac
ralll
ampnt
o 2
84
0
4
07
6
Yes
8
0
27
9
3 6
4 4
7
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
28
4
00
0
70
Y
es
70
1
14
3
7 4
49
Hen
ry F
ord
Ho
spit
al
Det
roit
2
83
0
4
07
3
Yes
7
5
18
2
3 4
4 4
9
Un
iver
sity
of
Vir
gin
ia H
ealt
h Sc
ienc
amps
Cen
ter
Ch
arlo
ttes
vil
le
282
0
3
08
1
Yes
7
0
22
7
3 9
4 50
S
t
Jose
ph H
osp
ital
D
enve
r 2
80
0
0
06
3
No
70
1
03
3
6 3
2001
G
ynec
olog
y B
est
Ho
spit
al L
ist
Hos
p1ta
lwid
e T
echn
olog
y G
ynec
olog
y R
eput
atio
nal
mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
serv
ices
R
ank
Ho
spit
al
IHQ
sc
ore
ra
te
Mem
ber
(of
8)
Dis
char
ges
to b
eds
Cen
ter
(of
4)
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
32
5
0B
2
Yes
8
0
24
0
14
2
Yes
4
2 M
ayo
Cli
nic
R
oche
ster
M
inn
7
53
2
10
0
72
Y
es
80
13
40
13
1
Yes
3
3 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 6
70
1
77
0
81
Y
es
80
4
83
1
43
Y
es
4 4
UCLA
Med
ical
Cen
ter
L
os A
ngel
es
58
3
14
2
08
3
Yes
8
0
310
10
8
Yes
4
5 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
cer
Cen
ter
Hou
ston
5
72
1
59
0
89
Y
es
60
2
34
2
68
No
0
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
49
9
10
9
09
3
Yes
8
0
512
18
1
Yes
4
7 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
49
8
11
0
09
3
Yes
8
0
418
13
8
Yes
4
8 P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 4
89
1
01
0
77
Y
es
80
9
4
19
8
Yes
3
11 Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
4
37
1
00
1
15
Y
es
80
56
0 1
32
Y
es
4 1
0
Un
iver
sity
of
Nor
th C
arol
ina
Ho
spit
als
Cha
pel
Hil
l 4
06
6
1
07
9
Yes
7
0
34
3
15
2
Yes
4
11
Mem
oria
l S
loan
-Ket
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
03
7
4
07
9
Yes
7
0
179
21
2
No
1 1
2
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
3
87
6
7
08
6
Yes
5
0
274
16
1
Yes
2
13
M
agee
-Wom
ens
Ho
spit
al
Pit
tsb
urg
h
38
4
50
0
67
Y
es
65
55
1 1
53
No
3
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
38
3
52
0
82
Y
es
80
3
90
1
79
Y
es
3 15
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
36
5
52
0
92
Y
es
70
29
1 1
70
Y
es
4 (+
3 SD
) 1
6
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
36
3
50
0
92
Y
es
80
34
6 1
53
Y
es
4 17
C
leve
land
Cli
nic
3
59
3
7
06
7
Yes
7
0
711
19
4
No
3 18
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
3
54
5
5
10
2
Yes
8
0
222
16
1
Yes
4
19
Un
iver
sity
of
Chi
cago
Ho
spit
als
35
1
43
0
90
Y
es
80
2
33
1
94
Y
es
4 2
0
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
34
3
50
0
85
Y
es
70
51
1
75
No
3
21
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
33
B
35
0
84
Y
es
B_O
30
2 2
40
Y
es
3 2
2
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
2
12
0
S3
Y
es
80
16
9 1
09
Y
es
4 2
3
Los
Ang
eles
Cou
nty-
uSC
Med
ical
Cen
ter
31
7
12
0
20
Y
es
65
4
0
16
7
Yes
4
24
Bar
nes-
Jew
ish
Ho
spit
al
St
L
ouis
3
16
2
3
08
2
Yes
7
5
62
3
14
9
Yes
4
25
R
ush
-Pre
sby
teri
an-S
t
Luk
es
Med
ical
Cen
ter
Chi
oago
3
15
2
2
07
0
Yes
8
0
30
3
114
No
3
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irmin
gham
3
14
3
1
09
6
Yes
8
0
411
15
1
Yes
4
(+2
SO)
27
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
97
1
9
08
5
Yes
7
0
33
7
12
3
Yes
4
28
U
niv
ersi
ty M
edic
al C
ente
r T
uoso
n A
riz
2
95
0
8
06
6
Yes
7
0
150
17
2
Yes
3
29
U
niv
ersi
ty H
osp
ital
D
enve
r 2
92
1
3
07
4
Ves
6
0
90
2
40
Y
es
4 3
0
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 2
92
3
2
11
1
Yes
8
0
317
15
7
Yes
4
31
Art
hur
G
Jam
es C
ance
r H
osp
ital
C
olum
bus
O
hio
29
1
00
0
57
Y
es
70
1
73
1
56
Y
es
3 32
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
90
0
0
05
5
Yes
6
0
69
21
0
Yes
4
33
U
niv
ersi
ty o
f C
alif
orn
ia
Irv
ine
Med
ical
Cen
ter
Ora
nge
2B
9
30
0
82
Y
es
60
69
1
05
Y
es
1 3
4
Un
iver
sity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
28
8
24
0
87
Y
es
80
2
07
1
10
No
4
35
S
tbull
Jose
ph H
osp
ital
D
enve
r 2
88
0
8
05
3
No
70
2
89
1
03
No
4
36
C
edar
smiddotS
inai
Med
ical
Cen
ter
Lo
s A
ngel
es
29
4
29
1
07
Y
es
BO
S
02
10
6
Yes
4
37
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
83
0
0
06
8
Yes
6
5
37
6
14
9
Yes
4
38
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r D
alla
s 2
8S
1
6
08
8
Yes
6
5
559
12
2
Yes
4
39
M
ary
Hit
chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
28
2
12
0
86
V
es
70
2
34
1
94
Y
es
4 4
0
emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
28
1
38
0
90
Y
es
80
2
09
0
93
No
0
41
Wom
en a
nd
Infa
nts
Ho
spit
al O
f R
hode
Is
lan
d
Pro
vide
nce
28
1
04
0
29
Y
es
50
5
19
0
63
No
4
42
B
eth
Isra
el
Oea
cone
ss M
edic
al C
ente
r B
osto
n 2
80
1
2
08
4
Yes
7
0
286
15
8
Yes
3
43
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 2
79
1
1
08
7
Yes
8
0
55
8
16
7
Yes
3
44
Ohi
o S
tate
un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
77
1
0
07
6
Yes
6
5
157
10
1
Yes
4
45
W
illi
am
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
2
75
0
4
08
5
Yes
9
0
59
5
18
9
Yes
4
46
L
uthe
ran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
27
4
00
0
70
Y
es
70
2
60
1
14
Y
es
4 4
7
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nic
s
Mad
ison
2
12
1
2
07
7
Yes
7
0
20
7
13
6
Yes
1
48
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
27
1
05
0
76
Y
es
70
2
62
1
57
Y
es
2 4
9
Gre
ater
Bal
tim
ore
Med
ical
Cen
ter
Bal
tim
ore
27
0
00
0
69
Y
es
55
46
0 2
00
No
4
50
FG
M
oGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
70
1
0
08
7
Yes
7
0
186
16
2
Yes
4
rmiddot--
I
i L
L
2001
H
eart
Bes
t H
osp
ital
Lis
t
Ran
k H
osp
ital
1 C
leve
land
Cli
nic
2
May
o C
11ni
o
Roc
hest
er
Min
n
3 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
4 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
5 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
7
Tex
as H
eart
In
stit
ute
-St
Luk
es
Epi
scop
al H
osp
ital
H
oust
on
B
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
9 Em
ory
un
iver
sity
Ho
spit
al
Atl
anta
1
0
Bet
h Is
rael
Dea
oone
ss M
edic
al C
tlnt
er
Bos
ton
11
B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
is
12
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
13
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
1
4
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
1
5
Lah
ey H
itch
oock
Cli
nic
B
url
ing
ton
M
ass
1
6
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
1
7
Orl
ando
Reg
iona
l M
edic
al C
ente
r O
rlan
do
Fla
18
Hen
ry F
ord
Ho
spit
al
Det
roit
1
9
Thom
as
Jeff
erso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
20
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
21
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
2
2
Bos
ton
Med
ical
Cen
ter
2
3
St
Lou
is U
niv
ersi
ty H
osp
ital
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddotS
alem
2
5
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
6
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
2
7
Mou
nt
Sin
ai M
edic
al C
ente
r
New
Yor
k
28
N
ew Y
ork
pre
sby
teri
an H
osp
ital
2
9
UCLA
Med
ioal
Cen
ter
Los
Ang
eles
3
0
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nio
s
Mad
ison
31
L
uthe
ran
Gen
eral
Hea
lths
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m
Par
k R
idge
Il
l
32
F
lori
da
Ho
spit
al M
edic
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ente
r O
rlan
do
Fla
33
V
and
erb
ilt
Un
iver
sity
Ho
spit
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nd C
lin
ic
Nas
hv
ille
3
4
Un
iver
sity
of
Was
hing
ton
Mad
ical
Cen
ter
Sea
ttle
3
5
Ru
sh-P
resb
yte
rian
middotSt
L
uke
s M
edic
al C
ente
r C
hica
go
36
S
t
Lu
ke
s H
osp
ital
B
ethl
ehem
P
a
37
S
enta
ra N
orfo
lk G
ener
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osp
ital
N
orfo
lk
Va
3
8
St
Vin
cent
Ho
spit
al a
nd H
ealt
h C
ente
r
Ind
ian
apo
lis
3
9
How
ard
Un
iver
sity
Ho
spit
al
Was
hing
ton
4
0
Ced
ars-
Sin
ai M
edic
al C
ente
r
LOS
Ang
eles
41
S
inai
Ho
spit
al o
f B
alti
mor
e
42
S
pect
rum
Hea
lth
Gra
nd R
apid
s
Mio
h
43
N
orth
Sho
re U
niv
ersi
ty H
osp
ital
M
anha
sset
N
V
44
Was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
45
M
ary
Hit
chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
46
Geo
rget
own
Un
iver
sity
Ho
spit
al
waS
hing
ton
D
C
47
M
edic
al C
ente
r o
f D
elaw
are
Wilm
ingt
on
48
C
hri
st H
osp
ital
C
inci
nn
ati
4
9
St
Tho
mas
Ho
spit
al
Nas
hv
illa
5
0
Lan
kena
u H
osp
ital
W
ynne
woo
d
Ill
Tec
hnol
ogy
R
epu
tati
on
al
Mo
rtal
ity
CO
TH
sco
re
Su
rgic
al
RN
s
Tra
uma
IH
Q
sco
re
rate
M
embe
r (o
f 9
) vo
lum
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bed
s C
tlnt
er
10
00
6
42
0
65
Y
es
90
9
07
30
00
0
19
4
No
90
9
55
5
01
2
Yes
9
0
82
78
00
00
1
31
Y
es
63
4
31
6
08
2
Yes
9
0
52
05
00
00
1
38
Y
es
58
1
29
1
09
1
Yes
9
0
34
79
00
00
1
42
Y
es
57
1
26
2
08
5
Yes
9
0
43
21
00
00
1
43
Y
es
53
4
21
3
08
1
Yes
9
0
58
92
00
00
1
81
Y
as
45
3
19
3
09
4
Yes
B
O
60
27
00
00
1
33
No
4
32
1
56
0
91
Y
es
70
3
00
60
00
0
16
1
Yes
(+
3 SO
) 3
15
1
14
0
91
Y
es
90
4
66
90
00
0
09
3
No
35
9
87
0
94
Y
es
80
5
60
80
00
0
15
8
Yes
3
55
5
0
08
0
Yes
9
0
39
87
00
00
1
49
Y
es
(+2
SO)
34
2
37
0
84
Y
es
90
8
66
70
00
0
18
8
Yes
3
34
6
8
09
9
Yes
9
0
51
54
00
00
1
51
Y
es
32
8
61
0
83
Y
es
80
9
82
00
00
1
75
No
3
18
0
6
07
0
Yes
8
0
29
03
00
00
1
52
Y
es
31
8
13
0
66
Y
es
90
1
37
00
00
1
98
Y
es
31
4
00
0
70
Y
es
90
2
81
60
00
0
12
8
Yes
3
12
0
0
07
2
Yes
8
5
18
58
00
00
1
82
Y
es
30
7
21
0
90
Y
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80
1
82
90
00
0
12
3
Yes
3
05
0
0
07
2
Yes
8
0
22
46
00
00
1
49
Y
es
30
5
28
0
94
Y
es
90
4
71
80
00
0
16
7
Yes
3
03
1
0
07
6
Yes
7
0
17
60
00
00
2
10
Y
es
30
2
08
0
76
V
es
90
1
15
30
00
0
14
7
Yes
3
02
0
3
08
3
Yes
9
0
39
93
00
00
1
61
Y
es
30
1
06
0
74
Y
es
80
1
09
30
00
0
17
2
Yes
3
00
1
7
09
1
Yes
9
0
26
91
00
00
1
79
Y
es
29
8
47
1
06
Y
es
90
4
25
30
00
0
15
7
Yes
2
91
6
1
11
1
Yes
9
0
57
76
00
00
1
32
Y
es
29
5
37
0
92
Y
es
90
1
50
40
00
0
10
8
Yes
2
95
0
0
07
6
Ves
9
0
15
10
00
00
1
36
Y
es
29
3
00
0
72
Y
es
80
1
70
90
00
0
11
4
Yes
2
93
0
3
07
5
No
80
1
09
16
00
00
1
61
Y
es
29
3
14
0
89
Y
es
90
1
73
80
00
0
24
0
Yes
2
92
1
07
1
16
Y
es
80
1
20
80
00
0
11
0
No
29
2
14
0
76
Y
es
90
1
41
50
00
0
11
4
No
29
1
00
0
76
Y
es
80
3
29
80
00
0
08
7
Yes
2
91
0
0
08
2
Yes
8
0
55
75
00
00
1
51
Y
es
28
9
06
0
84
Y
es
80
8
04
80
00
0
13
7
Yes
2
89
0
0
06
5
Yes
9
0
25
60
00
0
11
0
Yes
2
89
3
5
09
9
Yes
9
0
39
64
00
00
1
06
Y
es
28
9
00
0
76
Y
es
80
2
03
30
00
0
12
1
Yes
2
89
0
0
07
9
Yes
8
0
28
37
00
00
1
06
Y
es
28
9
06
0
87
Y
es
90
4
71
00
00
0
12
7
Yes
2
88
0
0
08
6
Yes
8
0
89
54
00
00
1
92
Y
es
28
7
00
0
84
Y
es
80
2
44
50
00
0
19
4
YeS
2
86
0
0
06
0
Yes
8
0
79
90
00
0
10
9
Yes
2
85
0
0
08
7
Yes
8
0
40
88
00
00
1
15
Y
es
28
4
00
0
70
N
o 8
5
45
27
00
00
1
59
N
o 2
83
0
6
07
6
No
80
8
15
10
00
0
19
9
No
28
3
00
0
71
No
8
0
31
45
00
00
1
10
N
o
2001
H
oroo
nal
Dis
ord
ers
Bes
t H
osp
ital
lis
t
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
RN
s
T
raum
a R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (O
f 7
) D
isch
arge
s to
bed
s C
ente
r
May
o C
lin
ic
Roc
hest
er
Min
n
10
00
6
12
0
66
Y
es
70
14
59
13
1
Yes
2
Mas
sach
uset
ts G
ener
al H
OSp
tal
B
osto
n 9
89
5
27
0
91
Y
es
70
l1
B3
13
B
Yes
3
John
s H
opki
ns H
osp
ital
B
alti
mor
e 5
96
2
52
0
64
Y
es
70
B
07
14
2
Yes
4
Bri
gham
and
Wom
en s
H
osp
ital
B
osto
n 5
36
2
05
0
72
Y
es
70
6
17
1
43
Y
es
I
Bet
h Is
rael
Dee
cone
ss M
edic
al C
ente
r B
osto
n 4
55
1
13
0
62
Y
es
60
11
46
15
8
Ves
6
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
45
4
11
5
04
9
Yes
6
0
1029
2
27
No
7
Un
iver
sity
of
Cal
ifo
rnia
Se
n F
ranc
isco
Med
ical
Cen
ter
45
3
14
5
07
2
Yes
6
0
416
17
5
No
9 B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
45
3
11
6
09
5
Yes
7
0
1968
1
49
Y
es
9 C
leve
land
Cli
nic
4
37
9
3
04
6
Ves
7
0
1133
1
94
No
(+
3 11
m
10
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
41
6
82
0
66
Y
es
10
8
13
1
19
Y
es
11
Un
iver
sity
of
Chi
cago
Ho
spit
als
41
1
89
0
B2
Y
es
70
00
1 1
94
Y
es
12
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
41
0
10
4
00
4
Yes
7
0
752
10
8
Yes
13
u
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
B8
0
4
05
6
Yes
1
0
31
9
11
0
No
14
Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
3
83
1
11
1
54
Y
es
70
15
52
13
2
Yes
15
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
78
3
9
05
5
Ves
7
0
757
24
0
Yes
16
N
orth
Wes
tern
Mem
oria
l H
osp
ital
C
hica
go
37
5
51
0
73
Y
es
60
97
5 1
70
Y
es
17
Hen
ry F
ord
Ho
spit
al
Det
roit
3
75
1
2
05
6
Yes
6
5
19
45
1
82
Y
es
(+2
SD)
18
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
st
anfo
rd
Ca1
1f
36
1
68
0
83
Y
es
50
47
2 1
61
Y
es
19
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 3
64
3
6
05
6
Yes
7
0
328
19
8
Yes
2
0
Duk
e U
nive
rSit
y M
edic
al C
ente
r D
urha
m
NC
3
59
2
7
06
8
Yes
7
0
91
6
18
1
Yes
21
U
niv
ersi
ty H
osp
ital
D
enve
r 3
58
2
5
04
5
Yes
8
0
320
24
0
Yes
2
2
was
hing
ton
Ho
spit
al C
ente
r W
ashi
ngto
n
DC
3
57
2
0
07
6
Yas
6
0
1658
1
92
Y
es
23
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
35
4
16
0
65
Y
es
70
12
59
16
7
Yes
2
4
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 3
47
2
7
05
1
Yes
5
5
719
10
1
Yes
2
5
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
34
5
23
0
13
Y
es
70
86
6 1
61
Y
es
26
S
t
lou
is U
niv
ersi
ty H
osp
ital
3
43
0
7
04
0
Yes
1
0
637
14
1
Yes
2
7
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
3
43
1
1
06
4
Yes
1
0
1080
1
51
Y
es
28
U
niv
ersi
ty H
osp
ital
P
ort
lan
d
ore
3
42
2
8
048
Y
es
60
32
8 0
111
Yes
2
9
Un
iver
sity
of
Tex
as M
edic
al B
ranc
h H
osp
ital
s
Gal
vest
on
33
9
05
0
4B
Y
es
60
81
8 1
53
Y
es
30
G
ood
Sam
arit
an R
egio
nal
Med
ioal
Cen
ter
Pho
enix
3
38
1
0
01
7
Yes
7
0
58
0
10
7
Yes
31
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
Cha
pel
Hil
l 3
37
0
6
05
2
Yes
6
0
791
15
2
Yes
32
U
niv
ersi
ty o
f W
isco
nsin
Hos
pita
l an
d C
Hn
ics
Mad
ison
3
37
0
5
03
3
Yes
7
0
519
13
6
Yes
33
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al O
ak
Mio
h
33
7
06
0
80
Y
es
70
14
14
18
8
Yes
3
4
Flo
rid
a H
osp
ital
Med
ical
Cen
ter
Orl
ando
F
la
33
7
00
0
51
No
6
0
1698
1
67
Y
es
35
U
niv
ersi
ty o
f M
aryl
and
Med
ical
sys
tem
B
alti
mor
e 3
36
0
6
05
1
Ves
7
0
55
3
111
4 Y
es
36
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edic
al C
ente
r S
acra
men
to
33
4
06
0
59
Y
es
70
55
7 2
19
Y
es
37
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
33
3
05
0
50
Y
es
60
56
0 1
57
Y
es
38
Yal
emiddotN
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
33
2
38
1
03
Y
es
10
8
10
1
53
Y
es
39
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
9
00
0
38
Y
es
60
76
8 1
14
Y
es
40
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
3
29
0
0
04
9
Yes
5
5
656
13
5
Yes
41
A
lleg
heny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
32
8
00
0
66
Y
es
60
6
10
1
91
Y
es
42
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 3
27
6
4
16
7
Yes
7
0
1555
1
57
Y
es
43
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
6
05
0
20
Y
es
70
32
9 1
09
Y
es
44
M
emor
ial
Med
ical
Cen
ter
Sav
anna
h G
a
32
6
00
0
48
Y
es
60
5
52
1
42
V
es
45
Med
ical
Col
lege
of
Geo
rgia
Ho
spit
al a
nd C
lin
iC
Aug
usta
3
23
0
0
03
1
Yes
5
0
381
15
0
Yes
46
S
t L
uk
es
Med
ioal
Cen
ter
Milw
auke
e W
is
32
3
00
0
62
Y
es
60
13
70
08
6
Yes
4
1
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
trd
ty
May
woo
d
Ill
3
23
1
0
07
1
Yes
6
0
64
3
16
2
Yes
4
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
32
3
07
0
68
Y
es
70
6
85
1
34
Y
es
49
M
edic
al C
ente
r o
f D
elaw
are
Wil
min
gton
3
21
0
0
08
1
ves
60
12
35
17
5
Ves
50
u
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
32
1
00
0
68
Y
es
70
77
3 1
51
Y
es
- L
2001
K
idne
y D
isea
se B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Dis
char
ge
Med
ical
l R
epu
tati
on
al
Mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
pla
nn
ing
S
urg
ical
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 5
) D
isch
arg
es
to
beds
C
ente
r (o
f 3
) B
eds
Mas
sach
use
tts
Gen
eral
Ho
spit
al
B
osto
n 1
00
0
27
6
09
5
Yes
5
0
1091
1
36
Y
es
3 83
2
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
95
6
25
6
061
Y
es
50
74
2 1
43
Y
es
3 30
3
May
o C
lin
iC
Ro
ches
ter
M
inn
82
B
18
5
06
3
Yes
5
0
1217
1
31
Y
es
3 94
4
Cle
vel
and
Cli
nic
8
28
1
94
0
53
Y
es
50
11
24
19
4
No
3 44
5
New
Yor
k P
resb
yte
rian
Ho
spit
al
80
6
19
6
12
2
Yes
5
0
1617
1
32
Y
es
3 11
1
6 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
77
3
17
4
05
4
Yes
4
5
811
14
2
Yes
3
41
7 UC
LA M
edic
al C
ente
r
Los
Ang
eles
7
26
1
53
0
60
Y
es
50
97
5 1
08
Y
es
3 54
8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
69
6
14
3
07
8
Yes
5
0
1108
1
81
Y
es
3 57
9
Bar
nes
-Jew
ish
Ho
spit
al
S
t
Lou
is
88
7
12
0
05
9
Yes
5
0
1863
1
49
Y
es
3 76
10
U
niv
ersi
ty H
osp
ital
D
enve
r 6
58
1
41
0
61
Yes
4
0
408
24
0
Yes
3
0 11
U
niv
ersi
ty O
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbor
5
89
8
8
05
4
Yes
5
0
922
17
9
Yes
3
60
12
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
iC
Nas
hv
ille
5
78
9
1
04
9
Yes
4
0
850
24
0
Yes
3
28
13
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
56
6
89
0
63
Y
es
40
52
8 1
61
Y
es
3 67
14
P
ark
lan
d M
emor
ial
Ho
spit
al
D
alla
s 56
1
73
0
31
Yes
5
0
660
19
8
Yes
3
39
15
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
41
6
6
06
2
Yes
5
0
1128
1
67
Y
es
3 80
16
U
niv
ersi
ty o
f C
ali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
53
4
74
0
45
Y
es
50
63
1 1
75
N
o 3
35
17
Ho
spit
al o
f th
e U
niv
ersi
ty O
f P
enn
sylv
ania
P
hil
adel
ph
ia
52
8
75
0
73
Y
es
50
96
2 1
61
Yes
3
44
18
Em
ory
Un
iver
sity
Ho
spit
al
A
tlan
ta
52
1
77
0
58
Y
es
45
78
4 0
93
N
o 3
48
19
un
ivers
ity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
51
6
78
0
55
Y
es
50
42
1 1
10
N
o 2
46
(+3
SO)
20
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
47
3
56
0
93
Y
es
40
12
02
15
1
Yes
2
86
21
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
45
3
47
0
61
Yes
5
0
1013
1
58
Y
es
3 0
22
Hen
ry F
ord
Ho
spit
al
Detr
oit
4
47
2
1
05
8
Yes
5
0
1459
1
82
Y
es
3 76
2
3
Un
iver
sity
of
No
rth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
44
5
37
0
48
Y
es
40
10
33
15
2
Yes
3
16
24
F
airv
ieW
-Un
iver
sity
Med
ical
Cen
ter
Min
neap
Oli
s 4
44
5
2
07
2
Yamp
s 5
0
690
15
6
No
3 24
2
5
Un
iver
sity
of
Chi
cago
Ho
spit
als
44
2
31
0
47
Y
es
50
75
8 1
94
Y
es
3 3
0
26
H
erm
ann
Ho
spit
al
Hou
ston
4
24
1
7
03
0
Yes
4
5
668
11
4
Yes
3
54
27
Ru
sh-P
resb
yte
rian
-St
L
uke
s
Med
ical
Cen
ter
C
hica
go
41
8
16
0
37
Y
es
50
12
73
11
4
No
3 49
2
8
New
Eng
land
Med
ical
Cen
ter
8
0st
on
4
16
4
2
07
9
Yes
5
0
330
24
2
Yes
2
30
2
9
Un
iver
sity
of
Cali
forn
ia
Dav
iS M
edic
al C
ente
r
Sac
ram
ento
4
16
2
2
05
5
Yes
5
0
681
27
9
Yes
3
40
30
Yal
e-N
ew H
aven
H
osp
ital
N
ew H
aven
C
onn
4
12
3
8
09
9
Yes
5
0
943
15
3
Yes
3
52
(+2
SO)
31
Los
An
gel
es C
ount
y-U
SC
Med
ical
Cen
ter
40
9
04
0
08
Y
es
45
21
3 1
67
Y
es
3 43
32
S
hand
s H
osp
ital
et
the U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
40
6
34
0
74
Y
es
45
69
9 1
57
Y
es
2 3
0
33
St
L
ou
is U
niv
ersi
ty H
osp
ital
3
99
1
2
041
Y
es
45
58
7 1
47
Y
es
3 43
3
4
Bos
ton
Med
ical
Cen
ter
39
4
15
0
44
Y
es
40
40
5 2
10
Y
es
3 36
35
U
niv
ersi
ty o
f T
exes
Med
ical
Bra
nch
Ho
spit
als
G
alv
esto
n
39
0
05
0
41
Yes
5
0
890
15
3
Yes
3
38
36
Un
iver
sity
Ho
spit
al
Po
rtla
nd
are
3
90
3
4
07
2
Yes
4
5
356
091
Y
es
3 18
37
M
eth
od
ist
Ho
spit
al
Hou
ston
3
89
3
3
10
0
Yes
4
6
796
13
3
No
3 69
38
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
88
0
6
06
0
Yes
5
0
935
17
0 Y
es
3 6
3
39
Fro
edte
rt M
emor
ial
Lu
ther
an H
osp
ital
M
ilw
auke
e 3
87
1
2
05
5
Yes
5
0
784
14
6
Yes
3
35
40
Un
iver
sity
Ho
spit
els
and
Cli
niC
S
Col
umbi
a
Mo
3
87
2
6
06
6
Yes
4
5
374
15
1
Yes
2
30
41
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
niC
S
Chi
cago
3
85
0
0
01
9
Yes
4
5
382
12
9
Yes
3
42
42
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
Ari
z
38
3
00
0
29
Y
es
45
37
6 1
72
Y
es
3 46
43
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
38
3
12
0
41
Y
es
00
81
4 1
68
N
o 91
44
W
illi
am B
eaum
ont
Ho
spit
el
Roy
al O
ak
Mic
h
38
3
03
0
74
Y
es
50
16
88
18
8
Yes
3
60
45
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
3
81
0
5
06
1
Yes
4
5
941
19
4
Yes
3
63
46
Un
iver
sity
01
Wis
con
sin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
7
22
0
82
Y
es
50
82
0 1
36
Y
es
3 32
4
7
Sax
ar C
ount
y H
osp
ital
Dis
tric
t
San
An
ton
io
37
7
16
0
64
Y
es
45
36
8 1
21
Y
es
3 51
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
WaS
hing
ton
D
C
37
7
05
0
43
Y
es
50
39
5 1
09
Y
es
3 53
49
U
niv
ersi
ty 0
1 V
irg
inie
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
3
77
1
4
06
4
Yes
5
0
930
22
7
No
3 34
50
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r
Dal
las
31
5
05
0
72
Y
es
45
97
6 1
22
Y
es
3 86
j r
l
~
2001
N
euro
logy
and
Neu
rosu
rger
y B
est
Ho
spit
al L
ist
Tec
hnol
ogy
Re p
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
so
ore
rate
M
embe
r (o
f 7)
D
isoh
arge
s to
bed
s C
ente
r
1 M
ayo
Cli
nic
R
oche
ster
M
inn
1
00
0
57
5
09
1
Yes
7
0
4763
1
31
Y
es
2 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
83
7
46
0
09
5
Yes
7
0
3705
1
38
Y
es
3 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
74
6
37
2
07
0
Yes
7
0
2641
1
42
Y
es
4 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
7
27
3
73
0
95
Y
as
70
40
78
13
2
Yes
5
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
51
6
24
1
10
0
Yes
6
0
1503
1
75
No
6 C
leve
land
Cli
nic
5
12
1
88
0
65
Y
es
70
33
38
19
4
No
7 B
arne
smiddotJe
wis
h H
osp
ital
S
t l
ou
is
38
9
92
0
81
Y
es
70
46
67
14
9
Yes
8
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
37
4
10
5
09
1
Yes
7
0
22
86
1
61
Y
es
(+3
SD)
9 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
32
4
70
1
02
Y
es
70
29
21
18
1
Yes
1
0
UCLA
Med
ioal
Cen
ter
lo
s A
ngel
es
32
2
64
0
80
Y
es
70
19
67
10
8
Yes
11
M
ount
S
inai
Med
ical
Cen
ter
Ne
w Y
ork
31
7
55
0
85
Y
es
70
23
83
15
7
Yes
12
M
etho
dist
Ho
spit
al
Hou
ston
3
15
6
2
08
6
Yes
6
0
3768
1
33
No
13
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
15
6
6
09
3
Yes
7
0
1925
1
43
Y
es
14
Un
iver
sity
of
Mic
higa
n M
edic
al C
arot
er
Ann
Arb
or
30
4
68
1
06
Y
es
70
17
02
17
9 Y
es
15
S
t J
ose
ph
s H
osp
ital
and
Med
ical
Cen
ter
Pho
enix
3
04
5
2
09
2
Yes
6
0
3336
1
27
Y
es
16
Los
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
29
9
04
0
29
Y
es
55
39
9 1
67
Y
es
17
H
enry
F
ord
Ho
spit
al
Det
roit
2
99
1
3
06
4
Yes
6
5
3299
1
82
Y
es
18
Den
ver
Hea
lth
and
Ho
spit
als
29
5
04
0
16
No
5
5
353
17
0
Yes
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
29
4
49
0
89
Y
es
50
19
06
16
1
Yes
2
0
Dan
amiddotF
arbe
r C
ence
r In
stit
ute
B
osto
n 2
94
0
3
00
0
No
85
6
22
7
No
21
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
29
3
15
0
46
Y
es
70
11
51
10
9
Yes
2
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
29
1
37
0
82
Y
es
70
21
86
13
4
Yes
(+
2 SD
) 2
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
28
8
13
0
36
V
es
60
33
6 2
68
No
2
4
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 2
88
1
8
07
0
Yes
7
0
3234
1
18
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
28
8
27
0
70
Y
es
60
15
98
15
7
Yes
2
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
87
2
1
07
0
Yes
6
0
1970
1
70
Y
es
27
u
niv
ersi
ty H
osp
ital
D
enve
r 2
87
3
3
07
3
Yes
6
0
613
24
0
Yes
2
8
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
28
6
08
0
19
Y
es
70
44
69
16
7
Yes
2
9
Un
iver
sity
of
Vir
gIn
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
28
5
34
0
83
Y
es
60
32
29
22
7
No
30
D
ooto
rs C
Onm
luni
ty H
osp
ital
la
nham
M
d
28
0
00
0
05
No
5
5
901
09
7
No
31
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
2
78
0
0
00
0
Yes
3
0
870
03
4
Ho
32
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 2
77
1
8
07
0
Yes
7
0
896
19
8
Yes
3
3
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
O
ak
Mic
h
27
6
00
0
82
V
es
70
48
44
18
8
Yes
3
4
St
L
uke
s H
osp
ital
N
ewbu
rgh
N
Y
27
5
00
0
02
No
5
0
82
6
08
0
No
35
B
osto
n M
edio
al C
ente
r 2
74
2
5
07
7
Ves
5
0
1255
2
10
Y
es
36
F
airv
ieW
-Uni
vers
ity
Med
ical
Cen
ter
Min
neap
olis
2
74
2
0
06
1
Ves
5
0
1685
1
56
No
37
U
nIv
ersi
ty M
edic
al C
ente
r T
ucso
n
Ari
z
27
4
00
0
50
Y
es
60
86
5 1
72
Y
es
38
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
73
0
0
06
6
Yes
6
0
3299
1
49
Y
es
39
Sc
hwab
Reh
abil
itat
ion
Ho
spit
al
Chi
cago
2
70
0
0
02
3
Yes
2
5
769
04
1 Y
es
40
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
68
0
0
04
9
Yes
5
0
498
21
0
Yes
41
S
t V
ince
nt H
ospI
tal
and
Hea
lth
Cen
ter
In
dia
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olb
2
66
0
0
07
0
Yes
6
0
32
89
1
37
Y
es
42
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
Chi
cago
2
65
0
6
05
4
Yes
7
0
1848
1
14
No
4
3
Bet
h Is
rael
Dea
oone
ss M
edio
al C
ente
r B
osto
n 2
65
1
4
08
5
Yes
6
0
2838
1
58
Y
es
44
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
2
64
0
0
00
6
No
35
12
64
03
8
No
45
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
2
63
1
8
08
8
Yes
7
0
1659
2
40
Y
es
46
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
nic
s C
hioa
go
26
2
13
0
62
Y
es
45
83
0 1
29
Y
es
47
H
arpe
r H
osp
ital
D
etro
it
26
1
04
0
55
Y
es
60
20
72
12
6
No
48
E
vans
ton
Nor
thw
este
rn H
ealt
h C
are
E
vans
ton
Il
l
28
1
09
0
75
Y
es
60
29
33
10
2
Yes
4
9
was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
2
59
0
4
07
7
Yes
6
0
2269
1
92
Y
es
50
Car
din
al H
ill
Reh
abil
itat
ion
Ho
spit
al
lex
ing
ton
K
y
25
8
00
0
02
No
0
5
1313
0
55
No
t
2001
O
rth
op
edio
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
GOTH
so
ore
R
N
$
Tra
uma
Ran
k H
osp
ital
IH
O
sco
re
rate
M
embe
r (o
f 5)
D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
49
2
05B
Y
es
50
77
52
13
1
Yes
2
Ho
spit
al f
or
Sp
ecia
l S
urg
ery
N
ew Y
ork
88
3
40
6
01
3
Yes
4
5
6837
1
57
Y
es
3 M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 7
13
3
20
1
01
Y
es
50
34
89
13
8
Yes
4
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
43
1
90
0
73
Y
es
50
16
28
14
2
Yes
5
Cle
vel
and
Cli
nic
5
19
1
73
0
63
Y
es
50
36
20
19
4
No
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
40
1
34
1
07
Y
es
50
28
63
18
1
Yes
7
Har
borv
iew
Med
ical
Cen
ter
S
eatt
le
37
2
101
1
05
Yes
3
5
820
23
3
Yes
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
37
0
75
0
74
Y
es
50
15
09
13
4
Yes
9
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
36
0
84
0
99
Y
es
50
17
57
10
8
Yes
(+
3 SO
) 10
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
2
68
0
56
Y
es
50
97
3 1
10
No
11
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
A
rbor
3
29
3
9
06
8
Yes
5
0
1586
1
79
Y
es
12
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
32
7
43
0
80
Y
es
50
26
80
14
3
Yes
13
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
32
6
48
0
92
Y
es
50
28
72
16
7
Yes
14
B
exar
Cou
nty
Ho
spit
al D
istr
ict
San
Ant
onio
3
24
3
9
04
8
Yes
4
0
645
12
1
Yes
15
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
3
49
0
87
Y
es
30
21
43
161
Y
es
16
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
35
0
67
Y
es
50
11
56
19
4
Yes
17
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
31
8
71
1
23
Y
es
50
58
7 1
98
Y
es
18
Un
iver
sity
Ho
spit
al
Den
ver
31
7
31
0
44
Y
es
40
63
3 2
40
Y
es
19
Bar
nes
middotJew
ish
Ho
spit
al
St
lo
uis
3
11
3
6
08
9
Yes
5
0
2911
1
49
Y
es
20
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f fl
ori
da
Gai
nes
vil
le
30
7
21
05
9
Yes
4
0
1781
1
57
Y
es
21
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
30
5
62
1
04
Y
es
40
92
7 1
75
No
(+
2 SO
) 22
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
03
1
6
05
9
Yes
5
0
1608
2
40
Y
es
23
Ho
spit
al o
f th
e U
niv
ersi
ty o
f p
enn
sylv
ania
P
hil
adel
ph
ia
30
1
45
1
04
Y
es
50
10
76
161
Y
es
24
U
niv
ersi
ty o
f A
labe
ma
Ho
spit
al a
t B
irm
ingh
am
29
9
22
0
73
Y
es
50
15
94
151
Y
es
25
Ho
spit
al f
or
Join
t D
isea
sesmiddot
Ort
ho
ped
ic I
nst
itu
te
New
Yor
k 2
97
4
0
02
5
No
30
21
10
09
3
No
26
SUl1
l1la
Hea
lth
sy
stem
A
kron
O
hio
29
5
05
0
49
Y
es
40
38
99
14
9
Yes
27
Y
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
Onn
2
93
1
2
061
Y
es
50
14
62
15
3
Yes
28
N
ew Y
ork
Pre
sby
teri
an H
osp
ital
2
92
4
5
12
2
Yes
5
0
2394
1
32
Y
es
29
Un
iver
sity
of
Ten
ness
ee M
edic
al C
ente
r
Mem
phis
2
92
4
2
05
4
No
46
90
1
50
No
30
U
niv
ersi
ty o
f W
isco
nsi
n H
osp
ital
and
Cli
nic
s
Mad
ison
2
89
1
1
061
Y
es
50
14
42
13
6
Yes
31
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
sacr
amen
to
28
6
24
0
87
Y
es
50
11
56
27
9
Yes
32
S
t
lou
is U
niv
ersi
ty H
osp
ital
2
83
0
4
04
8
Yes
5
0
819
14
7
Yes
33
R
ushmiddot
Pre
sby
teri
an
-St
lu
kes
Med
ical
Cen
ter
Chi
cago
28
1
25
0
79
Y
es
50
21
23
11
4
No
34
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Ill
28
0
00
0
46
Y
es
40
25
63
11
4
Yes
35
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
2
80
0
6
04
7
Yes
5
0
952
10
9
Yes
36
C
aro
lin
as M
edic
al C
ente
r
Ch
arlo
tte
N
C
28
0
23
1
03
Y
es
50
29
00
18
4
Yes
37
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
27
9
06
0
71
Yes
4
0
2274
1
58
Y
es
38
Coo
k C
ount
y H
osp
ital
C
hica
go
27 _
7 1
2
05
5
Yes
3
0
184
21
0
Yes
39
U
niv
ersi
ty o
f lo
uis
vil
le H
osp
ital
lo
uis
vil
le
Ky
2
76
0
5
04
2
Yes
4
0
317
19
0
Yes
40
A
lleg
hen
y G
ener
al H
osp
ital
P
itts
bu
rgh
2
76
0
0
06
4
Yes
4
0
2161
1
91
Yes
41
H
enry
For
d H
osp
ital
D
etro
it
27
6
00
0_
63
Yes
4
5
1834
1
82
Y
es
42
Un
iver
sity
of
Mia
mi
Jack
son
Mem
oria
l H
osp
ital
2
78
3
0
06
2
Yes
0
0
748
16
8
No
43
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 2
75
0
5
06
6
Yes
4
0
1518
1
52
Y
es
44
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
27
5
00
0
32
Y
es
40
87
1 1
72
Y
es
45
Mar
y H
itch
cock
Mem
oria
l H
osp
ital
le
ban
on
N
H
27
4
00
0
57
Y
es
40
14
30
19
4
Yes
46
B
apti
st M
emor
ial
Ho
spit
al
Mem
phis
2
74
4
5
11
2
No
50
29
14
09
3
Yes
47
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
2
73
1
2
08
6
Yes
4
0
2025
1
70
Yes
48
L
os A
ngel
es C
ou
nty
USC
Med
ical
Cen
ter
27
3
05
0
00
Y
es
35
23
6 1
Il7
Yes
49
M
edic
al C
ente
r o
f C
entr
al M
assa
chu
sett
s W
orc
este
r 2
73
0
0
06
0
Yes
4
5
1285
1
89
Y
es
60
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
middotSal
em
27
3
11
0
92
Y
es
50
21
20
1I
II
Yes
r-
-
2001
R
esp
irat
ory
Dis
ord
ers
Bes
t H
osp
ital
Lis
t Tec
hnol
ogy
Dis
char
ge
Rep
uta
tio
nal
M
ort
ali
ty
COTH
sc
ore
R
N
s T
raum
a p
lan
nin
g
Ran
k H
osp
Ital
IH
Q
sco
re
rate
M
embe
r (o
f 4
) D
isch
arg
es
to b
eds
Cen
ter
(of
3)
1 N
atio
nal
Jew
ish
Cen
ter
D
enve
r 1
00
0
501
0
22
N
o 3
0
121
37
5
No
3 2
May
o C
lin
ic
Ro
ches
ter
M
inn
8
S2
41
1
08
1
Yes
4
0
4391
1
31
Yes
3
3 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
63
3
2B0
0
95
Y
es
40
14
61
14
2
Yes
3
4 B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
54
6
21
2
08
9
Yes
4
0
5329
1
49
Y
es
3 5
Un
iver
sity
Ho
spit
al
Den
ver
45
7
151
0
83
Y
es
40
9
80
2
40
Y
es
3 6
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
43
2
15
0
09
0
Yes
4
0
1015
1
75
N
o 3
7 M
assa
chu
sett
s G
ener
al H
osp
Ital
B
osto
n 43
1
16
4
11
4
Yes
4
0
3306
1
38
V
es
3 8
Cle
vel
and
Cli
nic
4
20
1
24
0
77
Y
es
40
27
32
19
4
No
3 9
Bri
gham
and
WO
men
s H
osp
ital
B
osto
n 3
69
9
0
08
2
Yes
4
0
2526
1
43
V
es
3 10
U
CSIl
Med
ical
Cen
ter
S
an D
iego
3
68
9
1
08
0
Yes
4
0
1130
1
48
Y
es
3 11
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
4
12
0
09
8
Yes
4
0
720
11
0
110
2 12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbo
r 3
48
8
1
08
7
Yes
4
0
1927
1
79
Ves
3
(+3
SO)
13
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
II
C
33
7
96
1
12
Y
es
40
29
49
18
1
Yes
3
14
Bo
sto
n M
edic
al C
ente
r 3
25
3
8
05
7
Yes
4
0
1105
2
10
Y
es
3 15
H
osp
ital
of
the U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
32
3
96
1
15
Y
es
40
15
07
16
1
Ves
3
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
32
2
74
0
95
Y
es
40
16
20
161
Y
es
3 1
7
Un
ivers
ity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
05
6
0
09
7
Yes
4
0
2957
1
67
Y
es
3 18
UC
LA M
edic
al C
ente
r
Los
Ang
eles
2
97
4
1
07
5
Yes
4
0
1910
1
08
Y
es
3 19
V
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
onn
2
95
5
3
09
3
Ves
4
0
2355
1
53
Y
es
3 20
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
85
5
5
10
0
Yes
4
0
1432
1
94
Y
es
3 21
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
28
5
25
0
74
V
es
40
27
79
15
2
Yes
3
(+2
SO)
22
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
27
9
35
0
87
V
es
40
20
51
24
0
Yes
3
23
Los
A
ng
eles
Cou
nty-
USC
Med
ical
Cen
ter
27
5
04
0
18
Y
es
40
46
9 1
67
Y
es
3 24
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
Sac
ram
ento
2
73
1
2
06
7
Yes
4
0
1820
2
79
V
es
3 2
5
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
73
1
0
06
2
Yes
4
0
1475
1
47
Y
es
3 26
C
ook
Cou
nty
Ho
spit
al
C
hica
go
27
3
00
0
49
Y
es
40
11
45
21
0
Yes
3
27
San
Fra
nci
sco
Gen
eral
Ho
spit
al M
edio
al C
ente
r 2
70
5
6
08
7
Yes
2
0
899
11
0
No
3 28
H
enne
pin
Cou
nty
Med
ical
Cen
ter
M
inn
eap
oli
s 2
67
0
0
05
2
Yes
4
0
1959
1
05
Y
es
3 29
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
26
4
07
0
66
Y
es
40
17
63
15
7
Yes
3
30
Geo
r-ge
tow
n U
niv
ersi
ty H
osp
ital
w
ash
ing
ton
D
C
26
2
04
0
59
Y
es
40
99
3 1
09
Y
es
3 31
C
lar-
ian
Hea
lth
Part
ners
In
dia
nap
Oli
S
26
0
12
0
79
Y
es
40
42
95
16
7
Yes
3
32
Ru
sh-P
resb
yte
rian
-St
L
uk
es
Med
ical
Cen
ter
C
hica
go
25
4
28
0
82
Y
es
40
18
56
11
4
No
3 33
H
enry
Fo
rd H
osp
ital
D
etr
oit
2
54
1
4
08
5
Yes
4
0
3875
1
82
Y
es
3 34
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
2
53
2
2
08
3
Yes
4
0
2302
2
27
No
3
35
W
est
Jeff
ers
on
Med
ical
Cen
ter
M
arre
ro
La
2
52
0
0
05
3
No
40
14
94
11
3
Ves
3
36
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
251
0
0
07
1
Yes
4
0
6185
1
49
Y
es
3 37
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
iCS
M
adis
on
25
0
05
0
70
Y
es
40
14
28
13
6
Yes
3
38
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
50
0
4
07
2
Yes
4
0
1071
1
72
Y
es
3 39
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
sity
M
ayw
ood
Ill
2
49
1
8
08
6
Yes
4
0
1415
1
62
V
es
3 40
U
niv
ersi
ty o
f Il
lin
ois
Ho
spit
al a
nd C
11
nic
s
Chi
cago
2
49
0
5
06
6
Yes
3
5
779
12
9
Yes
3
41
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
46
0
0
06
3
Yes
3
5
1677
1
01
Yes
3
42
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
2
45
3
7
10
3
Yes
4
0
2116
1
51
Ves
2
43
Har
bo
rvie
w M
edic
al C
ente
r
Seett
le
24
4
24
0
89
Y
es
30
80
5 2
33
Y
es
3 44
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
2
44
2
3
09
2
Ves
4
0
1334
1
34
Y
es
3 45
T
rum
an M
adic
al C
ente
r-W
est
K
ansa
s C
ity
M
o
24
4
00
0
64
Y
es
35
99
1 1
14
Y
es
3 46
M
emor
ial
Med
ical
Cen
ter
S
avan
nah
G
a
24
2
00
0
71
Y
es
40
14
03
14
2
Yes
3
47
Tou
ro
Infi
rmar
y
lew
Orl
ean
s 24
1
00
0
65
V
es
40
14
07
06
5
Ves
3
48
St
Jo
sep
h H
osp
ital
D
enve
r 2
41
0
0
05
5
No
40
25
11
10
3
No
3 49
L
os A
ng
eles
Cou
nty-
Har
bor-
UC
LA
Med
ical
Cen
ter
24
0
13
0
10
No
4
0
420
16
5
Yes
2
50
Bay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
40
1
2
08
7
Ves
4
0
3026
1
22
V
es
3
-
J 1
2001
R
heum
atol
ogy
Bes
t H
osp
ital
lis
t
Hos
pita
lwid
e T
echn
olog
y D
isch
arge
R
epu
tati
on
al
mo
rtal
ity
CO
TH
sco
re
RN
s
plan
ning
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 5
) to
bed
s (o
f 3
)
May
o C
lin
ic
Roo
hest
er
Min
n
10
00
4
96
0
72
Y
es
50
1
31
3
2 Jo
hns
Hop
kins
Has
p ta
l 8
alti
mo
rs
85
9
38
0
08
2
Yes
5
0
14
2
3 3
Ho
spt
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 8
09
2
70
0
10
Y
es
45
1
57
3
4 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 7
17
2
54
0
81
Y
es
50
1
43
3
5 C
leve
land
Cli
nic
6
76
2
03
0
67
Y
es
50
1
94
3
6 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
66
4
22
1
09
3
Yes
5
0
1 3
8
3 7
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
66
2
21
2
08
3
Yes
5
0
10
8
3 B
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
64
1
20
8
09
6
Yes
5
0
15
1
2 9
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
5
68
1
34
0
93
Y
es
50
1
81
3
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co M
edic
al C
ente
r 5
58
1
23
0
85
Y
es
40
1
75
3
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
5
37
1
12
0
86
Y
es
30
1
61
3
12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
52
1
82
0
82
Y
es
50
1
79
3
(+3
SD)
13
B
arne
s-Je
wis
h H
osp
ital
S
t
lou
is
49
2
57
0
82
Y
es
50
1
49
3
14
H
osp
ital
fo
r Jo
int
Dis
ease
s-O
rtho
pedi
c In
stit
ute
N
ew Y
ork
48
9
59
0
55
No
3
0
09
3
3 1
5
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 4
86
7
8
10
5
Yes
5
0
11
8
3 1
6
los
Ang
eles
Cou
nty-
USC
Med
ical
can
ter
48
4
00
0
20
Y
es
35
1
S7
3
17
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
47
7
46
0
84
Y
es
50
1
67
3
la
St
lu
kes
Ho
spit
al
New
burg
h
NY
4
74
0
0
00
1
No
35
0
80
3
19
U
niv
ersi
ty H
osp
ital
D
enve
r 4
70
3
6
07
4
Yes
-4
0
24
0
3 2
0
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
46
9
32
0
77
Y
es
50
1
98
3
21
Doc
tors
Com
mun
ity H
osp
ital
L
anha
m
Md
4
69
0
0
00
7
No
35
0
97
2
(+2
SO)
22
Den
ver
Hea
lth
and
Ho
spit
als
48
1
00
0
21
No
4
0
17
0
2 2
3
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
46
6
53
1
02
Y
es
50
1
61
3
24
R
ehab
ilit
atio
n I
nst
itu
te o
f C
hica
go
46
3
00
0
03
Y
es
25
0
34
2
25
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
DC
4
62
0
9
05
3
Yes
5
0
10
9
3 2
6
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
4
58
0
0
00
9
No
25
0
38
3
27
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
45
4
39
0
92
Y
es
40
1
70
3
28
T
he
Inst
itu
te f
or
Reh
abil
itat
ion
and
Res
earc
h H
oust
on
45
3
00
0
13
No
1
5
06
9
3 2
9
Un
iver
sity
of
Chi
cago
Ho
spit
als
45
2
29
0
90
Y
es
50
1
94
3
30
C
ard
inal
Hil
l R
ehab
ilit
atio
n H
osp
ital
L
exin
gton
K
y
44
9
00
0
01
No
0
5
05
5
3 31
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
47
2
6
08
4
Yes
4
0
15
8
3 3
2
Reh
abil
itat
ion
In
stit
ute
of
Mic
higa
n
Det
roit
4
47
0
0
01
2
No
25
0
39
2
33
S
t
lou
is U
niv
ersi
ty H
osp
ital
4
44
0
4
07
1
Yes
5
0
14
7
3 3
4
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
44
4
05
0
66
Y
es
40
1
72
3
35
Coo
k C
ount
y H
osp
ital
C
hica
go
44
3
00
0
55
Y
es
30
2
10
)
36
Su
nnyv
iew
Ho
spit
al a
nd R
ehab
ilit
atio
n C
ente
r S
chen
ecta
dy
NY
4
42
0
0
00
7
No
10
0
43
2
37
B
osto
n M
edic
al C
ente
r 4
39
1
6
07
5
Yes
3
0
21
0
3 3
8
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
niC
S
Mad
ison
4
39
0
8
07
7
Yes
5
0
13
6
3 3
9
Hil
lsid
e R
ehab
ilit
atio
n H
osp
ital
W
arre
n
Ohi
o 4
38
0
0
01
2
No
15
0
30
2
40
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
4
36
1
4
08
6
Yes
5
0
13
4
3 41
U
niv
ersi
ty o
f M
aryl
and
Med
ical
Sys
tem
B
alti
mor
e 4
35
1
6
09
2
Yes
5
0
19
4
3 4
2
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hiO
4
35
0
0
06
8
Yes
4
0
14
9
3 4
3
UCSD
Med
ical
Cen
ter
San
Die
go
43
5
26
0
90
Y
es
30
1
48
3
44
R
ush
-pre
sby
teri
an-S
t
luk
es
Med
ical
can
ter
Chi
cago
4
34
0
0
07
0
Yes
5
0
11
4
3 4
5
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
43
4
15
0
92
Y
es
50
1
53
3 4
6
Hen
ry F
ord
Ho
spit
al
Det
roit
4
34
0
0
07
3
Yes
4
5
18
2
3 4
7
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
can
ter
S
acra
men
to
43
4
00
0
76
Y
es
50
2
19
3
48
H
enne
pin
coun
ty M
edic
al c
ante
r M
inne
apol
is
43
2
00
0
61
Y
es
35
1
05
3
49
W
est
Jeff
erso
n M
edic
al C
ente
r M
arre
ro
lao
43
2
00
0
55
No
4
0
11
3
3 5
0
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
43
2
09
0
87
Y
es
50
1
67
3
~
-
2001
U
rolo
gy B
est
Has
pi ta
l li
st
Tec
hnol
ogy
Rep
uta
tio
nal
M
Ort
alit
y CO
TH
sco
re
RN
s
Tra
uma
Ran
k H
osp
ital
IH
O so
ore
rate
M
embe
r (o
f 8
) D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
70
7
07
8
Yes
7
5
1231
1
42
Y
es
2 C
leve
land
Cli
nio
6
94
4
14
0
50
Y
es
80
1
61
8
19
4
No
3 M
ayo
Cli
nic
R
oche
ster
M
inn
6
80
3
92
0
50
Y
es
80
3
81
8
13
1
Yes
4
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
50
0
25
7
12
3
Yes
8
0
14
50
1
08
Y
es
5 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
4
41
1
79
0
79
Y
es
80
30
61
13
2
Yes
6
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
35
1
73
0
56
Y
es
70
11
61
21
2
No
1 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
13
1
49
0
81
Y
es
80
1
75
8
18
1
Yes
8 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
40
7
15
3
09
6
Yes
8
0
1401
1
38
Y
es
9 B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
iS
39
0
12
9
08
2
Yes
8
0
1778
1
49
Y
es
10
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
38
5
15
2
12
9
Yes
5
0
973
16
1
Yes
11
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
co M
edic
al C
ente
r 3
57
1
07
0
62
Y
es
70
78
3 1
75
No
(+
3 SO
) 1
2
Met
hodi
st H
osp
ital
H
oust
on
33
8
10
9
11
0
Yes
6
5
1381
1
33
No
1
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
33
0
10
8
11
1
Yes
6
0
69
0
26
8
No
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
32
0
60
0
78
Y
es
80
1
28
5
17
9
Yes
1
5
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
31
0
54
0
86
Y
es
80
14
97
16
7
Yes
1
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
07
3
7
04
8
Yas
7
0
95
9
17
0
Yes
1
7
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
30
0
31
0
55
Y
es
80
12
74
16
1
Yes
(+
2 SD
) 1
6
Van
der
bil
t U
niv
ersi
ty H
osp
ital
an
d C
11ni
c
Nas
hv
ille
2
92
5
6
11
5
Yes
7
0
83
3
24
0
Yes
1
9
Lah
ey H
itch
cock
Cli
nic
B
url
ing
ton
M
ass
2
91
2
7
05
4
Yes
7
0
886
15
2
Yes
2
0
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
28
7
51
1
09
Y
es
80
69
7 1
43
Y
as
21
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
28
8
41
0
65
Y
es
80
2
83
1
98
Y
es
22
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
seatt
le
27
9
27
0
24
Y
es
80
5
32
1
10
No
2
3
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
cen
ter
Ch
arlo
ttes
vil
le
27
7
28
0
51
Y
es
70
73
2 2
27
No
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddot S
alem
2
77
1
8
07
7
Yes
8
0
957
16
1
Yes
2
5
Shan
ds H
osp
ital
at
the
Un
iver
sity
of
Flo
rid
a
Gai
nes
vil
le
27
7
15
0
57
Y
es
65
90
5 1
57
Y
es
26
Car
oli
nas
Med
ical
Cen
ter
C
har
lott
e
N C
2
78
0
0
03
3
Yes
8
0
908
18
4
Yes
27
U
niv
ersl
ty o
f W
isco
nsin
Hos
pita
l an
d C
lin
ios
Mad
ison
2
74
0
5
04
5
Yes
8
0
1151
1
36
Y
es
28
Ne
w Y
ork
Un
iver
sity
Med
ioal
Cen
ter
27
3
16
0
66
Y
es
80
16
70
11
8
Yes
2
9
Hen
ry F
ord
Ho
spit
al
Det
roit
2
72
0
0
04
3
Yes
7
5
1079
1
82
Y
es
30
U
niv
ersi
ty H
osp
ital
D
enve
r 2
70
1
0
00
0
Yes
6
0
371
24
0
Y9$
31
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
67
1
4
06
9
Yes
7
0
1011
1
23
Y
es
32
Y
ale-
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
2
67
0
5
06
8
Yes
8
0
98
4
15
3
Yes
33
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
26
7
00
0
42
Y
es
60
9
17
1
92
Y
es
34
A
lban
y M
adic
al C
ente
r A
lban
y
NY
2
66
0
5
04
7
Yes
6
0
77
3
16
7
Yes
3
5
36
Lo
s A
ngel
es C
ount
ymiddotU
SC M
edic
al C
ente
r W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
26
5
26
4
14
0
0
00
0
06
2
Yes
Y
es
60
8
0
65
1
73
0
16
7
18
8
Yes
Y
es
37
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edio
al C
ente
r
Sao
ram
ento
2
64
1
0
05
1
Yes
8
0
412
27
9
Yes
3
8
Nor
th S
hore
Un
iver
sity
Ho
spit
al
Man
hass
et
NY
2
63
0
0
05
5
Yes
8
0
35
4
12
7
Yes
3
9
Sum
ma
Ilea
lth
Sys
tem
A
kron
O
hio
26
2
00
0
04
5
Yes
6
5
775
14
9
Yes
4
0
St
L
ouis
Un
iver
sity
Ho
spit
al
26
1
18
0
72
Y
es
75
4
25
1
47
Y
es
41
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
26
0
21
0
66
Y
es
70
1
12
9
09
3
No
42
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
25
9
00
0
26
Y
es
65
3
56
1
72
Y
es
43
U
niv
ersi
ty o
f L
ou
isv
ille
Ho
spit
al
Lo
uis
vil
le
Ky
2
58
0
8
00
0
Yes
6
0
28
1
90
Y
es
44
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
2
57
0
0
05
9
Yes
6
0
96
5
13
5
Yes
4
5
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
57
1
4
09
9
Yes
7
0
84B
1
62
Y
es
46
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
25
6
04
0
77
Y
es
75
83
3 1
94
Y
es
47
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
25
6
09
0
78
Y
es
60
80
1 1
52
Y
es
48
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
56
2
0
10
9
Yes
8
0
701
19
4
Yes
4
9
Bex
ar C
ount
y H
osp
ital
Dis
trio
t
San
Ant
onio
2
56
0
5
00
0
Yes
8
5
229
12
1
Yes
5
0
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
25
5
13
0
57
Y
es
80
34
9 1
09
Yes
~
l
i i
f
AppendixG
r bull Reputational Rankings for Special-Service Hospitals
i
I
I L
1~
r-
2001
E
yes
Rep
uta
tio
nal
Sco
re
Rep
uta
tio
nal
R
ank
Ho
spit
al
soo
re
Joh
ns
Hop
kins
Ho
spit
al
(Wilm
er
Eye
In
stit
ute
)
Bal
tim
ore
71
2
2 U
niv
ersi
ty o
f M
iam
i (B
asC
om
Pal
mer
Ey
e In
stit
ute
) 6
46
3
Wil
ls E
VQ
Hos
pita
l--
h
ilad
llip
hia
57
0
(+3
l
4 M
assa
chu
sett
s E
ye
and
Ear
In
firm
ary
B
osto
n 4
00
5
UCLA
Med
ioal
Cen
ter
(JII
IIIS
Ste
in E
ye
Inst
itu
te)
lo
s A
ngeJ
es
30
3
(+2
SO)
6 U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nio
s
Iow
a C
ity
1
93
7
USC
Un
iver
sity
Ho
spit
al
(Doh
eny
Eye
In
stit
ute
)
los
Ang
eles
1
03
8
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
B3
9
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
BO
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
66
11
M
ayo
Cli
nic
R
och
este
r
Min
n
63
12
N
ew Y
ork
Eye
an
d E
ar I
nfi
rmar
y
61
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
58
14
C
lev
elan
d C
lin
ic
54
16
M
eth
od
ist
Ho
spit
al
(Cul
len
Eye
Inst
itu
te)
H
oust
on
39
16
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
17
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
6
I
-~
r
middot
2001
P
edia
trio
s R
epu
tati
on
al S
core
Ran
k H
osp
ital
Ch
ild
ren
s H
osp
ital
Bos
ton
2 C
hil
dre
ns
Ho
spit
al o
f P
hil
adel
ph
ia
3 Jo
hns
Hop
kins
Ho
spit
al
BaU
iID
ore
4 C
hil
dre
ns
Ho
spit
al o
f P
itts
bu
rgh
5
Ch
ild
ren
s H
osp
ital
D
enve
r 6
Ch
ild
ren
s H
osp
ital
lo
s A
ngel
es
7 U
niv
H
osp
ital
s o
f C
lev
elan
d
(Rai
nbow
Bab
ies
amp C
hil
dre
ns
Hos
p J
8
Tex
llS C
hil
dre
ns
Ho
spit
al
Hou
ston
9
New
Yor
k P
resb
yte
rian
Ho
spit
al
(Bab
ies
amp C
hil
dre
ns
Ho
spit
al)
10
Ch
ild
ren
s H
osp
ital
Med
ical
Cen
ter
C
inci
nn
ati
11
Ch
ild
ren
s M
emor
ial
Ho
spit
al
Chi
cago
12
M
ayo
Cli
nic
R
och
este
r M
inn
13
U
niv
ersi
ty o
f C
a11
forn
ia
San
Fra
nci
sco
Med
ical
cen
ter
14
UCLA
(M
atte
I C
hild
ren
lS C
ente
r)
los
Ang
eles
15
lu
cil
le P
acka
rd C
hil
dre
ns
Ho
spit
al
Sta
nfo
rd
Cali
f
16
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
17
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
18
Ch
ild
ren
s H
osp
ital
and
Med
ical
Cen
ter
S
eatt
le
19
Ch
ild
ren
s N
atio
nal
Med
ical
Cen
ter
Was
hing
ton
D
C
20
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
21
Ch
ild
ren
s H
osp
ital
B
uff
alo
N
Y bull
22
Un
iver
sity
of
Mic
higa
n H
osp
ital
s
Ann
Arb
or
23
St
Ch
rist
op
her
s H
osp
ital
P
hil
adel
ph
ia
24
Met
ho
dis
t H
osp
ital
H
oust
on
Rep
uta
tio
nal
S
core
49
4
38
9
27
4
12
2
11
6
10
9
10
9
99
9
4
89
8
7
74
7
2
62
6
0
5S
4
9
48
4
3
39
3
7
37
3
6
32
(+3
SD)
(+2
SlY
j
i r-
2001
p
sych
iatr
y R
epu
tati
on
al S
oore
Rep
uta
tio
nal
R
ank
Ho
spit
al
Soo
re
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
31
8
2 N
ew Y
ork
pre
sby
teri
an H
osp
ital
25
2
3 C
F
M
enni
nger
Mem
oria
l H
osp
ital
T
opek
a
Kan
2
10
4
MoL
ean
Ho
spit
al
Bel
mon
t
Mas
s
20
6
5 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mor
e 19
9
+3
SOl
6 UC
LA N
euro
PIgt
iQh
atl
ic
Hos
rgt
1al
105
Ang
eles
~8~_
Il
ifJl
7
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
10
0
8 Y
ale-
New
Hav
en
Ho
spit
al
New
Hav
en
Con
n
92
9
May
o C
lin
iC
Ro
ches
ter
M
inn
8
8
10
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
6
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
52
12
S
hepp
ard
and
Eno
ch P
ratt
Ho
spit
al
Bal
tim
ore
52
13
U
niv
ersi
ty o
f C
ali
forn
ia
san
Fra
nci
sco
Med
ical
Cen
ter
46
14
U
nv
ars
ity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
4
0
e
15
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
7
16
Mou
nt S
inai
-NY
U M
edic
al C
ente
r
New
Yor
k 3
5
17
Cle
vel
and
Cli
nic
3
1
l r-shy
2001
R
ehab
ilit
atio
n R
epu
tati
on
al S
core
Rep
uta
tio
nal
R
ank
Ho
spit
al
Soo
re
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
6
37
2
The
In
stit
ute
fo
r R
ehab
ilit
atio
n a
nd
Res
earc
h
Hou
ston
3
74
3
Un
iver
sity
of
Was
hina
ton
Med
ioal
Cen
ter
$l
I1It
tle
32
9
___j+
3 S
O)
4 K
essl
er I
nst
itu
te f
or
Reh
abil
itat
ion
W
est
Ora
nge
N
J
23
8
5 M
ayo
Cli
nic
R
och
este
r
Min
n
20
3
6 C
raig
HQ
spit
al
Eng
lew
ood
c()l~
__
__
__
_
___2
00
(+
2 SO
l 7
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 1
40
8
Ohi
o st
ate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
11
1
9 T
hom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
10
7
10
Ran
oho
Los
AlII
igos
Med
ioal
Cen
ter
D
owne
y
Cali
f
10
0
11
Un
iver
sity
of
Mio
higa
n M
edio
al C
ente
r A
nn A
rbor
9
6
12
Sp
auld
ing
Reh
abil
itat
ion
Ho
spit
al
Bos
ton
69
13
N
atio
nal
Rs
hab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
8
6
14
Mou
nt
Sin
ai M
edic
al C
ente
r
New
Yor
k 6
7
15
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
9
16
Alb
ert
Ein
stei
n M
ed
Cen
ter
(Mos
s R
ehab
H
osp
)
Ph
ilad
elp
hia
5
6
17
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
39
18
S
heph
erd
Cen
ter
A
tlan
ta
39
1
9
Un
iver
sity
Ho
spit
al
Den
ver
31
2
0
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
31
L
AppendixH
The 2001 Honor Roll
Lj
l
r
t
The Honor Roll
To lend additional perspective we have constructed a measure called the Honor Roll to
indicate excellence across a broad range ofspecialties
To be listed on the Honor Roll a hospital has to rank at least 2 standard deviations
(SD s) above the mean in at least 6 ofthe 16 specialties A hospitals ranking in the Honor
Roll is based on points assigned as follows
bull For ranking between 2 and 3 standard deviations above the mean in a specialty a
hospital receives one point
bull For ranking at least 3 standard deviations above the mean a hospital receives two
points
We chose to use a standard deviation based criteria rather than simply adding up a
hospitals rankings in individual specialties for three reasons (1) the number ofoutstanding
hospitals varies from specialty to specialty (2) setting a threshhold is more informative because
it establishes a level ofalmost excellent and (3) it gives some measure ofthe distance
between hospitals which rankings do not
f
middot1
THE 2001 HONOR ROLL
16
Mayo Clinic Rochester Minn 27 13 1
Massachusetts General Hospital Boston 26 12 2
4 Cleveland Clinic 23 11 1
5 UCLA Medical Center Los Angeles 22 8 6
6 Duke University Medical Center Durham NC 20 8 4
7 Barnes-Jewish Hospital St Louis 18 6 6
7 University of Michigan Medical Center Ann Arbor 18 6 6
7 University of California San Francisco Medical Center 18 7 4
10 Stanford University Hospital Stanford Calif 17 6 5
11 Brigham and Womens Hospital Boston 16 6 4
12 University of Washington Medical Center Seattle 12 4 4
13 New York Presbyterian Hospital 12 5 2
14 Hospital of the University of Pennsylvania Philadelphia 11 3 5
15 University of Chicago Hospitals 9 1 7
16 University QfPittsburgh Medical Center 9 2 5 1 1
l
i
The 2001 Index of Hospital Quality
I Introduction middot 3
II The Index ofHospital Quality
A Universe Definition 6
B Composite Measures of Structure9
C Process 13 f D Outcome18 l E The Calculation ofthe Index 22
III Directions for Future Releases 24
IV References25
V Appendices
A Technology indices by specialty
B Structural variable map
C Diagnosis-related group (DRG) groupings by specialty
D 2001 Sample physician questionnaire
E Predicted mortality APR-DRG methodology
F Index ofHospital Quality (IHQ) scores by specialty
G Reputational rankings for specialmiddotservice hospitals
H The 2001 Honor Roll
i
l
r
r l
NORC 6021
1 Introduction
l
f
L
Health care providers and consumers today face a dynamic and often puzzling array of
choices with few tools to inform their critical decisions about quality of care No single
standard measure of quality of care is available for the 6116 hospitals in the United States In
1993 the National Opinion Research Center at the University of Chicago (NORC) developed
such a measure This report card is supported and published annually by U S News amp World
Report in an issue entitled Americas Best Hospitals
In the NORC report card each hospital receives a score called the Index of Hospital
Quality (IHQ) that assesses hospital quality by taking into account the three fundamental
dimensions of health care delivery process structure and outcome None of these dimensions
by itself can completely and accurately represent quality of care all three must be assessed and
combined Care starts with the structural characteristics of an institution (such as the number of
patients served and the range of medical technology available) moves through the process of
delivering care and produces results or outcomes for the patients served To be most useful to
the consumer and provider of care the IHQ--our application of the Donabedian paradigml2 of
structure process and outcomes--combines robust and sensitive measures of each of these
dimensions for the universe of tertiary-care hospitals across a wide range ofmedical and surgical
practice specialties The IHQ draws from secondary sources such as the Annual Survey of
Hospitals by the Americ~ Hospital Association (AHA) for data about various quality
dimensions We continually try to improve the specificity and sensitivity of the measures we use
to rank hospitals and to identify the best possible sources ofdata
For the 2001 rankings we made the following changes bull Introduced new procedures allowing all hospitals that do not respond to the AHA
survey to be eligible for ranking bull Completed the transition to a revised calculation ofmortality ratios bull Refined the selection of Diagnosis-Related Groups (DRGs) for the heart and
orthopedic specialties bull Tested the impact on the response rate to the annual physician survey of either an
explicit reference in the survey letter or questionnaire to the Americas Best Hospitals issue of us News amp World Report or implicitly to the 12th Annual Survey ofPhysicians for US News amp World Report
bull Redesigned the appearance of the questionnaire bull Incorporated into this report a flow chart illustrating the analytical steps of the
methodology
3
(
L
We regularly examine the impact of hospital mergers on our rankings For this release
three mergers among hospitals previously ranked as independent entities appear on the lists
Albany Medical Center NY Evanston Northwestern Medical Center Evanston Ill and
Harper Hospital Detroit These hospitals responded as new corporate entities for the first time
in the 1999 AHA database The following sections define the universe of tertiary-care
hospitals for the purpose of this project describe and define the standardized mortality ratios
and the structural components and explain how process-related data is collected As a guide
the materials on which each of the components of the index is based are outlined below
I Reputation bull The reputational score is based on cumulative infonnation from three NORC
surveys of physicians carried out in 1999 2000 and 2001 the sample design is consistent across the three years
bull The sample for the 2001 survey consists of 2550 board-certified physicians selected from the American Medical Associations (AMA) Physician Masterfile of 811000 physicians
bull StratifYing by region and by specialty within region we selected a sample of 150 physicians from each of 17 specialty areas for a total of2550 physicians
bull The final sample includes both non-federal and federal medical and osteopathic physicians residing in the 50 states and the District ofColumbia
II Structure bull The structural score is based on data related to the structural characteristics of
each specialty within each hospital bull These elements represent volume of work technology and other elements of the
hospital environment bull Most of the data comes from the 1999 AHA Annual Survey bull The volume data comes from the Health Care Financing Administrations
(HeFA) MEDP ARS database which contains information on all Medicare discharges (primarily aged over 65) in each specialty
III ()utco~e
bull The outcome measure is based on HCFAs MEDP ARS database
bull An adjusted mortality rate is computed based on predicted mortality rates bull The data and the model were provided by Solucient Inc of Evanston Ill using
the All Patient Refined Diagnosis Related Group (APR-DRG) method designed by 3M Health Infonnation Systems
bull The APR-DRG adjusts expected deaths for severity of illness by means of principal diagnosis and categories of secondary diagnoses
bull This method is applied to the pooled 1997 1998 and 1999 data set of Medicare reimbursement claims made to HCF A by hospitals
4
In the final section we outline new directions anticipated for the index For a more
exhaustive review of the foundation as well as the development and use of the individual
measures and the composite index see ItBest Hospitals A Description of the Methodology for
the Index ofHospital Quality3
shy
J
r
5
IL The Index ofHospital Quality
A Universe Defmition
We have implemented a two-stage approach to defining eligible hospitals for each of the
IHQ specialty lists
First eligible hospitals must be considered tertiary-care centers To be identified as a
tertiary-care hospital a hospital must meet at least one of the following criteria
bull COTH membership or
bull medical school affiliation or
bull a score of9 or higher on our hospital-wide high-technology index
(Appendix A)
Using these criteria we identified 1878 tertiary-care hospitals that were eligible for any of the
thirteen IHQ-based rankings Once the eligible hospitals were identified data for these hospitals
were drawn from the 1999 AHA Annual Survey As with any data collection effort the AHA
Annual Survey database is incomplete due to nonresponding hospitals Although it did not affect
the analysis this year we have a procedure to allow eligible hospitals that are nonresponders to
the current AHA Annual Survey to remain in our database First for all previously ranked
hospitals that are nonresponders to the current survey we average the two prior years ofdata and
substitute the result for the missing data Two-year non-responders that lack data both from the
current survey and from the previous two surveys are ranked without any structure data
Although nonresponding hospitals need to be treated separately for the IHQ analysis it is
unnecessary to do so for the four reputation-only lists
We then created separate analytic universes for each of the 13 IHQ-driven specialties
using criteria such as specialty-specific technology or facilities and a minimum number of
discharges across appropriate DRGs (Figure 1) However hospitals with a non-zero reputational
score were deemed eligible for ranking even if they had insufficient volume (discharges) in a
specialty
The flow chart in Figure 2 illustrates the eligibility process
6
Figure 1 1999 Universe Definition by Specialty
~pec~~ltyi bull Number ()fllospit~ Imiddotimiddotf~~ifji~t~~f~frl~~~~~~~~~fmiddot ~~ bull~~ bullbull ~ f~middot~~~~ ~ ~~)~~~~ ~~~ Imiddotmiddot~ lt IA~~~~~ri1j~(~~tl = ~-~ ~~~~~f~~-~)~~lt-)-_~- ~~ ~ ~ v~_~ ~_~~ ~~
Cancer minimum of 380 discharges for relevant DRGs or 935 non-zero reputation score
Digestive disorders minimum of734 discharges for relevant DRGs or non- 1394 zero reputation score
Ear nose and minimum of37 discharges for relevant DRGs or non- 1371 throat zero reputation score
Geriatrics score of 1 or more on the geriatrics service index and 1412 minimum of 5947 discharges for all DRGs or nonshy
zero reputation score
Gynecology minimum of 52 discharges for relevant DRGs or non- 1356 zero reputation score
have a cardiac catheterization lab or Heart offer open heart surgery or 853
offer angioplasty and minimum of 245 surgical discharges for relevant
DRGs or non-zero reputation score
Hormonal Minimum of3615 discharges for relev 944 disorders non-zero reputation score
Kidney disease Minimum of 185 discharges for relev 1389 non-zero reputation score
Neurology and Minimum of464 discharges for rete 1408 Neurosurgery non-zero reputation score Orthopedics Minimum of392 discharges for relevant DRGs or 1406
non-zero reputation score Respiratory Minimum of881 discharges for relevant DRGs or 1409
disorders non-zero reputation score Rheumatology Minimum of22 discharges for relevant DRGs or non- 1376
zero reputation score Urology Minimum of 133 discharges for relevant DRGs or 1370
non-zero reputation score
7
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B Composite Measure of Structure
The structural dimension defines the tools and environment available to care providers in
treating patients It represents the possibilities of care for a patient and physician Healthcare
research overwhelmingly supports the use of a measure of structure in assessing quality of care
However no prior research has revealed a single indicator of quality that summarizes all others
or that adequately represents the structure construct on its own Thus the structural component
must be represented by a composite variable comprising different measures that are specialtyshy
specific and are weighted relative to each other
For the 2001 index all structural elements other than volume are derived from the 1999
AHA Annual Survey of Hospitals database and are described below For specific mapping of
variables to the AHA data elements see Appendix B
COTH membership This dichotomous variable indicates membership in the Council of
Teaching Hospitals
Technology indices In 2001 we added medical and surgical intensive care beds to
the list of nephrology elements All other technology elements for all other specialties are
unchanged A complete list of the technologies considered for each specialty can be found in
AppendixA
Since the 1996 version of the index we have allowed our technology indices to reflect
the real cost of high-technology services While providing a service inside the hospital is
convenient for patients the cost may be unacceptable to some hospitals Many hospitals
provide access to technology services through the hospitals health system a local community
network or a contractual arrangement or joint venture with another provider in the
community We have taken this into account by giving hospitals that provide a service such as
ultrasound on-site one full point for that element hospitals that provide the service locally
through a formal arrangement receive a half-point A hospital receives no more than one point
for each element of the index
Volume The volume measure reflects the total number of medical or surgical (or both
when appropriate) discharges in the appropriate specialty-specific ORO groupings submitted for
HCF A reimbursement In the heart specialty surgical discharges indicates volume Data from
the three most recent years is pooled The ORO groupings are shown in Appendix C
9
RNs to beds The number of beds is defined by the AHA as beds set up and staffed at
the end of the reporting period Only nurses who have graduated with RN degrees from
approved schools of nursing and who are currently registered by their state are considered
Nurses must be full-time (35 hoursweek or more) and on staff Private-duty nurses nursing
staff whose salary is financed entirely by outside sources (eg an agency or a research grant)
and LPNs are not counted Registered nurses more appropriately classified in other
occupational categories (eg supervisory nurses facility administrators) also are not counted
Trauma In 1992 the annual US News survey of board-certified physicians ranked the
presence of an emergency room and a hospitals trauma provider level high on a list of hospital
quality indicators Physicians in nine specialties ranked trauma as one of the top five indicators
of quality The indications of these specialists and resultant high factor loadings supported the
inclusion of this data for heart hormonal disorders digestive disorders gynecology kidney
disease neurology and neurosurgery orthopedics ear nose and throat respiratory disorders and
urology
The trauma indicator is dichotomous and reflects two variables from the AHA database
whether the hospital has a certified trauma center in the hospital and the level of the trauma
center To receive credit for trauma services hospitals must provide either Level 1 or Level 2
trauma services in-hospital (as opposed to providing trauma services only as part of a health
system network or joint venture) Levell trauma service is defined as a regional resource
trauma center which is capable of providing total care for every aspect of injury and plays a
leadership role in trauma research and education4 Level 2 is defined by the AHA as a
community trauma center which is capable ofproviding trauma care to all but the most severely
injured patients who require highly specialized care4
Discharge planning The three elements of discharge planning are patient-education
services case management services and patient representative services TA service must be
provided in-hospital to receive credit
Service mix This indicator ranges from 0 to 10 points and comprises alcoholdrug abuse
or dependency inpatient care hospice home health services social work services reproductive
health services psychiatric education services womens health centerservices and psychiatric
consultationlliaison services Services must be provided within the hospital We do not award a
half-point for items in this measure
10
L
Geriatric services This indicator ranges from 0 to 7 points and comprises arthritis
treatment centers adult day care programs patient representative services geriatric services
meals on wheels assisted living and transportation to health facilities Again to receive credit
for a service it must be provided in-hospital
Gynecology services This indicator was introduced in 19975 It provides a means to
better rate the quality of services a hospital provides for its gynecological and obstetric patients
High factor loadings provide support to this variables inclusion With a range of 0 to 4 the
services included are obstetric care reproductive health care birthing rooms and womens
health center The half-point scheme used for the technology indices was not employed for this
indicator
Medicalsurgical intensive care beds This indicator is new in 2001 it surfaced as an
important factor for the nephrology specialty The AHA database provides the number of
medical and surgical intensive care beds per facility To be counted beds must be physically
located within the hospital and set up and staffed at the end of the reporting period
To combine these structural variables we weight the elements to create a flnal
composite measure Using factor analysis we force a one-factor solution and use the resultant
loadings as weight values for each variable in the composite structural measure The
relative weight assigned to each element varies from specialty to specialty and from one release
to the next within specialty Figure 3 provides the factor weights assigned to each element for
the 2001 release
11
F
Fig
ure
3 F
acto
r Lo
adin
g by
Spe
cial
ty
CO
TH
Imiddot
Tec
hnic
al
V
olum
e R
Ns
lBed
s D
is-
Goomiddot
Inde
xes
chan
ze
Can
cer
73
59
70
70
Dig
esti
ve d
isor
ders
69
52
60
63
Ear
nos
e a
nd th
roat
72
54
64
63
Ger
iatr
ics
35
81
Gyn
ecol
ogy
61
71
I H
eart
72
62
65
61
I
56
Hor
mon
al d
isor
ders
71
53
56
65
I
63
Kid
ney
dise
ase
63
66
62
57
I 54
Neu
rolo
gy a
nd n
euro
surg
ery
68
54
62
66
62
Ort
hope
dics
69
46
54
66
63
Res
pira
tory
dis
orde
rs
50
73
31
51
58
Rhe
umat
olog
y 45
82
Uro
logy
73
49
C Process
The process dimension of the quality equation is the sum or net effect of physicians
clinical decision-making Physicians clinical choices about the use of medication or diagnostic
tests admission to the hospital or one ofits units and length ofstay account for a large fraction
of the outcomes experienced by patients However measurements ofprocess on a national scale
are extremely difficult to obtain In order to measure process we rely on an alternative measure
to act as a proxy for process We contend that when a qualified expert identifies a hospital as
one of the best he or she is in essence endorsing the process choices made at that hospital
Thus we use the nomination of a hospital by a board-certified specialist as a measure off process In order to collect these nominations we conduct an annual survey of board-certified
f - physicians As in past releases we have pooled nominations for the past three years [1999-2001] I to arrive at the process measure i
Survey sample The sample for the 2001 survey consists of 2550 board-certified
physicians selected from the American Medical Associations (AMA) Physician Masterfile of
811000 physicians From within the Masterfile we selected a target population of 194916
board-certified physicians who met the eligibility requirements listed in Figure 4 Stratifying by
region and by specialty within region we selected a probability (random) sample of 150
t l physicians from each of 17 specialty areas for a total of 2550 physicians The final sample
r includes both non-federal and federal medical and osteopathic physicians residing in the 50
states and the District ofColumbia Figure 4 displays the list of specialties surveyed in 2001
f Eligibility requirements We defined a probability sample of physicians who could
properly represent the 17 specialty groupings delineated by us News amp World Report We
used two rules of eligibility one related to a mapping between the 17 specialties and the AMAs
list of 85 self-designated specialties and the second related to a mapping between these 85
specialties and the 23 member boards of the American Boards ofMedical Specialties (ABMS)
Under the first rule we linked each of the 17 specialties to one or more relevant AMA
specialties from the list of AMA self-designated practice specialty codes Physicians who
designated a primary specialty in one of the 17 specialties were preliminarily eligible for the
survey Under the second rule the physicians must also be certified by the corresponding
member board of the ABMS Figure 4 displays the correspondence between the specialty [ specified for US News amp World Report AMA self-designated specialty and the corresponding
member board
13
Figure 4 Physician Sample Mapping
us NEWS SPECIALTY
Cancer
r Digestive disorders
Ear nose and throat
Eyes
Geriatrics
i
Gynecology L
Heart
Hormonal disorders
Kidney disease
Neurology and Neurosurgery
-l ~
Orthopedics
Pediatrics
Psychiatry
Rehabilitation
Respiratory disorders
Rheumatology
Urology
I AMAKEY CODE
HEMl22 ON24
GEl
OTO48
OPW46
FPG38 IMG38
GYN21 OBG42
CD08 CDS08
END14 DW12
NEP
N36 NS
ORS85
PO55 ADUOI
P63
PW62
PUD
RHU174
Ul91
AMASELF-middot DESIGNATED
Hematology Oncology
Gastroenterology
Otolaryngology
Ophthalmology
Geriatrics
Gynecology Obstetrics amp gynecology
Cardiovascular diseases Cardiovascular surgery
Endocrinology Diabetes
Nephrology
Neurology Neurological surgery
Orthopedic surgery
Pediatrics Adolescent medicine
Psychiatry
Physical medicine amp rehabilitation
Pulmonary diseases
Rheumatology
Urological surgery
14
AMERICAN BOARD OF
Internal medicine Internal medicine
almedicine
Otolaryngology
Ophthalmology
Internal medicine
Obstetrics amp gynecology Obstetrics amp gynecology
Internal medicine Surgery
Internal medicine Internal medicine
Internal Medicine
Psychiatry amp neurology
Orthopedic surgery
Pediatrics Pediatrics
Psychiatry amp neurology
Physical medicine amp rehabilitation
Internal medicine
I Internal medicine
Urology
r -
l
r
to
f -
1 bull
Stratification To compensate for the widely varying number of eligible physicians
across the targeted specialties we used different probabilities of selection for each grouping and
used proportionate stratification across the four United States Census regions (West Northeast
South and North Central) Within each of the 17 strata we achieved a sample that was also
geographically representative of the spread ofphysicians across the country
2001 physician survey Sampled physicians were mailed a three-page questionnaire (see
Appendix D) a cover letter and a prepaid return envelope We also included a token incentive
in the form of a two-dollar bilL One week after the initial survey mailing a reminder postcard
was sent to the sampled physicians Two weeks following the reminder mailing we sent a
second mailing to nonrespondents including the questionnaire a cover letter and a business reply
envelope Three weeks after the second mailing we re-sent the questionnaire to nonrespondents
This third mailing was sent by Federal Express and included the questionnaire a cover letter and
a business reply envelope
2001 questionnaire redesign In consultation with Dr Donald Dillman of Washington
State University a noted questionnaire designer we revised the physical layout of the project
questionnaire (Appendix D) so that respondents could read and complete it more easily We
believe that the redesign had appreciable impact on this years response rate (below and Figure
5)
Response rate Of the 2550 physicians surveyed for this years report 1377 physicians
returned a useable questionnaire a response rate of 547 percent (Response rate is calculated as
the ratio of completed questionnaires to the total eligible in accordance with standard practice
any member of the sample found to be ineligible was removed from the denominator of the
equation for calculation purposes) Figure 5 shows response rates by specialty for the three years
used for the 2001 index
2001 experiments NORC conducted two experiments as part of the physician survey
for 2001 Briefly the experiments were 1) a Web version of the survey permitting direct onshy
line response for physicians and 2) a comparison of explicit citations of the Americas Best
Hospitals project for US News amp World Report and implicit references to the 12th Annual
15
Survey of Physicians conducted for US News amp World Report Citations appeared on both the
cover letters and questionnaire cover As with last years experimental launching of the Web
version this years version was used successfully by a small number of respondents We plan to
evaluate the cost-effectiveness ofthis strategy before using it again next year With regard to the
project citation experiment half of the physicians in each specialty were told explicitly that their
responses would be used to rank hospitals in Americas Best Hospitals issue of US News amp
World Report and the other half were told that they were participating in an annual survey of
physicians for US News amp World Report Our comparison of the explicit and implicit project
citations indicated no difference in response rates The difference in the number of survey
questionnaires returned by each group within each specialty ranged from 1 to 8 Figure 5 [
details the total number of surveys returned for each specialty
16
r
~
r-
lt
ance
r ig
esti
ve d
isor
ders
orm
onal
dis
orde
rs
idne
y di
seas
e
euro
logy
and
esp
irat
ory
diso
rder
s gy
Fig
ure
5 R
espo
nse
Rat
e b
y Y
ear
(150
sam
pled
phy
sici
ans
per
spe
cial
ty p
erye
ar)
n 70
71
82
75
84
70
62
68
62
78
r
Weighting Weighting was carried out in two steps First weights were assigned to
physicians that reflected the probabilities of selection within specialty groups and the overall
rates ofresponse within these groups Second the weights from the first step were poststratified
using the two-dimensional contingency table of specialty (17 categories) by census region
(Northeast Midwest South and West) To check the weights we ~nfinned that the sum across
the sample of the weights in each cell of the classifications (specialty x region) equaled the
population size
D Outcome
Many healthcare professionals have decried the use of mortality rates because of
limitations in the methods used to adjust for risk Nonetheless research strongly suggests a
positive correlation between a risk-adjusted mortality rate that is better than average and overall
quality8-17 Based on these findings we used adjusted mortality rate as the outcome measure for
our quality of care model All predicted mortality rates were provided by Solucient Inc of
Evanston Ill using the All Patient Refined Diagnosis Related Group (APR-DRG) method
designed by 3M Health Information Systems The APR-DRG adjusts expected deaths for
severity of illness by means of principle diagnosis and categories of secondary diagnoses A
detailed description of the full APR-DRG methodology is provided in Appendix E Solucient
applied this method to the pooled 1997 1998 and 1999 data set of reimbursement claims made to
HCF A by hospitals These complete data sets were the most current available
2001 DRG refmements We annually review the DRG-groupings for every specialty In 2001
we chose to conduct a thorough examination of the DRG groupings in heart and orthopedics
Because we anticipated likely changes as a result we conducted two independent reviews
Solucient conducted a review of each specialty and an independent consultant shy
a cardiologist and an orthopedic surgeon--conducted a review in his specialty Where the two
reviews agreed as they did in each of the two specialties we implemented the recommended
changes Revisions for each specialty are detailed below
18
Heart DRGs Three DRGs were added
109 = Coronary bypass wlo cardiac cath
124 =Circulatory disorders except AMI w cardiac cath and complex diag
125 =Circulatory disorders except AMI w cardiac cath and wlo complex diag
Orthopedic DRGs Two DRGs were deleted and six were added
DeletedDRGs
214 =Back amp neck procedures wI CC
215 =Back amp neck procedures wlo CC
AddedDRGs
496 =Combined anteriorlposterior spinal fusion
497 = Spinal fusion wI CC r 498 = Spinal fusion wlo CC 501 =Knee proc wI pdx ofinfection wi CC
502 =Knee proc wI pdx ofinfection wlo CC
503 =Knee proc wlo pdx ofinfection
As in previous years we used an all-cases mortality rate for four specialties (geriatrics
gynecology ear nose and throat and rheumatology) rather than a specialty-specific rate either
because the number of hospitals with sufficient discharges in the particular DRG-grouping was
too low or because the DRG groupings proved to be less robust than was desired Appendix C r -
lists the DRGs for each specialty
In 2000 we modified the construction of the outcome measure The IRQ is the final
score for each hospital in the specialty rankings It gives equal weight to process (represented by
reputation) outcome (mortality) and structure (volume technology and other elements of the
hospital environment) The numbers produced for each of these three measures however differ
greatly in magnitude and in range or variability Without correcting for that the final score
even when the three measures are weighted equally would be distorted
19
Pre-2000 solution For each specialty prior to 2000 the calculated mortality ratio for each
hospital was inverted--the ratio of actual to expected deaths was divided into 1 so that as with
other measures higher meant better For example a better-than-expected mortality ratio of 08
would produce an inverted result of 125 a worse-than-expected ratio of 12 would produce an
inverted result of 083 (The published rankings continued to display the ratio of actual to
expected deaths) Then the scores for reputation mortality and structure were standardized or
adjusted so that the degree ofvariability in each measure was the same
A difficulty with this approach was that inverting caused very low mortality ratios to
distort the outcome (Inverted a mortality ratio of 025 produces a score of 4 a ratio of 005
produces a score of 20 and a ratio of 001 produces a score of 100) If instead of being divided
into 1 the mortality ratio is subtracted from I-this could be called reverse scoring-such extremes r
are eliminated Using reverse scoring a mortality ratio of 025 produces a score of 075 a ratio
of 005 produces a score of 095 and a ratio of 001 produces a mortality score of 99 This
maintains the magnitudes of the differences and avoids extreme values Accordingly the new
rankingsreflect reverse scoring in mortality To dampen the effect of year-to-year fluctuations
mortality scores will be averaged over three years
Finally scores at the extremes in mortality and in certain structural measures were
trimmed to eliminate the influence ofvery wide variation Figure 6 gives the percentile at which
each of the mortality distributions was trimmed
Lj Figure 6 Percentile at Which Each Mortality Distribution Was Trimmed
Specialty
Cancer
Digestive disorders
Ear nose and throat
Geriatrics
Gynecology
Heart
Hormonal disorders l ~
Percentile
95
99
95
99
99
95
95
Specialty Percentile
Kidney disease 99
Neurology and neurosurgery 99
Orthopedics 95
Respiratory disorders 99
Rheumatology 99
Urology 90
20
l
A second round of standardizing also was added in 2000 after trimming extremes
Previously this second standardization was not perfonned resulting in trimmed measures having
less influence on the final score than other measures did Restandardizing restores the balance so
that trimmed and untrimmed measures have the same influence
Phase-in The changes described affect the final scores so they are phased in over two
years For 2000 each hospitalts final score averaged pre-2000 and current methodologies As
before the top hospital in each specialty received a score of 100 with other hospitals scaled
down from that figure
In 2001 the phase-in is complete with the 2001 mortality ratios fully reflecting the
revised methodology
J
--
21
E Calculation of the Index
i
The calculation of the IRQ for each hospital (other than in specialties ranked solely on
reputation) considers equally the three dimensions of quality of care structure process and
outcome Although all three measures represent a specific aspect of quality a single score not
only provides an easier-to-use result but yields a more accurate portrayal of overall quality than
would the three aspects individually
Therefore in computing the final scores for a particular specialty the reputational score
mortality scores and the collective set of structural indicators receive arithmetically equivalent
importance
The total fonnula for calculation of the specialty-specific IHQs is
where
IHQi = Index for Hospital Quality for specialty i
Sl-n = Structural indicators (STRUCTURE)
F = Factor loading
P = Nomination score (PROCESS)
M = Standardized mortality ratio (OUTCOME)
The general fonnula for deriving the index scores for tertiary-level hospitals is the same
as it began in 1993 Each of the three components--structure process and outcomes--is
considered equally in determining the final overall score For presentation purposes we
standardized raw scores then equated the raw IRQ scores as computed above to a 100-point
scale where the top hospital in each specialty received a score of 100
The mean and standard deviation of each of the 17 specialties are listed in Figure 7
Note that for the four reputation-only rankings mean and standard deviation of the reputational
score are presented This data further illustrates that the spread of IRQ scores produces a very
small number of hospitals two and three standard deviations above the mean Horizontal lines
in each of the 17 specialty lists in Appendices F and G indicate the cutoff points of two and
three standard deviations above the mean
22
We could not calculate scores for hospitals that provide care in eyes pediatrics
psychiatry or rehabilitation because data for robust and meaningful structural and outcomes
measures are not available for these specialties Thus as shown in Appendix G we rank
hospitals in these specialties solely by reputation Although the four reputation-only specialties
are ranked without the Index of Hospital Quality standard deviations of the reputational scores
are still useful in identifying truly superior hospitals (in terms of statistically relevant nomination
scores)
Figure 7 Mean and Standard Deviations ofIHQ and Reputational Scores
Mean Standard deviation 1 SD above Z SDs above 3 SDs above the mean the mean the mean
~- IHQScore
Cancer 2390 652 3042 3694 4346
Digestive disorders 1514 538 2052 2590 3128
Ear nose and throat 2064 647 2711 3358 4005
Geriatrics 2049 588 2637 3225 3813 Gynecology 1857 598 2455 3053 3651
Heart 2079 674 2753 3427 4101 Hormonal disorders 2545 574 3119 3693 4267 Kidney disease 2600 758 3358 4116 4874
Neurology and 1781 562 2343 2905 3467 neurosurgery Orthopedicsmiddot 1960 539 2499 3038 3577I Respiratory disorders 1665 569 I 2234 2805 3372 Rheumatology 3768 454 4222 4676 5130 Urology 1930 502 2432 2934 3436
Reputational Score
lEyes 455 1272 1727 2999 4271 [pediatrics 299 659 958 1617 2276 psychiatry 252 524 776 1300 1824 Rehabilitation 287 777 1064 1841 2618
23
III Directions for Future Releases
The US News Index has since its inception used the most rigorous methodology
available to define measure and combine the components of quality incorporated in its
construction Over the next few years we plan to subject each of the components (process
outcome and structure) to a searching re-examination We are aware that the skewed
distribution of the reputation scores can appear to give an inappropriate advantage to hospitals
that obtain a high percentage ofnominations and we will continue to examine the way in which
the reputation scores are used to define the process score We intend to test and evaluate
different transformations of the raw scores to see whether a transformation would produce a
bull i superior measure With regard to outcome the refinement of definitions of non-fatal outcomesshy
particularly in some specialties-suggests incorporating some of these measures into outcome
scores We will continue to refine and develop our measures of technology for the structural
component Finally we will re-examine the way in which the three components are combined
into the IHQ There may be ways to maintain the principle of equal weight for the three
components while improving the method ofcombining them
We will also examine the possibility of extending the evaluation of the four specialties
that are currently ranked only on reputation to incorporate appropriate structure and outcome
measures
As in years past we welcome input from users of the index in charting new directions
Readers and users are encouraged to contact the authors with suggestions and questions
j bull
24
l
lmiddot
References 1 Donabedian A Evaluating the quality of medical care The Milbank Memorial Fund Quarterly
1966 44166-203
2 Donabedian A Promoting quality through evaluating the process of patient care Med Care 1968 6181
3 Hill CA Winfrey KL Rudolph BA Best Hospitals A description of the methodology for the index ofhospital quality Inquiry 1997 34(1)80-90
4 American Hospital Association 1996 Annual Survey of Hospitals Data Base Documentation Manual
5 Ehrlich RH Hill CA Winfrey KL 1997 Survey oBest Hospitals Chicago NORC 1997
6 Hill CA Winfrey KL1995 Survey on Best Hospitals Chicago NORC 1995
7 Palella FJ Jr Delaney KM Moorman AC Loveless MO Fuhrer J Satten GA Aschman DJ Holmberg SD Declining Morbidity and Mortality Among Patients With Advanced Human Immunodeficiency Virus Infection N Engl J Med 1998 338853-860
8 United States Department of Health and Human Services Medicare hospital mortality information HCFA publication 01-002 Report prepared by Otis R Bowen and William L Roper Washington DCUSGPO 1987
9 Blumberg MS Comments on HCFA hospital death rate statistical outliers HSR Health Services Research 1987 21715-40
10 Dubois RW Brook RH Rogers WH Adjusted hospital death rates a potential screen or the quality ofmedical care MPH 1987 771162-6
11 Gillis KD Hixson JS Efficacy of statistical outlier analysis for monitoring quality of care Journal oBusiness and Economic Statistics 1991 9241-52
12 Green J Wintfield N Sharkey P Passman LJ The importance of severity of illness in assessing hospital mortality JAMA 1990 263241-6
13 Green J Passman LJ Wintfield N Analyzing hospital mortality the consequences ofdiversity in patient mix JAMA 1991 2651849-53
14 Greenfield S Aronow HU ElashoffRM Watanabe D Flaws in mortality data the hazards of ignoring comorbid disease JAMA 1988 2602253-7
15 Rosen HM Green BA The HCFA excess mortality lists a methodological critique Hospital and Health Services Administration 1987 2119-24
16 Flood AB Scott WR Conceptual and methodological issues in measuring the quality of care in hospitals In Hospital structure and performance Baltimore Johns Hopkins University Press 1987
17 Iezzoni LI Ash AS Coffinan GA Moskowitz MA Predicting in-hospital mortality a comparison of severity measurement approaches Med Care 1992 30347-59
25
Appendix A
Technology Indices by Specialty t
1
All Hospital Index
17 elements (used to define eligible hospitals)
r
Cancer
7 Elements
AnRioplasty Cardiac Catheterization Lab
Cardiac Intensive Care Beds
Computed Tomography Scanner
Diagnostic Radioisotope Facility
Diagnostic Mammography Services
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
MedicaVSurgical Intensive Care
Neonatal Intensive Care Beds
Open Heart Surgery
Pediatric Intensive Care Beds
Positron Emission Tomography Scanner
ReprQductive Health
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraphy Scanner Magnetic Resonance Imaging
Oncology Services
Pediatric Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
I Digestive disorders
8 Elements Computed Tomography Scanner Diagnostic Radioisotope Facility
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound i
X-ray Radiation Therapy
Ear Nose and Throat
5 Elements Comouted Tomorrraohv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
Heart
9 Elements Angioplasty Cardiac Catheterization Lab
Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Open Heart Surgery
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
j
Hormonal disorders
7 Elements
Geriatrics
8 Elements
Gynecology
8 Elements
Computed TomoRraphv Scanner Diagnostic Radioisotope Facility
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Cardiac Catheterization Lab Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraDhv Scanner Diagnostic Mammography Services
Magnetic Resonance Imaging
Neonatal Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Kidney disease
5 Elements
Neurology and f Neurosurgery t j
7 Elements
t
l
Orthopedics
5 Elements I t
Respiratory disorders 4 Elements
Extracorporeal Shock Wave Lithiotripter Ultrasound
Computed Tomography Scanner
Diagnostic Radioisotope FacUity
Transplant Services
Computed Tomography Scanner Diagnostic Radioisotope FacUity
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed Tomolraphv Scanner Magnetic Resonance Imaging
Positron Emissions Tomography Scanner
Single Photon Emissions Computed Tomography
Ultrasound
Computed Tomographv Scanner Diagnostic Radioisotope FacUity
Radiation Therapy
Ultrasound
Rheumatology
5 Elements Computed TomoJraphv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
Urology
8 Elements Extracorporeal Shock Wave Lithiotripter X-ray Radiation Therapy
Computed Tomography Scanner
Diagnostic Radioisotope Facility
i Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
(
i
AppendixB
Structural Variable Map
f
L
r
t bull
r
tJ
L
The following variables used to construct structural elements of the 2001 IHQ were taken from the 1999 Annual Survey of Hospitals Data Base published by the American Hospital Association
ALL HOSP~TAL ~NDBX - used to define hospital eligibility 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ~GIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICBDHOS=l half point if CICBDSYS CICBDNET or CICBDVEN=l 1 point if CTS CNHOS=1 half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if MSICHOS=l half point if MSICSYS MSICNET or MSICVEN=l 1 point if NICBDHOS=l half point if NICBDSYS NICBDNET or NICBDVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PEDBDHOS=l half point if PEDBDSYS PEDBDNET or PEDBDVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if REPROHOS=l half point if REPROSYS REPRONET or REPROVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Cancer Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if ONCOLHOS=l half point if ONCOLSYS ONCOLNET or ONCOLVEN=l 1 point if PEDICHOS=l half point if PEDICSYS PEDICNET or PEDICVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
Digestive Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Ear I Nose and Throat Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRIVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
1
Heart Technology Index 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ANGIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNETor CICVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Hormonal Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRlHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Geriatrics Technology Index 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNET or ClCVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETROS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Gynecology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if NICHOS=l half point if NICSYS NICNET or NlCVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Kidney Disease Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=lhalf point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if TPLNTHOS=l half point if TPLNTSYS TPLNTNET or TPLNTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Neurology and Neurosurgery Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Orthopedics TeChn610gy ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Respiratory Disorders Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Rheumatology Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Urology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
r
I
Discharge Planning COTH ] point if CMNGTHOS=] Yes if MAPP8=1 ] point if PATEDHOS=] 1 point if PATRPHOS=l RN I s to Beds
Full-time Registered Nurses Geriatric Services (FTRNTF) divided by Total Hospital 1 point if ADULTHOS=l Beds (HOSPBD) ] point if ARTHCHOS=l 1 point if ASSTLHOS=l Trauma ] point if GERSVHOS=l Yes if TRAUML90=] or 2 and 1 point if MEALSHOS=l TRAUMHOS=l 1 point if PATRPHOS=l 1 point if TPORTHOS=l
Gynecology Services 1 point if BROOMHOS=l 1 point if OBLEV=2 or 3 and OBHOS=] 1 point if REPROHOS=l
l ~
1 point if WOMHCHOS=l r ~
Service Mix ] point if ALCHHOS=l ] point if COUTRHOS=l 1 point if HOMEHHOS=l ] point if HOSPCHOS=l ] point if PSYEDHOS=] 1 point if PSYLSHOS=] 1 point if REPROHOS=l ] point if SOCWKHOS=] ] point if WOMHCHOS=]
l
i
1
[ l
AppendixC
Diagnosis-Related Group (DRG) Groupings l by Specialty
r 1
DRG10 DRGll DRG64 DRG82 DRGl72 DRG173 DRG199 DRG203 DRG239
DRG257 DRG258 DRG259 DRG260 DRG274
r 1 DRG275 DRG338 DRG344 DRG346 DRG347 DRG354 DRG355 DRG357 DRG366 DRG367 DRG400 DRG401 DRG402 DRG403 DRG404 DRG405 DRG409 DRG410 DRG411 DRG412 DRG413 DRG414
r 1 DRG473 DRG492
1
U
I 1
LJ
Cancer
NERVOUS SYSTEM NEOPLASMS W CC NERVOUS SYSTEM NEOPLASMS WIO CC EAR NOSE MOUTH amp TIIROAT MALIGNANCY RESPIRATORY NEOPLASMS DIGESTIVE MALIGNANCY W CC DIGESTIVE MALIGNANCY WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS PAlHOLOGICAL FRACTURES amp MUSCULOSKELETAL amp CONN TISS MALIGNANCY TOTAL MASTECTOMY FOR MALIGNANCY W CC TOTAL MASTECTOMY FOR MALIGNANCY WIO CC SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC SUBTOTAL MASTECTOMY FOR MALIGNANCY WIO CC MALIGNANT BREAST DISORDERS W CC MALIGNANT BREAST DISORDERS WIO CC TESTES PROCEDURES FOR MALIGNANCY OTHER MALE REPRODUCTIVE SYSTEM OR PROCEDURES FOR MALIGNANCY MALIGNANCY MALE REPRODUCTIVE SYSTEM W CC MALIGNANCY MALE REPRODUCTIVE SYSTEM WIO CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG W CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG WIO CC UTERINE amp ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY MALIGNANCY FEMALE REPRODUCTIVE SYSTEM W CC_ MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WIO CC LYMPHOMA amp LEUKEMIA W MAJOR OR PROCEDURE LYMPHOMA amp NONmiddotACUTE LEUKEMIA W OTHER OR PROC W CC LYMPHOMA amp NON-ACUTE LEUKEMIA W OTHER OR PROC WIO CC LYMPHOMA amp NON-ACUTE LEUKEMIA W CC LYMPHOMA amp NON-ACUTE LEUKEMIA WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGE 0-17 RADIOlHERAPY CHEMOTHERAPY WIO ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS HISTORY OF MALIGNANCY WIO ENDOSCOPY HISTORY OF MALIGNANCY W ENDOSCOPY OlHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGEgt17 CHEMOTHERAPY W ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS
DRG146 DRG147 DRG148 DRG149 DRG150 DRG151 DRG152 DRG153 DRG154 DRG155 DRG156 DRG170
l i DRG171 DRG174 DRG175
L DRG176 DRG177 DRG178 DRG179 DRG180 DRG181 DRG182 DRG183 DRG184 DRG188
l DRG189 DRG190 DRG191
i J DRG192 DRG193 DRG194 DRG195 DRG196 DRG197
t
LeJ DRG198 DRG200 DRG201 DRG202 DRG204 DRG205 DRG206 DRG207 DRG208 DRG493 DRG494
Digestive Disorders
RECTAL RESECTION W CC RECTAL RESECTION WIO CC MAJOR SMALL amp LARGE BOWEL PROCEDURES W CC MAJOR SMALL amp LARGE BOWEL PROCEDURES WIO CC PERITONEAL ADHESIOLYSIS W CC PERITONEAL ADHESIOLYSIS WIO CC MINOR SMALL amp LARGE BOWEL PROCEDURES W CC MINOR SMALL amp LARGE BOWEL PROCEDURES WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE gt17 W CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGEgt17 WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE 0-17 OTHER DIGESTIVE SYSTEM OR PROCEDURES W CC OTHER DIGESTIVE SYSTEM OR PROCEDURES WO CC G HEMORRHAGE W CC GJ HEMORRHAGE WIO CC COMPLICATED PEPTIC ULCER UNCOMPLICATED PEPTIC ULCER W CC UNCOMPLICATED PEPTIC ULCER WIO CC INFLAMMATORY BOWEL DISEASE GI OBSTRUCTION W CC GI OBSTRUCTIONWO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 W CC ESOPHAGmS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 WIO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGE 0-17 OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 W CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 WIO CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0-17 PANCREAS LIVER amp SHUNT PROCEDURES W CC PANCREAS LIVER amp SHUNT PROCEDURES W 10 CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE W CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE WIO CC CHOLECYSTECTOMY W CDE W CC CHOLECYSTECTOMY W CDE WIO CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE W CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY OTHER HEPATOBILIARY OR PANCREAS OR PROCEDURES CIRRHOSIS amp ALCOHOLIC HEPATITIS DISORDERS OF PANCREAS EXCEPT MALIGNANCY DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEP A W CC DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEPA WIO CC DISORDERS OF THE BILIARY TRACT W CC DISORDERS OF THE BILIARY TRACT WO CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE W CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE WO CC
DRG49 DRG50 DRG51 DRG55 DRG57 DRG58 DRG61 DRG62 DRG63 DRG65 DRG66 DRG67
DRG68
DRG69 DRG70 DRG71 DRG72 DRG73 DRG74
DRG353 DRG356 DRG358 DRG359 DRG360 DRG361 DRG362 DRG363 DRG364 DRG365 DRG368 DRG369
Ear Nose and Throat
MAJOR HEAD amp NECK PROCEDURES SIALOADENECTOMY SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY MISCELLANEOUS EAR NOSE MOUTH amp TIiROAT PROCEDURES TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGEgt17 TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGE 0-17 MYRINGOTOMY W TUBE INSERTION AGE gt17 MYRINGOTOMY W TUBE INSERTION AGE 0-17 OTHER EAR NOSE MOUTH amp TIiROAT OR PROCEDURES DYSEQUILIBRIUM EPISTAXIS EPIGLOTTITIS
OTITIS MEDIA amp URI AGEgt17 W CC OTITIS MEDIA amp URI AGEgt17 WIO CC OTITIS MEDIA amp URI AGE 0-17 LARYNGOTRACHEITIS NASAL TRAUMA amp DEFORMITY OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE gt17 OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE 0-17
Geriatrics ALL CASES
Gynecology
PELVIC EVISCERATION RADICAL HYSTERECTOMY amp RADICAL VULVECTOMY FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY W CC UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY WIO CC VAGINA CERVIX amp VULVA PROCEDURES LAP AROSCOPY amp INCISIONAL TUBAL INTERRUPTION ENDOSCOPIC TUBAL INTERRUPTION DampC CONIZATION amp RADIO-IMPLANT FOR MALIGNANCY DampC CONIZATION EXCEPT FOR MALIGNANCY OrnER FEMALE REPRODUCTIVE SYSTEM OR PROCEDURES INFECTIONS FEMALE REPRODUCTIVE SYSTEM MENSTRUAL amp OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
DRG103 DRGl04 DRG105 DRG106 DRG107 DRG108 DRG109
DRG1l0 DRG1l1 DRG112 DRG115 DRG1l6 DRG117 DRG118 DRG121 DRG122 DRG123 DRG124 DRG125 DRG126 DRG127 DRG128 DRG129 DRG130 DRG131 DRG132 DRG133 DRG135 DRG136 DRG137 DRG138 DRG139 DRG140 DRG141middot DRG142 DRG 144 DRG145
r i
f ~
Heart
HEART TRANSPLANT CARDIAC VALVE PROCEDURES W CARDIAC CATH CARDIAC VALVE PROCEDURES WIO CARDIAC CATH CORONARY BYPASS W CARDIAC CATH CORONARY BYPASS WIO CARDIAC CATH OTHER CARDIOTHORACIC PROCEDURES CORONARY BYPASS WIO CARDIAC CATH
MAJOR CARDIOVASCULAR PROCEDURES W CC MAJOR CARDIOVASCULAR PROCEDURES WIO CC PERCUTANEOUS CARDIOVASCULAR PROCEDURES PERM CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK OTH PERM CARDIAC PACEMAKER IMPLANT OR AICD LEAD OR GENERATOR PRO
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT CARDIAC PACEMAKER DEVICE REPLACEMENT CIRCULATORY DISORDERS W AMI amp CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI WIO CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI EXPIRED CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH AND CMPLX DIAG CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH WIO CMPLX DIAG ACUTE amp SUBACUTE ENDOCARDmS HEART FAILURE amp SHOCK DEEP VEIN THROMBOPHLEBITIS CARDIAC ARREST UNEXPLAINED PERIPHERAL VASCULAR DISORDERS W CC PERIPHERAL VASCULAR DISORDERS WIO CC ATHEROSCLEROSIS W CC ATHEROSCLEROSIS WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 W CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGE 0-17 CARDIAC ARRHYTIIMIA amp CONDUCTION DISORDERS W CC CARDIAC ARRHYTHMIA amp CONDUCTION DISORDERS WIO CC ANGINA PECTORIS SYNCOPE amp COLLAPSE W CC SYNCOPE amp COLLAPSE WIO CC OTHER CIRCULATORY SYSTEM DIAGNOSES W CC OTHER CIRCULATORY SYSTEM DIAGNOSES WIO CC
1
DRG286 DRG287 DRG288 DRG289 DRG290 DRG292 DRG293 DRG294 DRG295 DRG296 DRG297
t DRG298 DRG299
DRG300 DRG301
~- --j
DRG316 DRG317 DRG320 DRG321 DRG322 DRG325 DRG326 DRG327 DRG 331 DRG332 DRG333
f
Hormonal Disorders
ADRENAL amp PITUITARY PROCEDURES SKIN GRAFTS amp WOUND DEBRID FOR ENDOC NUTRlT amp METAB DISORDERS OR PROCEDURES FOR OBESITY P ARA1HYROID PROCEDURES 1HYROIDPROCEDURES OrnER ENDOCRINE NUTRIT amp METAB OR PROC W CC 01HER ENDOCRINE NUTRIT amp METAB OR PROC WIO CC DIABETES AGE gt35 DIABETES AGE 0-35 NUTRlTIONAL amp MISC METABOLIC DISORDERS AGEgt17 W CC NUTRITIONAL amp MISC METABOLIC DISORDERS AGE gt17 WIO CC NUTRlTIONAL amp MISC METABOLIC DISORDERS AGE 0-17 INBORN ERRORS OF METABOLISM ENDOCRINE DISORDERS W CC ENDOCRINE DISORDERS WIO CC
Kidney Disease
RENAL FAILURE ADMIT FOR RENAL DISEASE KIDNEY amp URINARY TRACT INFECTIONS AGE gt17 W CC KIDNEY amp URINARY TRACT INFECTIONS AGEgt17 WIO CC KIDNEY amp URINARY TRACT INFECTIONS AGE 0-17 KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 W CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 WIO CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMS AGE 0-17 01HERKIDNEY amp URINARY TRACT DIAGNOSES AGE gt17 W CC 01HER KIDNEY amp URINARY TRACT DIAGNOSESgt 17 WIO CC 01HER KIDNEY amp URINARY TRACT DIAGNOSES AGE 0-17
Neurology and Neurosurgery
DRGl CRANIOTOMY AGE gt17 EXCEPT FOR TRAUMA DRG2 CRANIOTOMY FOR TRAUMA AGEgt17 DRG3 CRANIOTOMY AGE 0-17 DRG4 SPINAL PROCEDURES DRG5 EXTRACRANIAL VASCULAR PROCEDURES DRG6 CARPAL TUNNEL RELEASE DRG7 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC W CC DRG8 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC WIO CC DRG9 SPINAL DISORDERS amp INJURIES DRG12 DEGENERATIVE NERVOUS SYSTEM DISORDERS
j DRG13 MULTIPLE SCLEROSIS amp CEREBELLAR ATAXIA DRG14 SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA DRG15 TRANSIENT ISCHEMIC ArrACK amp PRECEREBRAL OCCLUSIONS DRG16 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC DRG17 NONSPECIFIC CEREBROVASCULAR DISORDERS WIO CC DRG18 CRANIAL amp PERIPHERAL NERVE DISORDERS W CC DRG19 CRANIAL amp PERIPHERAL NERVE DISORDERS WIO CC DRG20 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGmS DRG21 VIRAL MENlNGITIS DRG22 HYPERTENSIVE ENCEPHALOPATHY DRG23 NONTRAUMATICSTUPORampCOMA DRG24 SEIZURE amp HEADACHE AGEgt17 W CC DRG25 SEIZURE amp HEADACHE AGEgt17 WIO CC DRG26 SEIZURE amp HEADACHE AGE 0-17 DRG27 TRAUMATIC STUPOR amp COMA COMA gt1 HR DRG28 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGEgt17 W CC DRG29 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE gt17 WIO CC
imiddot DRG30 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE 0-17 DRG31 CONCUSSION AGEgt17 W CC DRG32 CONCUSSION AGEgt17 WIO CC DRG33 CONCUSSION AGE 0-17 DRG34 OTHER DISORDERS OF NERVOUS SYSTEM W CC DRG35 OTHER DISORDERS OF NERVOUS SYSTEM WIO CC
(
DRG209 DRG210 DRG211 DRG212 DRG213 DRG216 DRG217 DRG218 DRG219 DRG220 DRG221 DRG222 DRG223 DRG224 DRG225 DRG226 DRG227 DRG228 DRG229 DRG230 DRG231 DRG232 DRG233 DRG234 DRG235
j DRG236 DRG237 DRG238 DRG240 DRG241 DRG471 DRG485
DRG491 DRG496 DRG497 DRG498
f DRG501 DRG502 DRG503
Orthopedics
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 W CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 WIO CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0-17 AMPUTATION FOR MUSCULOSKELETAL SYSTEM amp CONN TISSUE DISORDERS BIOPSIES OF MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE WND DEBRID amp SKN GRFT EXCEPT HANDFOR MUSCSKELET amp CONN TISS DIS LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 W CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 WIO CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGE 0-17 KNEE PROCEDURES W CC KNEE PROCEDURES WO CC MAJOR SHOULDERIELBOW PROC OR OTHER UPPER EXTREMITY PROC W CC SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC WIO CC FOOT PROCEDURES SOFT TISSUE PROCEDURES W CC SOFT TISSUE PROCEDURES WIO CC MAJOR THUMB OR JOINT PROCOR OTH HAND OR WRIST PROC W CC HAND OR WRIST PROC EXCEPT MAJOR JOINT PROC WIO CC LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES OF HIP amp FEMUR LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES EXCEPT HIP amp FEMUR ARTHROSCOPY OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC W CC OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC WIO CC FRACTURES OF FEMUR FRACTURES OF HIP amp PELVIS SPRAINS STRAINS amp DISLOCATIONS OF HIP PELVIS amp THIGH OSTEOMYELmS CONNECTIVE TISSUE DISORDERS W CC CONNECTIVE TISSUE DISORDERS WIO CC BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY LIMB REATTACHMENT HIP AND FEMUR PROC FOR MULT SIGNIFICANT
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY COMBINED ANTERIORIPOSTERIOR SPINAL FUSION SPINAL FUSION WI CC SPINAL FUSION WIO CC KNEE PROC WI PDX OF INFECTION WI CC KNEE PROC WI PDX OF INFECTION WOCC KNEE PROC WOPDX OF INFECTION WI CC
~ t L ~
l
DRG76 DRG77 DRG78 DRG79 DRG80 DRG81 DRG85 DRG86 DRG87 DRG88 DRG89 DRG90 DRG91 DRG92 DRG93 DRG94 DRG95 DRG96 DRG97 DRG98 DRG99 DRG100 DRG101 DRG102 DRG475
DRG242 DRG244 DRG245 DRG246 DRG247 DRG256
i_J
Respiratory Disorders
OTHER RESP SYSTEM OR PROCEDURES W CC OTHER RESP SYSTEM OR PROCEDURES WO CC PULMONARYEMBOUSM RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 W CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 WO CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGE 0-17 PLEURAL EFFUSION W CC PLEURAL EFFUSION WO CC PULMONARY EDEMA amp RESPIRATORY F AlLURE CHRONIC OBSTRUCTIVE PULMONARY DISEASE SIMPLE PNEUMONIA amp PLEURISY AGEgt17 W CC SIMPLE PNEUMONIA amp PLEURISY AGEgt17 WO CC SIMPLE PNEUMONIA amp PLEURISY AGE 0-17 INTERSTITIAL LUNG DISEASE W CC INTERSTITIAL LUNG DISEASE W 10 CC PNEUMOTIIORAX W CC PNEUMOTIIORAX WO CC BRONCHmS amp ASTIIMA AGEgt17 W CC BRONCHmS amp ASTIIMA AGEgt17 WO CC BRONCIDTIS amp ASTIIMA AGE 0-17 RESPIRATORY SIGNS amp SYMPTOMS W CC RESPIRATORY SIGNS amp SYMPTOMS WO CC OTHER RESPIRATORY SYSTEM DIAGNOSES W CC OTHER RESPIRATORY SYSTEM DIAGNOSES WO CC RESPIRATORY SYSTEM DIAGNOSIS WITII VENTILATOR SUPPORT
Rheumatology
SEPTIC ARTHRITIS BONE DISEASES amp SPECIFIC ARTHROPATIIIES W CC BONE DISEASES amp SPECIFIC ARTHROPATIDES WO CC NON-SPECIFIC ARTHROPATHIES SIGNS amp SYMPTOMS OF MUSCULOSKELETAL SYSTEM amp CONN TISSUE OTIIER MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE DIAGNOSES
DRG302 DRG303 DRG304 DRG305 DRG306 DRG307 DRG308 DRG309 DRG31O DRG311 DRG312 DRG313 DRG314
DRG315 DRG323 DRG324 DRG328 DRG329 DRG330 DRG334 DRG335 DRG336 DRG337 DRG339 DRG340 DRG341 DRG342 DRG343 DRG348 DRG349 DRG350 DRG351 DRG352
Urology
KIDNEY TRANSPLANT KIDNEYURETER amp MAJOR BLADDER PROCEDURES FOR NEOPLASM KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL W CC KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL WIO CC PROSTATECTOMY W CC PROSTATECTOMY WIO CC MINOR BLADDER PROCEDURES W CC MINOR BLADDER PROCEDURES WIO CC TRANSURETHRAL PROCEDURES W CC TRANSURETHRAL PROCEDURES WIO CC URETHRAL PROCEDURES AGE gt17 W CC URETHRAL PROCEDURES AGEgt17 WIO CC URETHRAL PROCEDURES AGE 0-17 OTHER KIDNEY amp URINARY TRACT OR PROCEDURES URINARY STONES W CC amplOR ESW LTIHOTRIPSY URINARY STONES WIO CC URETHRAL STRICTURE AGEgt17 W CC URETHRAL STRICTURE AGE gt17 WIO CC URETHRAL STRICTURE AGE 0-17 MAJOR MALE PELVIC PROCEDURES W CC MAJOR MALE PELVIC PROCEDURES WIO CC TRANSURETHRAL PROSTATECTOMY W CC TRANSURETHRAL PROSTATECTOMY WIO CC TESTES PROCEDURES NON-MALIGNANCY AGEgt17 TESTES PROCEDURES NON-MALIGNANCY AGE 0-17 PENIS PROCEDURES CIRCUMCISION AGEgt17 CIRCUMCISION AGE 0-17 BENIGN PROSTATIC HYPERTROPHY W CC BENIGN PROSTATIC HYPERTROPHY WIO CC INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM STERILIZATION MALE OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES
AppendixD
f 2001 Sample Physician Questionnaire
( Americas Best Hospitals)
This survey of physicians judgments provides the
basis for the reputation component of the annual
ranking of hospitals for U S News amp World Report
c
Conducted by the National Opinion Research Center at the University of Ctlicago 1155 East 60th Street Chicago IL 60637
( THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with rehabilitation regardless of location or expense (weve provided space for both hospital andlor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
l L Answers to these questions will help Have your patients been helped ormiddot
us to understand the impact of the hindered by the information they have Internet on medica practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions
D Neith~imiddoto Yes
D BothONo D Does notapply
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
D Helped
D Hindered
D Neither
D Both
D I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D A day or two a week
l D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical L company web sites
DYes D No
D Does not apply
Do you ever access medical association web sites
DYes D No
ri D Does not apply L
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet isbullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes D No
Do you allow your patients to communicate with you via electronic mail
DYes o No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes D No
D Does not apply
Thank you again for your participation
r I
l~
National Opinion Research Center at the University of Chicago 1155 East 60th Street Chicago IL 60637
Jbullbullbull
(12th Annual Survey of PhysiciansJ Direct input from physicians is
crucial in evaluating hospital quality_ f
Conducted by the National Opinion Research Center at the University of Chicago 1155 East 60th Street Chica9o IL 60637
l J
(THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with cancer regardless of location or expense (weve provided space for both hospital andor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
Answers to these questions will help Have your patients been helped or us to understand the Impact of the hindered by the information they have Internet on medical practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions o NeitherOmiddotYes o BothD No o Does not apply
-Continued
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
HelpedD HinderedD NeitherD BothD
0 I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D Aday or two a week
D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical company web sites
DYes
D No
D Does not apply
Do you ever access medical association web sites
DYes
D No
D Does not apply
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet is bullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes
D No
Do you allow your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Thank you again for your participation
r
r
1 National Opinion Research Center at th~ University of Chicagobull 0 __ bull bull
1155 East 60th Street Chicago IL 60637
AppendixE
Predicted Mortality APR-DRG Methodology
r
shyi
Introduction to DRGs
The All Patient Refined Diagnosis Related Groups (APR-DRGs) were developed by 3M Health
Information Systems (3M-HIS) in conjunction with the National Association of Childrens Hospitals and
Related Institutions (NACHRI) APR-DRGs expand the basic diagnosis-related group (DRG) structure to
address patient severity of illness risk ofmorta1ity and resource intensity The APR-DRG Version 140
uses the Health Care Financing Administration (HCFA) Version 140 DRG methodology Because APRshy
DRGs are based on DRGs and All Patient DRGs (AP-DRGs) a brief explanation of both structures will
be useful
Current HCFA DRG Structure
Created from Adjacent Diagnosis Related Groups (ADGs) which combine patients into groups
with common characteristics DRGs were developed by Yale University in the 1970s to relate a
hospitals case mix index to the resource demands and associated costs experienced by the hospital
ADGs were created by subdividing an MDC1 into two groups based on the presence or absence of
an operating room procedure Surgical patients identified as those having an operating room procedure
were then classified by type ofprocedure to form surgical ADGs Patients with multiple procedures were
assigned to the highest surgical class Medical patients were divided into smaller groups based on their
principal diagnosis to form medical ADGs
DRGs use ADGs as a base and then further classify patients into selected disease and procedure
categories based on whether or not they have substantial comorbidities or complications (CC)
Approximately 3000 diagnosis codes have been designated by HCFA as substantial CCs (defined by a
list of additional diagnosis codes that a panel of physicians felt would increase the length of stay by at
least one day for 75 percent of the patients) This list covers a broad range of disease conditions and no
differentiation in severity or complexity level was made among the additional diagnoses The patients
age and discharge status were sometimes used in the definition ofDRGs
r
1 Major Diagnostic Categories (MDCs) are broad medical and surgical categories one step hierarchically higher than DRGs (several DRGs roll-up into an MDC) MDCs are divided by body systems such as nervous ear nose and throat and respiratory
Current AP-DRG Structure
In 1987 the New York State Department of Health entered into an agreement with 3M-HIS to
evaluate the applicability of DRGs to a non-Medicare population with a specific focus on neonates and
patients with Human Immunodeficiency Virus (HIV) infections The DRG definitions developed by this
relationship are referred to as the AP-DRGs
The AP-DRGs are modeled after the HCF A DRGs and attempt to improve the DRGs in an effort
to more accurately predict a hospitals resource demands and associated costs for all acute care patients
In the creation ofAP-DRGs the modifications made to the DRG structure can be summarized as follows
bull Except for neonates who die or are transferred within the first few days of life AP-DRGs define six ranges ofbirth weight that represent distinct demands on hospital resources Within each birth weight range neonates are then subdivided based on the presence of a significant operating room procedure and then further subdivided based on presence ofmultiple major minor or other problems
bull Assignment to neonatal MDC is based on age Specifically the AP-DRGs assign a patient to the neonatal MDC when the age of the patient is less than 29 days at admission regardless of the principal diagnosis
bull MDC 25 was created to account for the highly specialized treatment of multiple trauma patients Patients assigned to MDC 25 have at least two significant trauma diagnoses from different body sites
bull MDC 20 for alcohol and substance abuse was restructured to differentiate patients based on the substance being abused
bull Across all MDCs patient with a tracheostomy were put into either of two tracheostomy AP-DRGs tracheostomy performed for therapeutic reasons and tracheostomy representing long-term ventilation
bull All liver bone marrow heart kidney and lung transplant patients were assigned to an AP-DRG independent of the MDC ofthe principal diagnosis
bull For several MDCs a single major comorbidity and complication (CC) AP-DRG was formed across all surgical patients within an MDC and a single major CC AP-DRG was formed across all medical patients within an MDC
I I The AP-DRGs introduced changes to the HCF A DRGs in an attempt tomiddot depart from using the
LJ principal diagnosis as the initial variable for assignment The AP-DRGs were designed to more
accurately group patients into like groups that provide an operational means of defining and measuring a
hospitals case mix complexity
r
All Patient Refined DRGs
APR-DRG Objectives
The primary objective of the RCF A DRG and AP-DRG patient classification systems was to
relate the type ofpatients treated to the hospital resources they consumed This limited focus on resource
intensity does not allow providers to classify patients into other groups for meaningful analysis The
APR-DRG patient classification system goes beyond traditional resource intensity measures and was
designed with the ability to address the following needs
bull Compare hospitals across a wide range ofresource and outcome measures
bull Evaluate differences in inpatient mortality rates
bull Implement and support critical pathways
bull Identify continuous quality improvement initiatives
bull Support internal management and planning systems
bull Manage capitated payment arrangements
To meet these needs the APR-DRG system classifies patients according to severity of illness risk
of mortality and resource intensity Therefore in the APR-DRG classification system a patient is
assigned three distinct descriptors base APR-DRG severity of illness subclass and risk of mortality
subclass
Severity of illness can be defined as the extent of physiologic decompensation or organ system
loss of function experienced by the patient In contrast risk of mortality is defined as the patients
likelihood ofdying
For analyses such as evaluating resource intensity or patient care outcomes the base APR-DRGs
in conjunction with the severity of illness subclass is used For evaluating patient mortality the base
APR-DRGs in conjunction with the risk ofmortality subclass is used
Development of the APR-DRGs
The AP-DRGs were used as the base DRGs in the development of the APR-DRGs because they
were representative of the entire inpatient population and accounted for populations not included in DRGs
at the time of development Several consolidations additions and modifications were made to the APshy
DRGs to form the list of APR-DRGs used in the severity of illness and risk of mortality subclass
assignments
The following list summarizes the revisions made to the AP-DRGs in the creation ofthe APR-DRGs
bull All age CC and major CC splits were consolidated
bull Splits based on discharge status or death were consolidated
bull Definitions based on the presence or absence ofa complicated principal diagnosis were consolidated
bull Additional APR-DRGs were created for pediatric patients
bull APR-DRGs for newborns were completely restructured to create medical and surgical hierarchies within each birth weight range
bull Low volume APR-DRGs were consolidated into other related APR-DRGs
bull APR-DRGs that could be explained by the severity of illness subclasses were consolidated into one APR-DRG
bull Due to risk ofmortality subclasses several APR-DRGs were split to account for significant differences in mortality between patient groups
APR-DRG Severity oflllness Subclass Assignment
With the exception of neonatal patients after a patient has been given an APR-DRG code a
Severity of Illness Subclass is assigned based on the level of the secondary diagnoses presence of certain
non-OR procedures and the interaction among secondary diagnoses age APR-DRG and principal
diagnosis Neonatal patients have their own hierarchical method for determining severity of illness and
will be discussed later The four severity ofillness subclasses are
t l
~~~~~i~~ 1 Minor (Includes non CC)
2 Moderate
3 Major
i L 4 Extreme
The severity of illness subclass is used in conjunction with the patients base APR-DRG for
analysis such as evaluating resource intensity or patient care outcomes A patients severity of illness
subclass should not be used with their DRG because several DRGs may form one APR-DRG Therefore
since severity of illness subclasses correspond to the APR-DRG number and not the DRG it is important
to use the APR-DRG number to accurately interpret data
The process for assigning a patient a severity of illness subclass is a three phase process and is
summarized as follows
Phase
bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further analysis
bull Remaining secondary diagnoses are assigned one of four distinct Standard Severity of lllness Levels Figure 1 presents examples of secondary diagnoses in each severity ofillness leveL
Figure 1 Examples of Secondary Diagnoses by Severity of Illness Level
Minor Benign hypertension acute bronchitis lumbago
Moderate Chronic renal failure viral pneumonia diverticulitis
Major Diabetic ketoacidosis chronic heart failure acute cholecystitis
Extreme Septicemia acute myocardial infarction cerebral vascular accident
bull The Standard Severity of Illness Level is modified for some secondary diagnoses based on age APRshyDRG and presence of non-OR procedures Figure 2 displays an example of modifications to the standard severity ofillness level based on the APR-DRG
Bronchitis and asthma Minor
Chronic renal failure Moderate Diabetes Major LJ
Cardiomegaly Moderate Chronic heart failure Minor
Uncomplicated Minor Vaginal delivery Moderate LJ diabetes
f
f
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Severity of Illness Level is retained This prevents double counting clinically similar diagnoses
bull The Base Severity of Illness Subclass of the patient is set to the highest Standard Severity of lllness Level ofany of the secondary diagnoses
bull Patients with a Base Severity of Illness Subclass of major (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Standard Severity of Illness Level Figure 3 displays the requirements for keeping a severity of illness subclass ofmajor or extreme
Major
Extreme Two or more secondary diagnoses that are extreme or one secondary diagnosis that is extreme and at least two second dia oses that are maor
Phase III bull A minimum Severity of Illness Subclass is established based on the patients principal diagnosis This
accounts for patients assigned to codes that contain both the underlying disease and an associated manifestation of the disease (ie diabetes with hyperosmolar coma) but is only assigned to the APRshyDRG that accounts for the underlying disease
bull A minimum Severity of Illness Subclass is established based on combinations of principal diagnosis and age for specific APR-DRGs
bull A minimum Severity of Illness Subclass is established for some APR-DRGs with certain APR-DRG and non-OR procedure combinations as well as principal diagnosis and non-OR procedure combinations
bull A minimum Severity of Illness Subclass is established based on the presence of certain combinations ofsecondary diagnoses Figure 4 shows the combination of secondary diagnoses necessary to increase the severity of illness subclass to a minimum severity of illness level For example a type 1 combination would be a major bacterial infection with pleural effusion If a diagnosis from both of these categories is present plus at least one other secondary diagnosis that is at least a major severity of illness level then the minimum patient severity of illness subclass will be extreme
Figure 4 Minimum Severity of Illness Requirements
maor second dia osis 2 At least one additional Major
moderate secondary dia osis
3 Specified combinations of At least one additional Major a moderate and a minor moderate secondary cate 0 dia osis
4 Specified combinations of At least two additional Moderate r--1 Two minor cate ories minor second i Ii 5 Specified combinations of
Two moderate cate ories None Major
bull The final patient Severity of Illness Subclass is selected based on the maximum of the Phase II Base Patient Severity of Illness Subclass and the Phase III minimum Severity of Illness Subclass
Both medical and surgical patients are assigned a severity of illness level of 1-4 based on the
assignment process outlined previously
f
r-
I
l
r f
~
l
r 1
APR-DRG Risk of Mortality Subclass Assignment
Similar to the Severity ofIllness Subclass assignment the Risk ofMortality Subclass assignment
is based on the level ofthe secondary diagnoses and the interaction among secondary diagnoses age
APR-DRG and principal diagnosis In general the patients Risk ofMortality Level and Subclass will be
lower than the Severity ofIllness Level and Subclass respectively Neonatal patients have their own
hierarchical method for determining risk ofmortality and will be discussed later The four severity of
illness subclasses are
~~~~~~~G~~pound~) bull~~~~~~~~S~rs~~2bullbullmiddott~ 1 Minor (includes non CC)
2 Moderate
3 Major
4 Extreme
The risk ofmortality subclass is used in conjunction with the patients base APR-DRG for
evaluating patient mortality Like the severity of illness subclass a patients risk ofmortality subclass
should not be used with their DRG because several DRGs may form one APR-DRG Therefore since
risk ofmortality subclasses correspond to the APR-DRG number and not the DRG it is important to use
the APR-DRG number to accurately interpret data
The process for assigning a patient a risk ofmortality subclass is a three phase process and is
summarized as follows
Phase I bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further
analysis
bull Remaining secondary diagnoses are assigned one of four distinct Risk ofMortality Levels
bull The Risk ofMortality Level is modified for some secondary diagnosis based on the patients age and APR-DRG
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Risk ofMortality Level is retained This prevents double counting clinically-similar diagnoses
bull The Base Risk ofMortality Subclass of the patient is set to the highest Risk ofMortality Level ofany of the secondary diagnoses
bull Patients with a Base Risk ofMortality Subclass ofmajor (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Risk ofMortality Level
Phase III
bull A minimum Risk ofMortality Subclass is established based on the patients principal diagnosis This accounts for specific APR-DRGs that have a principal diagnosis indicative of a higher risk ofmortality relative to the other principal diagnoses in the APR-DRG r
i
l ~ bull A minimum Risk ofMortality Subclass is established based on the presence ofcertain combinations of secondary diagnoses
bull The final patient Risk ofMortality Subclass is selected based on the maximum ofthe Phase II Base l
Risk ofMortality Subclass and the Phase III minimum Risk ofMortality Subclass
J
r
AppendixF
f Index of Hospital Quality (lHQ) Scores by Specialty
i
i L
F-~
f laquo
2001
C
ance
r B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
con
sc
ore
R
N s
R
ank
Ho
spit
al
10
0
sco
re
rate
M
embe
r (o
f 7
) D
isch
arg
es
to b
eds
Mem
oria
l S
loan
-Ket
teri
ng
can
cer
Cen
ter
N
ew Y
ork
10
00
7
18
0
93
Y
es
60
51
67
21
2
2 U
niv
ersi
ty 0
1 T
exas
M
D
A
nder
son
Cen
cer
Cen
ter
H
oust
on
98
2
68
5
07
7
Yes
5
0
5103
2
68
3
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
78
3
59
0
69
Y
es
70
15
78
14
2
4 D
ana-
farb
er C
ance
r In
stit
ute
B
osto
n 6
37
3
88
0
81
No
60
21
8 2
27
5
May
o C
lin
ic
Ro
ches
ter
M
inn
5
81
2
50
0
60
Y
es
70
37
11
13
1
(+3
SO)
6 UC
LA M
edic
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ente
r
los
Ang
eles
41
0
79
0
56
Y
es
70
12
19
10
8 7
Un
iver
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01
Chi
cago
Ho
spit
als
40
6
65
0
66
Y
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14
69
19
4
8 D
uke
Un
iver
sity
Med
ical
Cen
ter
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ham
N
C
401
7
1
07
5
Yes
7
0
3494
1
81
9
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
40
0
91
0
82
Y
es
60
18
44
16
1
10
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
38
5
10
7
09
2
Yes
4
0
1105
1
61
11
Un
iver
sity
of
Mic
higa
n M
edic
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ente
r
Ann
Arb
or
38
4
31
0
42
Y
es
70
16
56
17
9
12
Un
iver
sity
01
was
hing
ton
Med
ical
Cen
ter
S
eatt
le
38
3
79
0
66
Y
es
60
92
6 1
10
13
M
assa
chu
sett
s G
ener
al H
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ital
B
osto
n 3
80
8
8
09
5
Yes
7
0
2022
1
38
14
C
lari
an H
ealt
h P
art
ners
In
dia
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oli
s 3
78
5
2
07
5
Yes
7
0
2149
1
67
15
U
niv
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ty o
f P
ittS
bu
rgh
Med
ical
Cen
ter
37
4
26
0
56
Y
es
65
23
10
16
7
(+2
SO)
16
Cle
vel
and
Cli
nic
3
62
3
1
07
4
Yes
7
0
2018
1
94
17
R
osw
ell
Par
k C
ance
r In
stit
ute
B
uff
alo
36
1
55
0
85
Y
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50
16
76
28
7
18
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
35
5
37
0
73
Y
es
60
14
15
14
3
19
Un
iver
sity
of
Ken
tuck
y H
osp
ital
le
xin
gto
n
351
0
5
05
6
Yes
7
0
1047
2
20
20
fo
x C
hase
can
cer
Cen
ter
P
hil
adel
ph
ia
35
0
56
0
83
Y
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50
10
46
15
8
21
H
lee M
off
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oer
Cen
ter
T
ampa
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la
35
0
15
0
65
Y
es
60
16
44
16
8lt
22
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
Cen
ter
Ch
arl
ott
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3
49
0
5
061
Y
es
60
13
48
22
7
23
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
34
8
17
0
67
Y
es
70
99
9 2
40
24
S
hand
s H
osp
ital
at
the
Un
iver
sity
of
flo
rid
a
Gei
nes
vil
le
34
7
14
0
46
Y
es
60
10
23
15
7
25
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
34
6
00
0
57
Y
es
60
12
22
191
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
34
4
17
0
67
Y
es
80
16
15
151
27
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
34
3
15
0
66
Y
es
55
14
14
15
8
28
Un
iver
sity
Ho
spit
al o
f A
rkan
sas
li
ttle
Roc
k 3
43
0
5
06
3
Yes
5
5
1287
2
54
29
U
niv
ersi
ty H
osp
ital
D
enve
r 3
42
2
7
05
7
Yes
5
0
431
24
0
30
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
34
2
23
0
49
Y
es
60
44
8 1
72
lt
31
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
34
2
00
0
61
Y
es
70
15
55
15
3
32
Art
hu
r G
Ja
mes
Can
cer
Ho
spit
al
Col
umbu
s
Ohi
o 3
41
0
0
04
8
Yes
5
5
2147
1
56
33
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
34
0
19
0
69
Y
es
70
11
42
13
6
34
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
33
9
00
0
50
Y
es
55
14
81
14
9
35
New
Yor
k P
resb
yte
rian
HO
spit
al
33
7
34
0
86
Y
es
70
31
03
13
2
36
Un
iver
sity
of
cali
forn
ia
San
Fra
nci
soo
Med
ical
Cen
ter
33
5
30
0
71
Yes
6
0
573
17
5
37
fG
M
cGaw
Ho
spit
al a
t lo
yo
la U
niv
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ty
May
woo
d
Ill
3
33
1
6
07
0
Yes
6
0
1023
1
62
38
U
niv
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ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
33
3
00
0
62
Y
es
60
12
79
15
2
39
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
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Win
ston
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em
33
3
19
0
84
Y
es
70
20
21
181
40
fa
irv
iew
-Un
iver
sity
Med
ical
Cen
ter
M
inn
eap
oli
s 3
32
0
4
06
2
Yes
5
0
1248
1
56
41
G
reat
er B
alti
mo
re M
edic
al C
ente
r B
alti
mo
re
33
2
00
0
58
Y
es
35
12
39
20
0
42
Un
iver
sity
Ho
spit
als
of
Cle
vel
and
3
30
0
0
06
4
YampS
70
19
71
12
1
43
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
lo
we
Cit
y
32
9
04
0
70
Y
es
70
13
05
13
4
44
St
Jo
hn
S H
osp
ital
S
pri
ng
fiel
d
Ill
3
29
0
0
05
5
Yes
6
0
996
13
3
45
Hen
ry F
ord
Ho
spit
al
Detr
oit
3
27
0
0
07
6
Yes
6
5
1473
1
92
46
B
arn
es-J
ewis
h H
osp
ital
S
t
lou
is
32
6
05
0
74
Y
es
85
27
56
14
9
47
luth
era
n G
ener
al H
ealt
hSys
tem
P
ark
Rid
ge
Ill
3
26
0
0
06
2
Ves
6
0
1420
1
14
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
3
24
0
5
05
0
Yes
7
0
776
10
9
49
Coo
k C
ount
y H
osp
ital
C
hica
go
32
3
04
0
49
Y
es
50
49
1 2
10
50
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
32
2
09
0
90
Y
es
50
13
24
19
2
1
2001
D
iges
tiv
e D
iso
rder
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N
s
Tra
uma
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 8
) D
isch
arg
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to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
59
8
05
9
Yes
8
0
7660
1
31
Yes
2
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
82
3
50
0
63
Y
es
75
31
28
14
2
Yes
3
Cle
vel
and
Cli
nic
6
27
3
05
0
57
Y
es
80
44
75
19
4 N
o 4
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
58
9
29
9
08
7
Yes
8
0
4403
1
38
Y
es
5 M
ount
Sin
ai
Med
ical
Cen
ter
N
ew Y
ork
49
5
23
2
09
8
Yes
8
0
5220
1
57
Y
es
6 UC
LA M
edic
al C
ente
r
Los
A
ngel
es
44
5
18
5
081
Y
es
80
25
40
10
8
Yes
7
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
39
7
14
3
09
0
Yes
8
0
3787
1
81
Yes
8
un
ivers
ity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
37
9
13
2
07
0
Yes
7
0
1596
1
75
N
o 9
Un
iver
sity
of
Chi
oago
Ho
spit
als
37
0
131
0
93
Y
es
80
19
84
19
4
Yes
(+
3 SO
) 10
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
30
6
57
0
61
Y
es
80
91
3 1
98
Y
es
11
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 2
99
5
2
07
5
Yes
8
0
4048
1
67
Y
es
12
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
2
95
7
7
09
9
Yes
8
0
2348
1
61
Yes
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
29
2
47
0
72
Y
es
80
56
89
14
9
Yes
14
U
niv
ersi
ty o
f M
iohi
gan
Med
ical
Cen
ter
Ann
Arb
or
291
3
8
06
8
Yes
8_
0 28
16
17
9
Yes
15
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 2
90
4
9
07
4
Yes
8
0
2636
1
43
Y
es
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
28
0
50
0
74
Y
es
50
20
34
161
Y
es
17
Cla
rian
Hea
lth
part
ners
In
dia
nap
oli
s 2
78
5
2
09
2
Yes
8
0
5286
1
67
Y
es
18
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
27
6
45
0
84
Y
es
80
28
28
15
3
Yes
19
B
eth
Isra
el
Dea
cone
ss M
edio
al C
ente
r
Bos
ton
21
4
34
0
73
Y
es
70
45
27
15
8
Yes
20
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
27
1
30
0
45
Y
es
80
99
2 1
09
Y
es
21
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
N
ew Y
ork
26
5
16
0
49
Y
es
70
26
18
21
2
No
22
New
Yor
k P
resb
yte
rian
Ho
spit
al
26
2
52
1
01
Yes
8
0
4884
1
32
Yes
23
U
niv
ers
ttv o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
26
0
20
0
65
Y
es
80
21
84
13
6 Y
es
(+2
SOI
24
Med
ical
Un
iver
sity
of
Sou
th C
aro
lin
a C
har
lest
on
2
58
6
9
12
0
Yes
7
0
2202
2
09
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
25
1 2
2
07
5
Yes
6
5
2472
1
57
Y
es
26
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
oak
M
ich
2
50
0
8
07
0
Yes
8
0
5809
1
88
Y
es
27
8ay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
49
2
6
07
8
Yes
6
0
4673
1
22
y
es
28
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
24
8
00
0
60
Y
es
70
26
48
191
Y
es
29
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
42
1
4
06
9
Yes
7
5
1677
1
47
Y
es
30
Los
A
ngel
es C
ount
y-U
Sc
Med
ical
Cen
ter
24
2
08
0
37
Y
es
60
39
5 1
67
Y
es
31
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
24
0
18
0
79
Y
es
70
18
25
24
0
Yes
32
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
24
0
39
0
78
y
es
80
11
34
11
0
No
33
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Il
l
23
8
00
0
59
Y
es
60
31
21
11
4
Yes
34
U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
oer
Cen
ter
H
oust
on
23
7
33
0
80
Y
es
60
13
61
26
8
No
35
Lah
ey H
itch
coo
k C
lin
io
Bu
rlin
gto
n
Mas
s
23
6
00
0
67
Y
es
70
26
77
15
2
Yes
36
C
edar
s-S
inai
Med
ical
Cen
ter
L
os A
ngel
es
23
4
27
0
94
Y
es
80
47
95
10
6
Yes
37
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
Sit
y
May
woo
d
Ill
2
34
0
0
06
6
Yes
7
0
2180
1
62
Y
es
38
Mar
y H
itch
coo
k M
emor
ial
Ho
sp
ital
le
ban
on
N
H
23
4
04
0
68
Y
es
70
15
58
19
4
Yes
39
U
niv
ersi
ty o
f C
ali
forn
ie
Dav
is M
edio
al C
ente
r
Sac
ram
ento
2
33
0
0
06
8
Yes
8
0
1751
2
79
Y
es
40
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
iCS
Io
wa
Cit
y
23
3
13
0
77
Y
es
80
19
31
13
4
Yes
41
N
ew E
ngla
nd M
edic
al C
ente
r
Bos
ton
23
3
20
0
82
Y
es
10
11
88
24
2
Yes
42
F
roed
tert
Mem
oria
l L
uth
eran
Ho
spit
al
Mil
wau
kee
23
2
00
0
63
Y
es
70
19
29
14
6
Yes
43
T
hom
as J
eff
ers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
32
0
8
07
6
Yes
1
0
3206
1
23
Y
es
44
Tem
ple
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
30
1
7
01
0
Yes
7
5
1450
1
46
N
o 45
G
reat
er B
alti
mo
re M
edic
al C
ente
r
Bal
tim
ore
2
30
1
2
071
Y
es
SO
24
95
20
0
No
46
Hen
ry F
ord
Ho
spit
al
Detr
oit
2
29
0
8
08
6
Yes
7
5
3475
1
82
Y
es
47
Un
iver
sity
Of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pal
Hil
l 2
29
1
0
081
Y
es
60
29
86
15
2
Yes
48
O
chsn
er F
ou
nd
atio
n H
osp
1ta
l
New
Orl
ean
s 2
28
1
5
07
4
Yes
6
5
2465
1
40
N
o 49
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
F
la
22
S
00
0
62
14
0 7
0
5778
1
67
Y
es
SO
Un
iVer
sity
Ho
spit
al
Den
ver
22
7
11
0
81
Yes
6
0
1151
2
40
Y
es
L r
middotmiddot
2001
E
ar
Nos
e
and
Thr
oat
Bes
t H
osp
ital
Lis
t
Hos
pita
lwid
e T
echn
olog
y R
eput
atio
nal
mo
rtal
ity
C
OTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
sc
ore
rate
M
embe
r (o
f 5)
D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
40
2
08
2
Ves
5
0
26
4
14
2
Yes
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
8S
4
32
4
08
6
Yes
5
0
219
13
4
Ves
3
Mas
saoh
uset
ts E
ye
and
Ear
In
firm
ary
B
osto
n 7
66
2
71
0
11
No
3
0
26
8
18
7
Ves
4
May
o C
lin
io
Roo
hest
er
Min
n
68
2
21
0
07
2
Ves
5
0
502
13
1
Ves
5
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
6
39
1
90
0
82
Y
es
50
28
3 1
79
Y
es
6 U
niv
ersi
ty o
f P
itts
bUrg
h M
edic
al C
ente
r 6
23
1
85
0
84
V
es
50
36
3 1
67
Y
es
7 UC
LA M
edic
al C
ente
r
los
Ang
eles
6
21
1
89
0
83
Y
es
50
2
88
1
08
Y
es
8 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
cano
er C
ente
r H
oust
on
51
6
14
7
08
9
Ves
4
0
124
26
8
No
9 H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
5
05
1
36
1
02
Y
es
50
26
7 1
61
Y
es
10
Cle
vela
nd C
lin
ic
49
5
10
6
06
7
Yes
5
0
23
6
19
4
No
11
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nio
N
ashv
ille
4
64
9
3
09
4
Yes
5
0
28
4
24
0
Yes
12
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
caU
f
46
1
10
8
08
6
Yes
3
0
13
4
16
1
Yes
1
3
Bar
nesmiddot
Jew
ish
Ho
spit
al
St
lo
uis
4
68
9
0
08
2
Yes
5
0
39B
1
49
Y
es
14
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
42
6
10
1
0middot8
7 Y
es
50
8
6
11
0
No
15
M
etho
dist
Ho
spit
al
Hou
ston
4
09
1
02
1
07
Y
es
40
2
30
1
33
No
(+
3 SO
l 16
M
emor
ial
Slo
anmiddotK
ette
rin
g e
ence
r C
ente
r
New
Vor
k 3
91
5
4
07
9
Yes
5
0
24
9
21
2
No
17
Mou
nt S
lnai
Med
ioal
Cen
ter
New
Vor
k 3
86
7
8
11
1
Yes
5
0
31
2
15
7
Yes
18
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
37
9
45
0
79
Y
es
50
16
6 1
57
Y
es
19
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
oo M
edio
al C
ente
r 3
78
6
3
08
5
Ves
4
0
131
17
5
No
20
Duk
e U
niv
ersi
ty M
edio
al C
ente
r D
urha
m
NC
3
50
4
3
09
3
Yes
5
0
15
3
18
1
Ves
21
U
niv
ersi
ty o
f W
isoo
nsin
Ho
spit
al a
nd C
lin
ios
Med
ison
3
40
1
9
07
7
Yes
5
0
23
2
13
6
Yes
22
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
enoe
s C
ente
r C
har
lott
esv
ille
3
39
3
0
08
1
Ves
4
0
195
22
7
No
23
un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 3
37
2
2
07
9
Ves
4
0
18
9
15
2
Yes
(+
2 SO
l 2
4
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
33
4
26
0
77
V
es
50
4
4
19
8
Ves
2
5
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty O
f F
lori
da
Gai
nes
vil
le
33
3
18
0
76
V
es
40
16
7 1
57
Y
es
26
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middot Sal
em
33
1
26
0
92
Y
es
50
2
43
1
61
Y
es
27
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
33
0
29
0
76
Y
es
35
11
2 1
01
V
es
28
H
enry
For
d H
osp
ital
D
etro
it
32
9
05
0
73
Y
es
45
2
14
1
82
V
es
29
st
lo
uis
Un
iver
sity
Ho
spit
al
32
5
12
0
71
Y
es
50
1
13
1
47
Y
es
30
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
w
ashi
ngto
n
DC
3
24
1
7
05
3
Ves
5
0
89
1
0
9middot
Yes
31
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hioa
go
32
3
26
0
92
V
es
40
18
4 1
70
ve
s 32
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
C
hica
go
32
3
20
0
70
V
es
50
14
5 1
14
No
3
3
Fai
rvie
w-U
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
32
3
23
0
79
Y
es
30
3
57
1
56
No
3
4
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
25
0
90
Y
es
50
1
00
1
94
Y
es
35
Un
iver
sity
Ho
spit
al
Den
ver
31
7
15
0
74
Y
es
40
52
2
40
Y
es
36
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
3
17
1
9
08
5
Yes
4
0
19
9
12
3
Yes
3
7
Sum
ma
Hea
lth
syst
em
Akr
on
Ohi
o 3
16
0
0
06
9
Ves
4
0
28
7
14
9
Yes
3
8
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
sa
cram
ento
3
15
0
5
07
6
Ves
5
0
14
3
27
9
Ves
3
9
lOS
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
31
2
13
0
20
Y
es
35
42
1
67
Y
es
40
Val
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
31
2
16
0
92
Y
es
50
2
43
1
53
V
es
41
Un
iver
sity
of
Tex
as M
edio
al B
rano
h H
osp
ital
s
Gal
vest
on
31
1
27
0
91
Yes
4
0
118
15
3
Yes
4
2
Lut
hera
n G
ener
al H
ealt
hsys
tem
P
ark
Rid
ge
Ill
3
09
0
0
07
0
Yes
4
0
212
11
4
Yes
4
3
Un
iver
sity
of
Illi
no
is
Ho
spit
al a
nd C
lin
iCs
Chi
cago
3
06
1
2
06
6
Yes
2
5
87
1
29
Y
es
44
lah
ey H
itoh
oook
Cli
nic
B
url
ing
ton
M
ass
3
05
0
5
07
6
Yes
4
0
138
15
2
Yes
4
5
Art
hur
G
Jam
es C
anoe
I H
osp
ital
C
olum
bus
O
hio
30
4
00
0
57
V
es
40
13
1 1
56
Y
es
46
w
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
30
3
05
0
86
Y
es
40
2
16
1
92
V
es
47
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 3
02
0
4
08
7
Yes
5
0
35
5
16
7
Ves
4
8
wil
liam
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
3
02
0
0
08
5
Yes
5
0
29
6
18
8
Yes
4
9
New
Vor
k Ey
e an
d E
ar
Infi
rmar
y
New
Yor
k 3
02
1
7
00
0
No
35
50
2
63
Y
es
50
F
G
McG
aw H
osp
ital
at
lOll
ola
Un
iver
sity
M
ayw
ood
Il
l
30
0
10
0
87
Y
es
40
16
6 1
62
Y
es
L L
2001
G
eria
tric
s B
est
Ho
spit
al L
ist
Hos
ptta
lwid
e T
echn
olog
y D
isch
arge
S
erv
ice
Ger
iatr
ic
Rep
utat
iona
l m
ort
alit
y
COTH
sc
ore
R
N
s
plan
ning
m
ix
serv
ices
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 8
) to
bed
s (o
f 3
) (o
f 1
0)
(of
7)
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
10
00
3
97
0
83
Y
es
80
1
08
3
6 5
2 JO
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
89
5
33
6
08
2
Yes
8
0
14
2
3 9
4 3
Mou
nt
Sin
ai M
edic
al C
ente
r N
ew Y
ork
73
3
27
6
11
1
Yes
8
0
15
7
3 8
4 4
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
6
11
1
98
0
93
Y
es
80
1
81
3
7 3
5 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
59
4
18
5
09
3
Yes
8
0
13
8
3 8
4 6
May
o C
11ni
c
Roo
hest
er
Min
n
51
1
11
2
07
2
Yes
8
0
13
1
3 1
0
8 7
St
L
ouis
Un
iver
sity
Ho
spit
al
45
2
95
0
71
Y
es
80
1
47
3
4 3
8 Y
alemiddot
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
4
33
1
00
0
92
Y
es
80
1
53
3
1 3
9 C
leve
land
lt1
1nio
4
28
7
0
06
7
Yes
8
0
19
4
3 8
4 10
U
niv
ersi
ty o
f M
ichI
gan
Med
ical
Cen
ter
Ann
Arb
or
42
2
79
0
82
Y
es
80
1
79
3
9 4
11
Bet
h Is
rael
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
11
7
7
08
4
Yes
7
0
15
8
3 9
4 (+
3 SO
) 12
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
68
7
3
08
7
Yes
7
0
11
0
2 6
2 1
3
Un
iver
sity
01
Chi
cago
Ho
spit
als
35
4
50
0
90
Y
es
80
1
94
3
8 4
14
B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
33
6
32
0
82
Y
es
80
1
49
3
9 4
15
U
niv
ersi
ty H
osp
ital
D
enve
r 3
34
2
5
07
4
Yes
7
0
24
0
3 8
5 16
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
28
3
0
08
1
Yes
8
0
14
3
3 7
4 17
R
ush
middotPre
sby
teri
anmiddotS
t L
uke
s M
edic
al C
ente
r C
hica
go
32
5
14
0
70
Y
es
80
1
14
3
9 5
19
u
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co l
led
ical
Cen
ter
32
5
36
0
85
Y
es
70
1
75
3
6 4
(+2
SO)
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
0
34
0
86
Y
es
60
1
61
3
9 3
20
Ho
spit
al o
f th
e U
niv
ersi
ty o
f pe
nnsy
lvan
ia
Ph
ilad
elp
hia
3
16
4
4
10
2
Yes
8
0
16
1
I 8
3 21
U
niv
ersi
ty H
osp
ital
s o
f C
leve
land
3
13
2
5
07
9
Yes
8
0
12
1
2 8
4 2
2
Par
klan
d ll
emor
ial
Ho
spit
al
Dal
las
31
3
1S
0
77
Y
es
80
1
98
3
7 4
23
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middotSai
em
31
1
20
0
92
Y
es
80
1
61
3
10
6
24
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
30
8
05
0
53
Y
es
70
1
09
3
8 4
25
U
niv
ersi
ty o
f Il
lin
Ois
Ho
spit
al a
nd C
lin
ios
C
hioa
go
30
7
11
0
66
Y
es
55
1
29
3
7 4
26
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 3
04
4
1
10
5
Yes
8
0
11
8
3 1
4 2
7
Fai
rvie
wmiddotu
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
30
4
14
0
19
Y
es
60
1
56
3
9 5
28
Sos
ton
Med
ioal
Cen
ter
30
4
16
0
75
Y
es
60
2
10
3
7 4
29
Fra
nci
s S
cott
Key
Med
ical
Cen
ter
Bal
tim
ore
30
4
18
0
80
Y
es
70
0
79
3
8 5
30
S
parr
ow H
osp
ital
and
Hea
lth
Sys
tem
L
anS
ing
M
ich
3
04
0
0
06
5
No
70
1
13
3
10
6
31
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
02
0
8
08
4
Yes
8
0
16
7
3 9
7 3
2
Los
Ang
eles
cou
ntymiddot
uSC
lle
dica
l C
ente
r 3
01
0
3
02
0
Yes
6
5
16
7
3 8
3 3
3
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
98
2
3
09
2
Yes
7
0
17
0
3 9
4 3
4
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
29
7
03
0
68
Y
es
70
1
49
3 9
3 3
5
Coo
k C
ount
y H
osp
ital
C
hica
go
28
6
00
0
55
Y
es
60
2
10
3
7 4
36
U
niv
ersi
ty o
f C
onne
ctic
ut H
ealt
h C
ente
r
Far
min
gton
2
94
4
6
10
0
Yes
6
0
26
0
3 3
2 3
7
Ho
spit
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 2
91
0
0
01
0
Yes
6
0
15
1
3 5
4 3
8
Un
iver
sity
Med
ioal
Cen
ter
Tuc
son
A
riz
2
90
0
0
06
6
Yes
7
0
17
2
3 7
3 3
9
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
28
9
07
0
79
Y
es
70
1
52
3
10
3
40
Thom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
28
9
13
0
85
Y
es
70
1
23
3
9 4
41
Hen
nepi
n C
ount
y M
edic
al C
ente
r
Min
neap
olis
2
89
0
0
06
1
Yes
6
5
10
5
3 7
3 4
2
St
L
uk
es
Ho
spit
al
Ch
este
rfie
ld
Mo
2
88
0
0
06
7
No
70
1
06
3
8 8
43
Aug
usta
Hea
lth
Car
e
Fis
her
svil
le
Va
2
87
0
0
06
5
No
50
1
35
3
8 5
44
John
D
Arc
hbol
d M
emor
ial
Ho
spit
al
Tho
maS
Vil
le
Ga
2
86
0
0
06
3
No
70
0
93
3
7 4
45
F
G
McG
aw H
osp
ital
at
Loy
ola
un
iver
sity
M
ayw
ood
Il
l
28
5
14
0
87
Y
es
70
1
62
3
9 3
46
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
Sac
ralll
ampnt
o 2
84
0
4
07
6
Yes
8
0
27
9
3 6
4 4
7
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
28
4
00
0
70
Y
es
70
1
14
3
7 4
49
Hen
ry F
ord
Ho
spit
al
Det
roit
2
83
0
4
07
3
Yes
7
5
18
2
3 4
4 4
9
Un
iver
sity
of
Vir
gin
ia H
ealt
h Sc
ienc
amps
Cen
ter
Ch
arlo
ttes
vil
le
282
0
3
08
1
Yes
7
0
22
7
3 9
4 50
S
t
Jose
ph H
osp
ital
D
enve
r 2
80
0
0
06
3
No
70
1
03
3
6 3
2001
G
ynec
olog
y B
est
Ho
spit
al L
ist
Hos
p1ta
lwid
e T
echn
olog
y G
ynec
olog
y R
eput
atio
nal
mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
serv
ices
R
ank
Ho
spit
al
IHQ
sc
ore
ra
te
Mem
ber
(of
8)
Dis
char
ges
to b
eds
Cen
ter
(of
4)
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
32
5
0B
2
Yes
8
0
24
0
14
2
Yes
4
2 M
ayo
Cli
nic
R
oche
ster
M
inn
7
53
2
10
0
72
Y
es
80
13
40
13
1
Yes
3
3 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 6
70
1
77
0
81
Y
es
80
4
83
1
43
Y
es
4 4
UCLA
Med
ical
Cen
ter
L
os A
ngel
es
58
3
14
2
08
3
Yes
8
0
310
10
8
Yes
4
5 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
cer
Cen
ter
Hou
ston
5
72
1
59
0
89
Y
es
60
2
34
2
68
No
0
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
49
9
10
9
09
3
Yes
8
0
512
18
1
Yes
4
7 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
49
8
11
0
09
3
Yes
8
0
418
13
8
Yes
4
8 P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 4
89
1
01
0
77
Y
es
80
9
4
19
8
Yes
3
11 Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
4
37
1
00
1
15
Y
es
80
56
0 1
32
Y
es
4 1
0
Un
iver
sity
of
Nor
th C
arol
ina
Ho
spit
als
Cha
pel
Hil
l 4
06
6
1
07
9
Yes
7
0
34
3
15
2
Yes
4
11
Mem
oria
l S
loan
-Ket
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
03
7
4
07
9
Yes
7
0
179
21
2
No
1 1
2
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
3
87
6
7
08
6
Yes
5
0
274
16
1
Yes
2
13
M
agee
-Wom
ens
Ho
spit
al
Pit
tsb
urg
h
38
4
50
0
67
Y
es
65
55
1 1
53
No
3
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
38
3
52
0
82
Y
es
80
3
90
1
79
Y
es
3 15
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
36
5
52
0
92
Y
es
70
29
1 1
70
Y
es
4 (+
3 SD
) 1
6
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
36
3
50
0
92
Y
es
80
34
6 1
53
Y
es
4 17
C
leve
land
Cli
nic
3
59
3
7
06
7
Yes
7
0
711
19
4
No
3 18
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
3
54
5
5
10
2
Yes
8
0
222
16
1
Yes
4
19
Un
iver
sity
of
Chi
cago
Ho
spit
als
35
1
43
0
90
Y
es
80
2
33
1
94
Y
es
4 2
0
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
34
3
50
0
85
Y
es
70
51
1
75
No
3
21
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
33
B
35
0
84
Y
es
B_O
30
2 2
40
Y
es
3 2
2
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
2
12
0
S3
Y
es
80
16
9 1
09
Y
es
4 2
3
Los
Ang
eles
Cou
nty-
uSC
Med
ical
Cen
ter
31
7
12
0
20
Y
es
65
4
0
16
7
Yes
4
24
Bar
nes-
Jew
ish
Ho
spit
al
St
L
ouis
3
16
2
3
08
2
Yes
7
5
62
3
14
9
Yes
4
25
R
ush
-Pre
sby
teri
an-S
t
Luk
es
Med
ical
Cen
ter
Chi
oago
3
15
2
2
07
0
Yes
8
0
30
3
114
No
3
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irmin
gham
3
14
3
1
09
6
Yes
8
0
411
15
1
Yes
4
(+2
SO)
27
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
97
1
9
08
5
Yes
7
0
33
7
12
3
Yes
4
28
U
niv
ersi
ty M
edic
al C
ente
r T
uoso
n A
riz
2
95
0
8
06
6
Yes
7
0
150
17
2
Yes
3
29
U
niv
ersi
ty H
osp
ital
D
enve
r 2
92
1
3
07
4
Ves
6
0
90
2
40
Y
es
4 3
0
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 2
92
3
2
11
1
Yes
8
0
317
15
7
Yes
4
31
Art
hur
G
Jam
es C
ance
r H
osp
ital
C
olum
bus
O
hio
29
1
00
0
57
Y
es
70
1
73
1
56
Y
es
3 32
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
90
0
0
05
5
Yes
6
0
69
21
0
Yes
4
33
U
niv
ersi
ty o
f C
alif
orn
ia
Irv
ine
Med
ical
Cen
ter
Ora
nge
2B
9
30
0
82
Y
es
60
69
1
05
Y
es
1 3
4
Un
iver
sity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
28
8
24
0
87
Y
es
80
2
07
1
10
No
4
35
S
tbull
Jose
ph H
osp
ital
D
enve
r 2
88
0
8
05
3
No
70
2
89
1
03
No
4
36
C
edar
smiddotS
inai
Med
ical
Cen
ter
Lo
s A
ngel
es
29
4
29
1
07
Y
es
BO
S
02
10
6
Yes
4
37
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
83
0
0
06
8
Yes
6
5
37
6
14
9
Yes
4
38
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r D
alla
s 2
8S
1
6
08
8
Yes
6
5
559
12
2
Yes
4
39
M
ary
Hit
chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
28
2
12
0
86
V
es
70
2
34
1
94
Y
es
4 4
0
emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
28
1
38
0
90
Y
es
80
2
09
0
93
No
0
41
Wom
en a
nd
Infa
nts
Ho
spit
al O
f R
hode
Is
lan
d
Pro
vide
nce
28
1
04
0
29
Y
es
50
5
19
0
63
No
4
42
B
eth
Isra
el
Oea
cone
ss M
edic
al C
ente
r B
osto
n 2
80
1
2
08
4
Yes
7
0
286
15
8
Yes
3
43
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 2
79
1
1
08
7
Yes
8
0
55
8
16
7
Yes
3
44
Ohi
o S
tate
un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
77
1
0
07
6
Yes
6
5
157
10
1
Yes
4
45
W
illi
am
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
2
75
0
4
08
5
Yes
9
0
59
5
18
9
Yes
4
46
L
uthe
ran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
27
4
00
0
70
Y
es
70
2
60
1
14
Y
es
4 4
7
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nic
s
Mad
ison
2
12
1
2
07
7
Yes
7
0
20
7
13
6
Yes
1
48
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
27
1
05
0
76
Y
es
70
2
62
1
57
Y
es
2 4
9
Gre
ater
Bal
tim
ore
Med
ical
Cen
ter
Bal
tim
ore
27
0
00
0
69
Y
es
55
46
0 2
00
No
4
50
FG
M
oGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
70
1
0
08
7
Yes
7
0
186
16
2
Yes
4
rmiddot--
I
i L
L
2001
H
eart
Bes
t H
osp
ital
Lis
t
Ran
k H
osp
ital
1 C
leve
land
Cli
nic
2
May
o C
11ni
o
Roc
hest
er
Min
n
3 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
4 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
5 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
7
Tex
as H
eart
In
stit
ute
-St
Luk
es
Epi
scop
al H
osp
ital
H
oust
on
B
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
9 Em
ory
un
iver
sity
Ho
spit
al
Atl
anta
1
0
Bet
h Is
rael
Dea
oone
ss M
edic
al C
tlnt
er
Bos
ton
11
B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
is
12
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
13
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
1
4
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
1
5
Lah
ey H
itch
oock
Cli
nic
B
url
ing
ton
M
ass
1
6
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
1
7
Orl
ando
Reg
iona
l M
edic
al C
ente
r O
rlan
do
Fla
18
Hen
ry F
ord
Ho
spit
al
Det
roit
1
9
Thom
as
Jeff
erso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
20
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
21
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
2
2
Bos
ton
Med
ical
Cen
ter
2
3
St
Lou
is U
niv
ersi
ty H
osp
ital
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddotS
alem
2
5
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
6
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
2
7
Mou
nt
Sin
ai M
edic
al C
ente
r
New
Yor
k
28
N
ew Y
ork
pre
sby
teri
an H
osp
ital
2
9
UCLA
Med
ioal
Cen
ter
Los
Ang
eles
3
0
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nio
s
Mad
ison
31
L
uthe
ran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
Fla
33
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
4
Un
iver
sity
of
Was
hing
ton
Mad
ical
Cen
ter
Sea
ttle
3
5
Ru
sh-P
resb
yte
rian
middotSt
L
uke
s M
edic
al C
ente
r C
hica
go
36
S
t
Lu
ke
s H
osp
ital
B
ethl
ehem
P
a
37
S
enta
ra N
orfo
lk G
ener
al H
osp
ital
N
orfo
lk
Va
3
8
St
Vin
cent
Ho
spit
al a
nd H
ealt
h C
ente
r
Ind
ian
apo
lis
3
9
How
ard
Un
iver
sity
Ho
spit
al
Was
hing
ton
4
0
Ced
ars-
Sin
ai M
edic
al C
ente
r
LOS
Ang
eles
41
S
inai
Ho
spit
al o
f B
alti
mor
e
42
S
pect
rum
Hea
lth
Gra
nd R
apid
s
Mio
h
43
N
orth
Sho
re U
niv
ersi
ty H
osp
ital
M
anha
sset
N
V
44
Was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
45
M
ary
Hit
chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
46
Geo
rget
own
Un
iver
sity
Ho
spit
al
waS
hing
ton
D
C
47
M
edic
al C
ente
r o
f D
elaw
are
Wilm
ingt
on
48
C
hri
st H
osp
ital
C
inci
nn
ati
4
9
St
Tho
mas
Ho
spit
al
Nas
hv
illa
5
0
Lan
kena
u H
osp
ital
W
ynne
woo
d
Ill
Tec
hnol
ogy
R
epu
tati
on
al
Mo
rtal
ity
CO
TH
sco
re
Su
rgic
al
RN
s
Tra
uma
IH
Q
sco
re
rate
M
embe
r (o
f 9
) vo
lum
e to
bed
s C
tlnt
er
10
00
6
42
0
65
Y
es
90
9
07
30
00
0
19
4
No
90
9
55
5
01
2
Yes
9
0
82
78
00
00
1
31
Y
es
63
4
31
6
08
2
Yes
9
0
52
05
00
00
1
38
Y
es
58
1
29
1
09
1
Yes
9
0
34
79
00
00
1
42
Y
es
57
1
26
2
08
5
Yes
9
0
43
21
00
00
1
43
Y
es
53
4
21
3
08
1
Yes
9
0
58
92
00
00
1
81
Y
as
45
3
19
3
09
4
Yes
B
O
60
27
00
00
1
33
No
4
32
1
56
0
91
Y
es
70
3
00
60
00
0
16
1
Yes
(+
3 SO
) 3
15
1
14
0
91
Y
es
90
4
66
90
00
0
09
3
No
35
9
87
0
94
Y
es
80
5
60
80
00
0
15
8
Yes
3
55
5
0
08
0
Yes
9
0
39
87
00
00
1
49
Y
es
(+2
SO)
34
2
37
0
84
Y
es
90
8
66
70
00
0
18
8
Yes
3
34
6
8
09
9
Yes
9
0
51
54
00
00
1
51
Y
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32
8
61
0
83
Y
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80
9
82
00
00
1
75
No
3
18
0
6
07
0
Yes
8
0
29
03
00
00
1
52
Y
es
31
8
13
0
66
Y
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90
1
37
00
00
1
98
Y
es
31
4
00
0
70
Y
es
90
2
81
60
00
0
12
8
Yes
3
12
0
0
07
2
Yes
8
5
18
58
00
00
1
82
Y
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30
7
21
0
90
Y
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80
1
82
90
00
0
12
3
Yes
3
05
0
0
07
2
Yes
8
0
22
46
00
00
1
49
Y
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30
5
28
0
94
Y
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90
4
71
80
00
0
16
7
Yes
3
03
1
0
07
6
Yes
7
0
17
60
00
00
2
10
Y
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30
2
08
0
76
V
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90
1
15
30
00
0
14
7
Yes
3
02
0
3
08
3
Yes
9
0
39
93
00
00
1
61
Y
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30
1
06
0
74
Y
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80
1
09
30
00
0
17
2
Yes
3
00
1
7
09
1
Yes
9
0
26
91
00
00
1
79
Y
es
29
8
47
1
06
Y
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90
4
25
30
00
0
15
7
Yes
2
91
6
1
11
1
Yes
9
0
57
76
00
00
1
32
Y
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29
5
37
0
92
Y
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90
1
50
40
00
0
10
8
Yes
2
95
0
0
07
6
Ves
9
0
15
10
00
00
1
36
Y
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29
3
00
0
72
Y
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80
1
70
90
00
0
11
4
Yes
2
93
0
3
07
5
No
80
1
09
16
00
00
1
61
Y
es
29
3
14
0
89
Y
es
90
1
73
80
00
0
24
0
Yes
2
92
1
07
1
16
Y
es
80
1
20
80
00
0
11
0
No
29
2
14
0
76
Y
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90
1
41
50
00
0
11
4
No
29
1
00
0
76
Y
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80
3
29
80
00
0
08
7
Yes
2
91
0
0
08
2
Yes
8
0
55
75
00
00
1
51
Y
es
28
9
06
0
84
Y
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80
8
04
80
00
0
13
7
Yes
2
89
0
0
06
5
Yes
9
0
25
60
00
0
11
0
Yes
2
89
3
5
09
9
Yes
9
0
39
64
00
00
1
06
Y
es
28
9
00
0
76
Y
es
80
2
03
30
00
0
12
1
Yes
2
89
0
0
07
9
Yes
8
0
28
37
00
00
1
06
Y
es
28
9
06
0
87
Y
es
90
4
71
00
00
0
12
7
Yes
2
88
0
0
08
6
Yes
8
0
89
54
00
00
1
92
Y
es
28
7
00
0
84
Y
es
80
2
44
50
00
0
19
4
YeS
2
86
0
0
06
0
Yes
8
0
79
90
00
0
10
9
Yes
2
85
0
0
08
7
Yes
8
0
40
88
00
00
1
15
Y
es
28
4
00
0
70
N
o 8
5
45
27
00
00
1
59
N
o 2
83
0
6
07
6
No
80
8
15
10
00
0
19
9
No
28
3
00
0
71
No
8
0
31
45
00
00
1
10
N
o
2001
H
oroo
nal
Dis
ord
ers
Bes
t H
osp
ital
lis
t
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
RN
s
T
raum
a R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (O
f 7
) D
isch
arge
s to
bed
s C
ente
r
May
o C
lin
ic
Roc
hest
er
Min
n
10
00
6
12
0
66
Y
es
70
14
59
13
1
Yes
2
Mas
sach
uset
ts G
ener
al H
OSp
tal
B
osto
n 9
89
5
27
0
91
Y
es
70
l1
B3
13
B
Yes
3
John
s H
opki
ns H
osp
ital
B
alti
mor
e 5
96
2
52
0
64
Y
es
70
B
07
14
2
Yes
4
Bri
gham
and
Wom
en s
H
osp
ital
B
osto
n 5
36
2
05
0
72
Y
es
70
6
17
1
43
Y
es
I
Bet
h Is
rael
Dee
cone
ss M
edic
al C
ente
r B
osto
n 4
55
1
13
0
62
Y
es
60
11
46
15
8
Ves
6
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
45
4
11
5
04
9
Yes
6
0
1029
2
27
No
7
Un
iver
sity
of
Cal
ifo
rnia
Se
n F
ranc
isco
Med
ical
Cen
ter
45
3
14
5
07
2
Yes
6
0
416
17
5
No
9 B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
45
3
11
6
09
5
Yes
7
0
1968
1
49
Y
es
9 C
leve
land
Cli
nic
4
37
9
3
04
6
Ves
7
0
1133
1
94
No
(+
3 11
m
10
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
41
6
82
0
66
Y
es
10
8
13
1
19
Y
es
11
Un
iver
sity
of
Chi
cago
Ho
spit
als
41
1
89
0
B2
Y
es
70
00
1 1
94
Y
es
12
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
41
0
10
4
00
4
Yes
7
0
752
10
8
Yes
13
u
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
B8
0
4
05
6
Yes
1
0
31
9
11
0
No
14
Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
3
83
1
11
1
54
Y
es
70
15
52
13
2
Yes
15
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
78
3
9
05
5
Ves
7
0
757
24
0
Yes
16
N
orth
Wes
tern
Mem
oria
l H
osp
ital
C
hica
go
37
5
51
0
73
Y
es
60
97
5 1
70
Y
es
17
Hen
ry F
ord
Ho
spit
al
Det
roit
3
75
1
2
05
6
Yes
6
5
19
45
1
82
Y
es
(+2
SD)
18
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
st
anfo
rd
Ca1
1f
36
1
68
0
83
Y
es
50
47
2 1
61
Y
es
19
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 3
64
3
6
05
6
Yes
7
0
328
19
8
Yes
2
0
Duk
e U
nive
rSit
y M
edic
al C
ente
r D
urha
m
NC
3
59
2
7
06
8
Yes
7
0
91
6
18
1
Yes
21
U
niv
ersi
ty H
osp
ital
D
enve
r 3
58
2
5
04
5
Yes
8
0
320
24
0
Yes
2
2
was
hing
ton
Ho
spit
al C
ente
r W
ashi
ngto
n
DC
3
57
2
0
07
6
Yas
6
0
1658
1
92
Y
es
23
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
35
4
16
0
65
Y
es
70
12
59
16
7
Yes
2
4
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 3
47
2
7
05
1
Yes
5
5
719
10
1
Yes
2
5
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
34
5
23
0
13
Y
es
70
86
6 1
61
Y
es
26
S
t
lou
is U
niv
ersi
ty H
osp
ital
3
43
0
7
04
0
Yes
1
0
637
14
1
Yes
2
7
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
3
43
1
1
06
4
Yes
1
0
1080
1
51
Y
es
28
U
niv
ersi
ty H
osp
ital
P
ort
lan
d
ore
3
42
2
8
048
Y
es
60
32
8 0
111
Yes
2
9
Un
iver
sity
of
Tex
as M
edic
al B
ranc
h H
osp
ital
s
Gal
vest
on
33
9
05
0
4B
Y
es
60
81
8 1
53
Y
es
30
G
ood
Sam
arit
an R
egio
nal
Med
ioal
Cen
ter
Pho
enix
3
38
1
0
01
7
Yes
7
0
58
0
10
7
Yes
31
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
Cha
pel
Hil
l 3
37
0
6
05
2
Yes
6
0
791
15
2
Yes
32
U
niv
ersi
ty o
f W
isco
nsin
Hos
pita
l an
d C
Hn
ics
Mad
ison
3
37
0
5
03
3
Yes
7
0
519
13
6
Yes
33
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al O
ak
Mio
h
33
7
06
0
80
Y
es
70
14
14
18
8
Yes
3
4
Flo
rid
a H
osp
ital
Med
ical
Cen
ter
Orl
ando
F
la
33
7
00
0
51
No
6
0
1698
1
67
Y
es
35
U
niv
ersi
ty o
f M
aryl
and
Med
ical
sys
tem
B
alti
mor
e 3
36
0
6
05
1
Ves
7
0
55
3
111
4 Y
es
36
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edic
al C
ente
r S
acra
men
to
33
4
06
0
59
Y
es
70
55
7 2
19
Y
es
37
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
33
3
05
0
50
Y
es
60
56
0 1
57
Y
es
38
Yal
emiddotN
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
33
2
38
1
03
Y
es
10
8
10
1
53
Y
es
39
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
9
00
0
38
Y
es
60
76
8 1
14
Y
es
40
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
3
29
0
0
04
9
Yes
5
5
656
13
5
Yes
41
A
lleg
heny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
32
8
00
0
66
Y
es
60
6
10
1
91
Y
es
42
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 3
27
6
4
16
7
Yes
7
0
1555
1
57
Y
es
43
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
6
05
0
20
Y
es
70
32
9 1
09
Y
es
44
M
emor
ial
Med
ical
Cen
ter
Sav
anna
h G
a
32
6
00
0
48
Y
es
60
5
52
1
42
V
es
45
Med
ical
Col
lege
of
Geo
rgia
Ho
spit
al a
nd C
lin
iC
Aug
usta
3
23
0
0
03
1
Yes
5
0
381
15
0
Yes
46
S
t L
uk
es
Med
ioal
Cen
ter
Milw
auke
e W
is
32
3
00
0
62
Y
es
60
13
70
08
6
Yes
4
1
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
trd
ty
May
woo
d
Ill
3
23
1
0
07
1
Yes
6
0
64
3
16
2
Yes
4
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
32
3
07
0
68
Y
es
70
6
85
1
34
Y
es
49
M
edic
al C
ente
r o
f D
elaw
are
Wil
min
gton
3
21
0
0
08
1
ves
60
12
35
17
5
Ves
50
u
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
32
1
00
0
68
Y
es
70
77
3 1
51
Y
es
- L
2001
K
idne
y D
isea
se B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Dis
char
ge
Med
ical
l R
epu
tati
on
al
Mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
pla
nn
ing
S
urg
ical
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 5
) D
isch
arg
es
to
beds
C
ente
r (o
f 3
) B
eds
Mas
sach
use
tts
Gen
eral
Ho
spit
al
B
osto
n 1
00
0
27
6
09
5
Yes
5
0
1091
1
36
Y
es
3 83
2
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
95
6
25
6
061
Y
es
50
74
2 1
43
Y
es
3 30
3
May
o C
lin
iC
Ro
ches
ter
M
inn
82
B
18
5
06
3
Yes
5
0
1217
1
31
Y
es
3 94
4
Cle
vel
and
Cli
nic
8
28
1
94
0
53
Y
es
50
11
24
19
4
No
3 44
5
New
Yor
k P
resb
yte
rian
Ho
spit
al
80
6
19
6
12
2
Yes
5
0
1617
1
32
Y
es
3 11
1
6 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
77
3
17
4
05
4
Yes
4
5
811
14
2
Yes
3
41
7 UC
LA M
edic
al C
ente
r
Los
Ang
eles
7
26
1
53
0
60
Y
es
50
97
5 1
08
Y
es
3 54
8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
69
6
14
3
07
8
Yes
5
0
1108
1
81
Y
es
3 57
9
Bar
nes
-Jew
ish
Ho
spit
al
S
t
Lou
is
88
7
12
0
05
9
Yes
5
0
1863
1
49
Y
es
3 76
10
U
niv
ersi
ty H
osp
ital
D
enve
r 6
58
1
41
0
61
Yes
4
0
408
24
0
Yes
3
0 11
U
niv
ersi
ty O
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbor
5
89
8
8
05
4
Yes
5
0
922
17
9
Yes
3
60
12
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
iC
Nas
hv
ille
5
78
9
1
04
9
Yes
4
0
850
24
0
Yes
3
28
13
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
56
6
89
0
63
Y
es
40
52
8 1
61
Y
es
3 67
14
P
ark
lan
d M
emor
ial
Ho
spit
al
D
alla
s 56
1
73
0
31
Yes
5
0
660
19
8
Yes
3
39
15
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
41
6
6
06
2
Yes
5
0
1128
1
67
Y
es
3 80
16
U
niv
ersi
ty o
f C
ali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
53
4
74
0
45
Y
es
50
63
1 1
75
N
o 3
35
17
Ho
spit
al o
f th
e U
niv
ersi
ty O
f P
enn
sylv
ania
P
hil
adel
ph
ia
52
8
75
0
73
Y
es
50
96
2 1
61
Yes
3
44
18
Em
ory
Un
iver
sity
Ho
spit
al
A
tlan
ta
52
1
77
0
58
Y
es
45
78
4 0
93
N
o 3
48
19
un
ivers
ity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
51
6
78
0
55
Y
es
50
42
1 1
10
N
o 2
46
(+3
SO)
20
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
47
3
56
0
93
Y
es
40
12
02
15
1
Yes
2
86
21
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
45
3
47
0
61
Yes
5
0
1013
1
58
Y
es
3 0
22
Hen
ry F
ord
Ho
spit
al
Detr
oit
4
47
2
1
05
8
Yes
5
0
1459
1
82
Y
es
3 76
2
3
Un
iver
sity
of
No
rth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
44
5
37
0
48
Y
es
40
10
33
15
2
Yes
3
16
24
F
airv
ieW
-Un
iver
sity
Med
ical
Cen
ter
Min
neap
Oli
s 4
44
5
2
07
2
Yamp
s 5
0
690
15
6
No
3 24
2
5
Un
iver
sity
of
Chi
cago
Ho
spit
als
44
2
31
0
47
Y
es
50
75
8 1
94
Y
es
3 3
0
26
H
erm
ann
Ho
spit
al
Hou
ston
4
24
1
7
03
0
Yes
4
5
668
11
4
Yes
3
54
27
Ru
sh-P
resb
yte
rian
-St
L
uke
s
Med
ical
Cen
ter
C
hica
go
41
8
16
0
37
Y
es
50
12
73
11
4
No
3 49
2
8
New
Eng
land
Med
ical
Cen
ter
8
0st
on
4
16
4
2
07
9
Yes
5
0
330
24
2
Yes
2
30
2
9
Un
iver
sity
of
Cali
forn
ia
Dav
iS M
edic
al C
ente
r
Sac
ram
ento
4
16
2
2
05
5
Yes
5
0
681
27
9
Yes
3
40
30
Yal
e-N
ew H
aven
H
osp
ital
N
ew H
aven
C
onn
4
12
3
8
09
9
Yes
5
0
943
15
3
Yes
3
52
(+2
SO)
31
Los
An
gel
es C
ount
y-U
SC
Med
ical
Cen
ter
40
9
04
0
08
Y
es
45
21
3 1
67
Y
es
3 43
32
S
hand
s H
osp
ital
et
the U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
40
6
34
0
74
Y
es
45
69
9 1
57
Y
es
2 3
0
33
St
L
ou
is U
niv
ersi
ty H
osp
ital
3
99
1
2
041
Y
es
45
58
7 1
47
Y
es
3 43
3
4
Bos
ton
Med
ical
Cen
ter
39
4
15
0
44
Y
es
40
40
5 2
10
Y
es
3 36
35
U
niv
ersi
ty o
f T
exes
Med
ical
Bra
nch
Ho
spit
als
G
alv
esto
n
39
0
05
0
41
Yes
5
0
890
15
3
Yes
3
38
36
Un
iver
sity
Ho
spit
al
Po
rtla
nd
are
3
90
3
4
07
2
Yes
4
5
356
091
Y
es
3 18
37
M
eth
od
ist
Ho
spit
al
Hou
ston
3
89
3
3
10
0
Yes
4
6
796
13
3
No
3 69
38
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
88
0
6
06
0
Yes
5
0
935
17
0 Y
es
3 6
3
39
Fro
edte
rt M
emor
ial
Lu
ther
an H
osp
ital
M
ilw
auke
e 3
87
1
2
05
5
Yes
5
0
784
14
6
Yes
3
35
40
Un
iver
sity
Ho
spit
els
and
Cli
niC
S
Col
umbi
a
Mo
3
87
2
6
06
6
Yes
4
5
374
15
1
Yes
2
30
41
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
niC
S
Chi
cago
3
85
0
0
01
9
Yes
4
5
382
12
9
Yes
3
42
42
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
Ari
z
38
3
00
0
29
Y
es
45
37
6 1
72
Y
es
3 46
43
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
38
3
12
0
41
Y
es
00
81
4 1
68
N
o 91
44
W
illi
am B
eaum
ont
Ho
spit
el
Roy
al O
ak
Mic
h
38
3
03
0
74
Y
es
50
16
88
18
8
Yes
3
60
45
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
3
81
0
5
06
1
Yes
4
5
941
19
4
Yes
3
63
46
Un
iver
sity
01
Wis
con
sin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
7
22
0
82
Y
es
50
82
0 1
36
Y
es
3 32
4
7
Sax
ar C
ount
y H
osp
ital
Dis
tric
t
San
An
ton
io
37
7
16
0
64
Y
es
45
36
8 1
21
Y
es
3 51
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
WaS
hing
ton
D
C
37
7
05
0
43
Y
es
50
39
5 1
09
Y
es
3 53
49
U
niv
ersi
ty 0
1 V
irg
inie
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
3
77
1
4
06
4
Yes
5
0
930
22
7
No
3 34
50
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r
Dal
las
31
5
05
0
72
Y
es
45
97
6 1
22
Y
es
3 86
j r
l
~
2001
N
euro
logy
and
Neu
rosu
rger
y B
est
Ho
spit
al L
ist
Tec
hnol
ogy
Re p
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
so
ore
rate
M
embe
r (o
f 7)
D
isoh
arge
s to
bed
s C
ente
r
1 M
ayo
Cli
nic
R
oche
ster
M
inn
1
00
0
57
5
09
1
Yes
7
0
4763
1
31
Y
es
2 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
83
7
46
0
09
5
Yes
7
0
3705
1
38
Y
es
3 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
74
6
37
2
07
0
Yes
7
0
2641
1
42
Y
es
4 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
7
27
3
73
0
95
Y
as
70
40
78
13
2
Yes
5
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
51
6
24
1
10
0
Yes
6
0
1503
1
75
No
6 C
leve
land
Cli
nic
5
12
1
88
0
65
Y
es
70
33
38
19
4
No
7 B
arne
smiddotJe
wis
h H
osp
ital
S
t l
ou
is
38
9
92
0
81
Y
es
70
46
67
14
9
Yes
8
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
37
4
10
5
09
1
Yes
7
0
22
86
1
61
Y
es
(+3
SD)
9 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
32
4
70
1
02
Y
es
70
29
21
18
1
Yes
1
0
UCLA
Med
ioal
Cen
ter
lo
s A
ngel
es
32
2
64
0
80
Y
es
70
19
67
10
8
Yes
11
M
ount
S
inai
Med
ical
Cen
ter
Ne
w Y
ork
31
7
55
0
85
Y
es
70
23
83
15
7
Yes
12
M
etho
dist
Ho
spit
al
Hou
ston
3
15
6
2
08
6
Yes
6
0
3768
1
33
No
13
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
15
6
6
09
3
Yes
7
0
1925
1
43
Y
es
14
Un
iver
sity
of
Mic
higa
n M
edic
al C
arot
er
Ann
Arb
or
30
4
68
1
06
Y
es
70
17
02
17
9 Y
es
15
S
t J
ose
ph
s H
osp
ital
and
Med
ical
Cen
ter
Pho
enix
3
04
5
2
09
2
Yes
6
0
3336
1
27
Y
es
16
Los
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
29
9
04
0
29
Y
es
55
39
9 1
67
Y
es
17
H
enry
F
ord
Ho
spit
al
Det
roit
2
99
1
3
06
4
Yes
6
5
3299
1
82
Y
es
18
Den
ver
Hea
lth
and
Ho
spit
als
29
5
04
0
16
No
5
5
353
17
0
Yes
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
29
4
49
0
89
Y
es
50
19
06
16
1
Yes
2
0
Dan
amiddotF
arbe
r C
ence
r In
stit
ute
B
osto
n 2
94
0
3
00
0
No
85
6
22
7
No
21
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
29
3
15
0
46
Y
es
70
11
51
10
9
Yes
2
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
29
1
37
0
82
Y
es
70
21
86
13
4
Yes
(+
2 SD
) 2
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
28
8
13
0
36
V
es
60
33
6 2
68
No
2
4
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 2
88
1
8
07
0
Yes
7
0
3234
1
18
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
28
8
27
0
70
Y
es
60
15
98
15
7
Yes
2
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
87
2
1
07
0
Yes
6
0
1970
1
70
Y
es
27
u
niv
ersi
ty H
osp
ital
D
enve
r 2
87
3
3
07
3
Yes
6
0
613
24
0
Yes
2
8
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
28
6
08
0
19
Y
es
70
44
69
16
7
Yes
2
9
Un
iver
sity
of
Vir
gIn
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
28
5
34
0
83
Y
es
60
32
29
22
7
No
30
D
ooto
rs C
Onm
luni
ty H
osp
ital
la
nham
M
d
28
0
00
0
05
No
5
5
901
09
7
No
31
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
2
78
0
0
00
0
Yes
3
0
870
03
4
Ho
32
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 2
77
1
8
07
0
Yes
7
0
896
19
8
Yes
3
3
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
O
ak
Mic
h
27
6
00
0
82
V
es
70
48
44
18
8
Yes
3
4
St
L
uke
s H
osp
ital
N
ewbu
rgh
N
Y
27
5
00
0
02
No
5
0
82
6
08
0
No
35
B
osto
n M
edio
al C
ente
r 2
74
2
5
07
7
Ves
5
0
1255
2
10
Y
es
36
F
airv
ieW
-Uni
vers
ity
Med
ical
Cen
ter
Min
neap
olis
2
74
2
0
06
1
Ves
5
0
1685
1
56
No
37
U
nIv
ersi
ty M
edic
al C
ente
r T
ucso
n
Ari
z
27
4
00
0
50
Y
es
60
86
5 1
72
Y
es
38
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
73
0
0
06
6
Yes
6
0
3299
1
49
Y
es
39
Sc
hwab
Reh
abil
itat
ion
Ho
spit
al
Chi
cago
2
70
0
0
02
3
Yes
2
5
769
04
1 Y
es
40
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
68
0
0
04
9
Yes
5
0
498
21
0
Yes
41
S
t V
ince
nt H
ospI
tal
and
Hea
lth
Cen
ter
In
dia
nap
olb
2
66
0
0
07
0
Yes
6
0
32
89
1
37
Y
es
42
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
Chi
cago
2
65
0
6
05
4
Yes
7
0
1848
1
14
No
4
3
Bet
h Is
rael
Dea
oone
ss M
edio
al C
ente
r B
osto
n 2
65
1
4
08
5
Yes
6
0
2838
1
58
Y
es
44
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
2
64
0
0
00
6
No
35
12
64
03
8
No
45
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
2
63
1
8
08
8
Yes
7
0
1659
2
40
Y
es
46
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
nic
s C
hioa
go
26
2
13
0
62
Y
es
45
83
0 1
29
Y
es
47
H
arpe
r H
osp
ital
D
etro
it
26
1
04
0
55
Y
es
60
20
72
12
6
No
48
E
vans
ton
Nor
thw
este
rn H
ealt
h C
are
E
vans
ton
Il
l
28
1
09
0
75
Y
es
60
29
33
10
2
Yes
4
9
was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
2
59
0
4
07
7
Yes
6
0
2269
1
92
Y
es
50
Car
din
al H
ill
Reh
abil
itat
ion
Ho
spit
al
lex
ing
ton
K
y
25
8
00
0
02
No
0
5
1313
0
55
No
t
2001
O
rth
op
edio
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
GOTH
so
ore
R
N
$
Tra
uma
Ran
k H
osp
ital
IH
O
sco
re
rate
M
embe
r (o
f 5)
D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
49
2
05B
Y
es
50
77
52
13
1
Yes
2
Ho
spit
al f
or
Sp
ecia
l S
urg
ery
N
ew Y
ork
88
3
40
6
01
3
Yes
4
5
6837
1
57
Y
es
3 M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 7
13
3
20
1
01
Y
es
50
34
89
13
8
Yes
4
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
43
1
90
0
73
Y
es
50
16
28
14
2
Yes
5
Cle
vel
and
Cli
nic
5
19
1
73
0
63
Y
es
50
36
20
19
4
No
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
40
1
34
1
07
Y
es
50
28
63
18
1
Yes
7
Har
borv
iew
Med
ical
Cen
ter
S
eatt
le
37
2
101
1
05
Yes
3
5
820
23
3
Yes
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
37
0
75
0
74
Y
es
50
15
09
13
4
Yes
9
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
36
0
84
0
99
Y
es
50
17
57
10
8
Yes
(+
3 SO
) 10
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
2
68
0
56
Y
es
50
97
3 1
10
No
11
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
A
rbor
3
29
3
9
06
8
Yes
5
0
1586
1
79
Y
es
12
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
32
7
43
0
80
Y
es
50
26
80
14
3
Yes
13
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
32
6
48
0
92
Y
es
50
28
72
16
7
Yes
14
B
exar
Cou
nty
Ho
spit
al D
istr
ict
San
Ant
onio
3
24
3
9
04
8
Yes
4
0
645
12
1
Yes
15
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
3
49
0
87
Y
es
30
21
43
161
Y
es
16
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
35
0
67
Y
es
50
11
56
19
4
Yes
17
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
31
8
71
1
23
Y
es
50
58
7 1
98
Y
es
18
Un
iver
sity
Ho
spit
al
Den
ver
31
7
31
0
44
Y
es
40
63
3 2
40
Y
es
19
Bar
nes
middotJew
ish
Ho
spit
al
St
lo
uis
3
11
3
6
08
9
Yes
5
0
2911
1
49
Y
es
20
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f fl
ori
da
Gai
nes
vil
le
30
7
21
05
9
Yes
4
0
1781
1
57
Y
es
21
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
30
5
62
1
04
Y
es
40
92
7 1
75
No
(+
2 SO
) 22
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
03
1
6
05
9
Yes
5
0
1608
2
40
Y
es
23
Ho
spit
al o
f th
e U
niv
ersi
ty o
f p
enn
sylv
ania
P
hil
adel
ph
ia
30
1
45
1
04
Y
es
50
10
76
161
Y
es
24
U
niv
ersi
ty o
f A
labe
ma
Ho
spit
al a
t B
irm
ingh
am
29
9
22
0
73
Y
es
50
15
94
151
Y
es
25
Ho
spit
al f
or
Join
t D
isea
sesmiddot
Ort
ho
ped
ic I
nst
itu
te
New
Yor
k 2
97
4
0
02
5
No
30
21
10
09
3
No
26
SUl1
l1la
Hea
lth
sy
stem
A
kron
O
hio
29
5
05
0
49
Y
es
40
38
99
14
9
Yes
27
Y
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
Onn
2
93
1
2
061
Y
es
50
14
62
15
3
Yes
28
N
ew Y
ork
Pre
sby
teri
an H
osp
ital
2
92
4
5
12
2
Yes
5
0
2394
1
32
Y
es
29
Un
iver
sity
of
Ten
ness
ee M
edic
al C
ente
r
Mem
phis
2
92
4
2
05
4
No
46
90
1
50
No
30
U
niv
ersi
ty o
f W
isco
nsi
n H
osp
ital
and
Cli
nic
s
Mad
ison
2
89
1
1
061
Y
es
50
14
42
13
6
Yes
31
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
sacr
amen
to
28
6
24
0
87
Y
es
50
11
56
27
9
Yes
32
S
t
lou
is U
niv
ersi
ty H
osp
ital
2
83
0
4
04
8
Yes
5
0
819
14
7
Yes
33
R
ushmiddot
Pre
sby
teri
an
-St
lu
kes
Med
ical
Cen
ter
Chi
cago
28
1
25
0
79
Y
es
50
21
23
11
4
No
34
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Ill
28
0
00
0
46
Y
es
40
25
63
11
4
Yes
35
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
2
80
0
6
04
7
Yes
5
0
952
10
9
Yes
36
C
aro
lin
as M
edic
al C
ente
r
Ch
arlo
tte
N
C
28
0
23
1
03
Y
es
50
29
00
18
4
Yes
37
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
27
9
06
0
71
Yes
4
0
2274
1
58
Y
es
38
Coo
k C
ount
y H
osp
ital
C
hica
go
27 _
7 1
2
05
5
Yes
3
0
184
21
0
Yes
39
U
niv
ersi
ty o
f lo
uis
vil
le H
osp
ital
lo
uis
vil
le
Ky
2
76
0
5
04
2
Yes
4
0
317
19
0
Yes
40
A
lleg
hen
y G
ener
al H
osp
ital
P
itts
bu
rgh
2
76
0
0
06
4
Yes
4
0
2161
1
91
Yes
41
H
enry
For
d H
osp
ital
D
etro
it
27
6
00
0_
63
Yes
4
5
1834
1
82
Y
es
42
Un
iver
sity
of
Mia
mi
Jack
son
Mem
oria
l H
osp
ital
2
78
3
0
06
2
Yes
0
0
748
16
8
No
43
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 2
75
0
5
06
6
Yes
4
0
1518
1
52
Y
es
44
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
27
5
00
0
32
Y
es
40
87
1 1
72
Y
es
45
Mar
y H
itch
cock
Mem
oria
l H
osp
ital
le
ban
on
N
H
27
4
00
0
57
Y
es
40
14
30
19
4
Yes
46
B
apti
st M
emor
ial
Ho
spit
al
Mem
phis
2
74
4
5
11
2
No
50
29
14
09
3
Yes
47
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
2
73
1
2
08
6
Yes
4
0
2025
1
70
Yes
48
L
os A
ngel
es C
ou
nty
USC
Med
ical
Cen
ter
27
3
05
0
00
Y
es
35
23
6 1
Il7
Yes
49
M
edic
al C
ente
r o
f C
entr
al M
assa
chu
sett
s W
orc
este
r 2
73
0
0
06
0
Yes
4
5
1285
1
89
Y
es
60
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
middotSal
em
27
3
11
0
92
Y
es
50
21
20
1I
II
Yes
r-
-
2001
R
esp
irat
ory
Dis
ord
ers
Bes
t H
osp
ital
Lis
t Tec
hnol
ogy
Dis
char
ge
Rep
uta
tio
nal
M
ort
ali
ty
COTH
sc
ore
R
N
s T
raum
a p
lan
nin
g
Ran
k H
osp
Ital
IH
Q
sco
re
rate
M
embe
r (o
f 4
) D
isch
arg
es
to b
eds
Cen
ter
(of
3)
1 N
atio
nal
Jew
ish
Cen
ter
D
enve
r 1
00
0
501
0
22
N
o 3
0
121
37
5
No
3 2
May
o C
lin
ic
Ro
ches
ter
M
inn
8
S2
41
1
08
1
Yes
4
0
4391
1
31
Yes
3
3 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
63
3
2B0
0
95
Y
es
40
14
61
14
2
Yes
3
4 B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
54
6
21
2
08
9
Yes
4
0
5329
1
49
Y
es
3 5
Un
iver
sity
Ho
spit
al
Den
ver
45
7
151
0
83
Y
es
40
9
80
2
40
Y
es
3 6
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
43
2
15
0
09
0
Yes
4
0
1015
1
75
N
o 3
7 M
assa
chu
sett
s G
ener
al H
osp
Ital
B
osto
n 43
1
16
4
11
4
Yes
4
0
3306
1
38
V
es
3 8
Cle
vel
and
Cli
nic
4
20
1
24
0
77
Y
es
40
27
32
19
4
No
3 9
Bri
gham
and
WO
men
s H
osp
ital
B
osto
n 3
69
9
0
08
2
Yes
4
0
2526
1
43
V
es
3 10
U
CSIl
Med
ical
Cen
ter
S
an D
iego
3
68
9
1
08
0
Yes
4
0
1130
1
48
Y
es
3 11
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
4
12
0
09
8
Yes
4
0
720
11
0
110
2 12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbo
r 3
48
8
1
08
7
Yes
4
0
1927
1
79
Ves
3
(+3
SO)
13
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
II
C
33
7
96
1
12
Y
es
40
29
49
18
1
Yes
3
14
Bo
sto
n M
edic
al C
ente
r 3
25
3
8
05
7
Yes
4
0
1105
2
10
Y
es
3 15
H
osp
ital
of
the U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
32
3
96
1
15
Y
es
40
15
07
16
1
Ves
3
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
32
2
74
0
95
Y
es
40
16
20
161
Y
es
3 1
7
Un
ivers
ity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
05
6
0
09
7
Yes
4
0
2957
1
67
Y
es
3 18
UC
LA M
edic
al C
ente
r
Los
Ang
eles
2
97
4
1
07
5
Yes
4
0
1910
1
08
Y
es
3 19
V
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
onn
2
95
5
3
09
3
Ves
4
0
2355
1
53
Y
es
3 20
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
85
5
5
10
0
Yes
4
0
1432
1
94
Y
es
3 21
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
28
5
25
0
74
V
es
40
27
79
15
2
Yes
3
(+2
SO)
22
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
27
9
35
0
87
V
es
40
20
51
24
0
Yes
3
23
Los
A
ng
eles
Cou
nty-
USC
Med
ical
Cen
ter
27
5
04
0
18
Y
es
40
46
9 1
67
Y
es
3 24
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
Sac
ram
ento
2
73
1
2
06
7
Yes
4
0
1820
2
79
V
es
3 2
5
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
73
1
0
06
2
Yes
4
0
1475
1
47
Y
es
3 26
C
ook
Cou
nty
Ho
spit
al
C
hica
go
27
3
00
0
49
Y
es
40
11
45
21
0
Yes
3
27
San
Fra
nci
sco
Gen
eral
Ho
spit
al M
edio
al C
ente
r 2
70
5
6
08
7
Yes
2
0
899
11
0
No
3 28
H
enne
pin
Cou
nty
Med
ical
Cen
ter
M
inn
eap
oli
s 2
67
0
0
05
2
Yes
4
0
1959
1
05
Y
es
3 29
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
26
4
07
0
66
Y
es
40
17
63
15
7
Yes
3
30
Geo
r-ge
tow
n U
niv
ersi
ty H
osp
ital
w
ash
ing
ton
D
C
26
2
04
0
59
Y
es
40
99
3 1
09
Y
es
3 31
C
lar-
ian
Hea
lth
Part
ners
In
dia
nap
Oli
S
26
0
12
0
79
Y
es
40
42
95
16
7
Yes
3
32
Ru
sh-P
resb
yte
rian
-St
L
uk
es
Med
ical
Cen
ter
C
hica
go
25
4
28
0
82
Y
es
40
18
56
11
4
No
3 33
H
enry
Fo
rd H
osp
ital
D
etr
oit
2
54
1
4
08
5
Yes
4
0
3875
1
82
Y
es
3 34
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
2
53
2
2
08
3
Yes
4
0
2302
2
27
No
3
35
W
est
Jeff
ers
on
Med
ical
Cen
ter
M
arre
ro
La
2
52
0
0
05
3
No
40
14
94
11
3
Ves
3
36
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
251
0
0
07
1
Yes
4
0
6185
1
49
Y
es
3 37
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
iCS
M
adis
on
25
0
05
0
70
Y
es
40
14
28
13
6
Yes
3
38
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
50
0
4
07
2
Yes
4
0
1071
1
72
Y
es
3 39
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
sity
M
ayw
ood
Ill
2
49
1
8
08
6
Yes
4
0
1415
1
62
V
es
3 40
U
niv
ersi
ty o
f Il
lin
ois
Ho
spit
al a
nd C
11
nic
s
Chi
cago
2
49
0
5
06
6
Yes
3
5
779
12
9
Yes
3
41
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
46
0
0
06
3
Yes
3
5
1677
1
01
Yes
3
42
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
2
45
3
7
10
3
Yes
4
0
2116
1
51
Ves
2
43
Har
bo
rvie
w M
edic
al C
ente
r
Seett
le
24
4
24
0
89
Y
es
30
80
5 2
33
Y
es
3 44
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
2
44
2
3
09
2
Ves
4
0
1334
1
34
Y
es
3 45
T
rum
an M
adic
al C
ente
r-W
est
K
ansa
s C
ity
M
o
24
4
00
0
64
Y
es
35
99
1 1
14
Y
es
3 46
M
emor
ial
Med
ical
Cen
ter
S
avan
nah
G
a
24
2
00
0
71
Y
es
40
14
03
14
2
Yes
3
47
Tou
ro
Infi
rmar
y
lew
Orl
ean
s 24
1
00
0
65
V
es
40
14
07
06
5
Ves
3
48
St
Jo
sep
h H
osp
ital
D
enve
r 2
41
0
0
05
5
No
40
25
11
10
3
No
3 49
L
os A
ng
eles
Cou
nty-
Har
bor-
UC
LA
Med
ical
Cen
ter
24
0
13
0
10
No
4
0
420
16
5
Yes
2
50
Bay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
40
1
2
08
7
Ves
4
0
3026
1
22
V
es
3
-
J 1
2001
R
heum
atol
ogy
Bes
t H
osp
ital
lis
t
Hos
pita
lwid
e T
echn
olog
y D
isch
arge
R
epu
tati
on
al
mo
rtal
ity
CO
TH
sco
re
RN
s
plan
ning
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 5
) to
bed
s (o
f 3
)
May
o C
lin
ic
Roo
hest
er
Min
n
10
00
4
96
0
72
Y
es
50
1
31
3
2 Jo
hns
Hop
kins
Has
p ta
l 8
alti
mo
rs
85
9
38
0
08
2
Yes
5
0
14
2
3 3
Ho
spt
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 8
09
2
70
0
10
Y
es
45
1
57
3
4 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 7
17
2
54
0
81
Y
es
50
1
43
3
5 C
leve
land
Cli
nic
6
76
2
03
0
67
Y
es
50
1
94
3
6 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
66
4
22
1
09
3
Yes
5
0
1 3
8
3 7
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
66
2
21
2
08
3
Yes
5
0
10
8
3 B
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
64
1
20
8
09
6
Yes
5
0
15
1
2 9
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
5
68
1
34
0
93
Y
es
50
1
81
3
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co M
edic
al C
ente
r 5
58
1
23
0
85
Y
es
40
1
75
3
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
5
37
1
12
0
86
Y
es
30
1
61
3
12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
52
1
82
0
82
Y
es
50
1
79
3
(+3
SD)
13
B
arne
s-Je
wis
h H
osp
ital
S
t
lou
is
49
2
57
0
82
Y
es
50
1
49
3
14
H
osp
ital
fo
r Jo
int
Dis
ease
s-O
rtho
pedi
c In
stit
ute
N
ew Y
ork
48
9
59
0
55
No
3
0
09
3
3 1
5
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 4
86
7
8
10
5
Yes
5
0
11
8
3 1
6
los
Ang
eles
Cou
nty-
USC
Med
ical
can
ter
48
4
00
0
20
Y
es
35
1
S7
3
17
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
47
7
46
0
84
Y
es
50
1
67
3
la
St
lu
kes
Ho
spit
al
New
burg
h
NY
4
74
0
0
00
1
No
35
0
80
3
19
U
niv
ersi
ty H
osp
ital
D
enve
r 4
70
3
6
07
4
Yes
-4
0
24
0
3 2
0
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
46
9
32
0
77
Y
es
50
1
98
3
21
Doc
tors
Com
mun
ity H
osp
ital
L
anha
m
Md
4
69
0
0
00
7
No
35
0
97
2
(+2
SO)
22
Den
ver
Hea
lth
and
Ho
spit
als
48
1
00
0
21
No
4
0
17
0
2 2
3
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
46
6
53
1
02
Y
es
50
1
61
3
24
R
ehab
ilit
atio
n I
nst
itu
te o
f C
hica
go
46
3
00
0
03
Y
es
25
0
34
2
25
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
DC
4
62
0
9
05
3
Yes
5
0
10
9
3 2
6
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
4
58
0
0
00
9
No
25
0
38
3
27
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
45
4
39
0
92
Y
es
40
1
70
3
28
T
he
Inst
itu
te f
or
Reh
abil
itat
ion
and
Res
earc
h H
oust
on
45
3
00
0
13
No
1
5
06
9
3 2
9
Un
iver
sity
of
Chi
cago
Ho
spit
als
45
2
29
0
90
Y
es
50
1
94
3
30
C
ard
inal
Hil
l R
ehab
ilit
atio
n H
osp
ital
L
exin
gton
K
y
44
9
00
0
01
No
0
5
05
5
3 31
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
47
2
6
08
4
Yes
4
0
15
8
3 3
2
Reh
abil
itat
ion
In
stit
ute
of
Mic
higa
n
Det
roit
4
47
0
0
01
2
No
25
0
39
2
33
S
t
lou
is U
niv
ersi
ty H
osp
ital
4
44
0
4
07
1
Yes
5
0
14
7
3 3
4
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
44
4
05
0
66
Y
es
40
1
72
3
35
Coo
k C
ount
y H
osp
ital
C
hica
go
44
3
00
0
55
Y
es
30
2
10
)
36
Su
nnyv
iew
Ho
spit
al a
nd R
ehab
ilit
atio
n C
ente
r S
chen
ecta
dy
NY
4
42
0
0
00
7
No
10
0
43
2
37
B
osto
n M
edic
al C
ente
r 4
39
1
6
07
5
Yes
3
0
21
0
3 3
8
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
niC
S
Mad
ison
4
39
0
8
07
7
Yes
5
0
13
6
3 3
9
Hil
lsid
e R
ehab
ilit
atio
n H
osp
ital
W
arre
n
Ohi
o 4
38
0
0
01
2
No
15
0
30
2
40
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
4
36
1
4
08
6
Yes
5
0
13
4
3 41
U
niv
ersi
ty o
f M
aryl
and
Med
ical
Sys
tem
B
alti
mor
e 4
35
1
6
09
2
Yes
5
0
19
4
3 4
2
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hiO
4
35
0
0
06
8
Yes
4
0
14
9
3 4
3
UCSD
Med
ical
Cen
ter
San
Die
go
43
5
26
0
90
Y
es
30
1
48
3
44
R
ush
-pre
sby
teri
an-S
t
luk
es
Med
ical
can
ter
Chi
cago
4
34
0
0
07
0
Yes
5
0
11
4
3 4
5
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
43
4
15
0
92
Y
es
50
1
53
3 4
6
Hen
ry F
ord
Ho
spit
al
Det
roit
4
34
0
0
07
3
Yes
4
5
18
2
3 4
7
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
can
ter
S
acra
men
to
43
4
00
0
76
Y
es
50
2
19
3
48
H
enne
pin
coun
ty M
edic
al c
ante
r M
inne
apol
is
43
2
00
0
61
Y
es
35
1
05
3
49
W
est
Jeff
erso
n M
edic
al C
ente
r M
arre
ro
lao
43
2
00
0
55
No
4
0
11
3
3 5
0
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
43
2
09
0
87
Y
es
50
1
67
3
~
-
2001
U
rolo
gy B
est
Has
pi ta
l li
st
Tec
hnol
ogy
Rep
uta
tio
nal
M
Ort
alit
y CO
TH
sco
re
RN
s
Tra
uma
Ran
k H
osp
ital
IH
O so
ore
rate
M
embe
r (o
f 8
) D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
70
7
07
8
Yes
7
5
1231
1
42
Y
es
2 C
leve
land
Cli
nio
6
94
4
14
0
50
Y
es
80
1
61
8
19
4
No
3 M
ayo
Cli
nic
R
oche
ster
M
inn
6
80
3
92
0
50
Y
es
80
3
81
8
13
1
Yes
4
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
50
0
25
7
12
3
Yes
8
0
14
50
1
08
Y
es
5 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
4
41
1
79
0
79
Y
es
80
30
61
13
2
Yes
6
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
35
1
73
0
56
Y
es
70
11
61
21
2
No
1 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
13
1
49
0
81
Y
es
80
1
75
8
18
1
Yes
8 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
40
7
15
3
09
6
Yes
8
0
1401
1
38
Y
es
9 B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
iS
39
0
12
9
08
2
Yes
8
0
1778
1
49
Y
es
10
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
38
5
15
2
12
9
Yes
5
0
973
16
1
Yes
11
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
co M
edic
al C
ente
r 3
57
1
07
0
62
Y
es
70
78
3 1
75
No
(+
3 SO
) 1
2
Met
hodi
st H
osp
ital
H
oust
on
33
8
10
9
11
0
Yes
6
5
1381
1
33
No
1
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
33
0
10
8
11
1
Yes
6
0
69
0
26
8
No
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
32
0
60
0
78
Y
es
80
1
28
5
17
9
Yes
1
5
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
31
0
54
0
86
Y
es
80
14
97
16
7
Yes
1
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
07
3
7
04
8
Yas
7
0
95
9
17
0
Yes
1
7
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
30
0
31
0
55
Y
es
80
12
74
16
1
Yes
(+
2 SD
) 1
6
Van
der
bil
t U
niv
ersi
ty H
osp
ital
an
d C
11ni
c
Nas
hv
ille
2
92
5
6
11
5
Yes
7
0
83
3
24
0
Yes
1
9
Lah
ey H
itch
cock
Cli
nic
B
url
ing
ton
M
ass
2
91
2
7
05
4
Yes
7
0
886
15
2
Yes
2
0
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
28
7
51
1
09
Y
es
80
69
7 1
43
Y
as
21
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
28
8
41
0
65
Y
es
80
2
83
1
98
Y
es
22
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
seatt
le
27
9
27
0
24
Y
es
80
5
32
1
10
No
2
3
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
cen
ter
Ch
arlo
ttes
vil
le
27
7
28
0
51
Y
es
70
73
2 2
27
No
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddot S
alem
2
77
1
8
07
7
Yes
8
0
957
16
1
Yes
2
5
Shan
ds H
osp
ital
at
the
Un
iver
sity
of
Flo
rid
a
Gai
nes
vil
le
27
7
15
0
57
Y
es
65
90
5 1
57
Y
es
26
Car
oli
nas
Med
ical
Cen
ter
C
har
lott
e
N C
2
78
0
0
03
3
Yes
8
0
908
18
4
Yes
27
U
niv
ersl
ty o
f W
isco
nsin
Hos
pita
l an
d C
lin
ios
Mad
ison
2
74
0
5
04
5
Yes
8
0
1151
1
36
Y
es
28
Ne
w Y
ork
Un
iver
sity
Med
ioal
Cen
ter
27
3
16
0
66
Y
es
80
16
70
11
8
Yes
2
9
Hen
ry F
ord
Ho
spit
al
Det
roit
2
72
0
0
04
3
Yes
7
5
1079
1
82
Y
es
30
U
niv
ersi
ty H
osp
ital
D
enve
r 2
70
1
0
00
0
Yes
6
0
371
24
0
Y9$
31
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
67
1
4
06
9
Yes
7
0
1011
1
23
Y
es
32
Y
ale-
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
2
67
0
5
06
8
Yes
8
0
98
4
15
3
Yes
33
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
26
7
00
0
42
Y
es
60
9
17
1
92
Y
es
34
A
lban
y M
adic
al C
ente
r A
lban
y
NY
2
66
0
5
04
7
Yes
6
0
77
3
16
7
Yes
3
5
36
Lo
s A
ngel
es C
ount
ymiddotU
SC M
edic
al C
ente
r W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
26
5
26
4
14
0
0
00
0
06
2
Yes
Y
es
60
8
0
65
1
73
0
16
7
18
8
Yes
Y
es
37
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edio
al C
ente
r
Sao
ram
ento
2
64
1
0
05
1
Yes
8
0
412
27
9
Yes
3
8
Nor
th S
hore
Un
iver
sity
Ho
spit
al
Man
hass
et
NY
2
63
0
0
05
5
Yes
8
0
35
4
12
7
Yes
3
9
Sum
ma
Ilea
lth
Sys
tem
A
kron
O
hio
26
2
00
0
04
5
Yes
6
5
775
14
9
Yes
4
0
St
L
ouis
Un
iver
sity
Ho
spit
al
26
1
18
0
72
Y
es
75
4
25
1
47
Y
es
41
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
26
0
21
0
66
Y
es
70
1
12
9
09
3
No
42
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
25
9
00
0
26
Y
es
65
3
56
1
72
Y
es
43
U
niv
ersi
ty o
f L
ou
isv
ille
Ho
spit
al
Lo
uis
vil
le
Ky
2
58
0
8
00
0
Yes
6
0
28
1
90
Y
es
44
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
2
57
0
0
05
9
Yes
6
0
96
5
13
5
Yes
4
5
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
57
1
4
09
9
Yes
7
0
84B
1
62
Y
es
46
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
25
6
04
0
77
Y
es
75
83
3 1
94
Y
es
47
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
25
6
09
0
78
Y
es
60
80
1 1
52
Y
es
48
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
56
2
0
10
9
Yes
8
0
701
19
4
Yes
4
9
Bex
ar C
ount
y H
osp
ital
Dis
trio
t
San
Ant
onio
2
56
0
5
00
0
Yes
8
5
229
12
1
Yes
5
0
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
25
5
13
0
57
Y
es
80
34
9 1
09
Yes
~
l
i i
f
AppendixG
r bull Reputational Rankings for Special-Service Hospitals
i
I
I L
1~
r-
2001
E
yes
Rep
uta
tio
nal
Sco
re
Rep
uta
tio
nal
R
ank
Ho
spit
al
soo
re
Joh
ns
Hop
kins
Ho
spit
al
(Wilm
er
Eye
In
stit
ute
)
Bal
tim
ore
71
2
2 U
niv
ersi
ty o
f M
iam
i (B
asC
om
Pal
mer
Ey
e In
stit
ute
) 6
46
3
Wil
ls E
VQ
Hos
pita
l--
h
ilad
llip
hia
57
0
(+3
l
4 M
assa
chu
sett
s E
ye
and
Ear
In
firm
ary
B
osto
n 4
00
5
UCLA
Med
ioal
Cen
ter
(JII
IIIS
Ste
in E
ye
Inst
itu
te)
lo
s A
ngeJ
es
30
3
(+2
SO)
6 U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nio
s
Iow
a C
ity
1
93
7
USC
Un
iver
sity
Ho
spit
al
(Doh
eny
Eye
In
stit
ute
)
los
Ang
eles
1
03
8
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
B3
9
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
BO
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
66
11
M
ayo
Cli
nic
R
och
este
r
Min
n
63
12
N
ew Y
ork
Eye
an
d E
ar I
nfi
rmar
y
61
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
58
14
C
lev
elan
d C
lin
ic
54
16
M
eth
od
ist
Ho
spit
al
(Cul
len
Eye
Inst
itu
te)
H
oust
on
39
16
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
17
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
6
I
-~
r
middot
2001
P
edia
trio
s R
epu
tati
on
al S
core
Ran
k H
osp
ital
Ch
ild
ren
s H
osp
ital
Bos
ton
2 C
hil
dre
ns
Ho
spit
al o
f P
hil
adel
ph
ia
3 Jo
hns
Hop
kins
Ho
spit
al
BaU
iID
ore
4 C
hil
dre
ns
Ho
spit
al o
f P
itts
bu
rgh
5
Ch
ild
ren
s H
osp
ital
D
enve
r 6
Ch
ild
ren
s H
osp
ital
lo
s A
ngel
es
7 U
niv
H
osp
ital
s o
f C
lev
elan
d
(Rai
nbow
Bab
ies
amp C
hil
dre
ns
Hos
p J
8
Tex
llS C
hil
dre
ns
Ho
spit
al
Hou
ston
9
New
Yor
k P
resb
yte
rian
Ho
spit
al
(Bab
ies
amp C
hil
dre
ns
Ho
spit
al)
10
Ch
ild
ren
s H
osp
ital
Med
ical
Cen
ter
C
inci
nn
ati
11
Ch
ild
ren
s M
emor
ial
Ho
spit
al
Chi
cago
12
M
ayo
Cli
nic
R
och
este
r M
inn
13
U
niv
ersi
ty o
f C
a11
forn
ia
San
Fra
nci
sco
Med
ical
cen
ter
14
UCLA
(M
atte
I C
hild
ren
lS C
ente
r)
los
Ang
eles
15
lu
cil
le P
acka
rd C
hil
dre
ns
Ho
spit
al
Sta
nfo
rd
Cali
f
16
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
17
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
18
Ch
ild
ren
s H
osp
ital
and
Med
ical
Cen
ter
S
eatt
le
19
Ch
ild
ren
s N
atio
nal
Med
ical
Cen
ter
Was
hing
ton
D
C
20
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
21
Ch
ild
ren
s H
osp
ital
B
uff
alo
N
Y bull
22
Un
iver
sity
of
Mic
higa
n H
osp
ital
s
Ann
Arb
or
23
St
Ch
rist
op
her
s H
osp
ital
P
hil
adel
ph
ia
24
Met
ho
dis
t H
osp
ital
H
oust
on
Rep
uta
tio
nal
S
core
49
4
38
9
27
4
12
2
11
6
10
9
10
9
99
9
4
89
8
7
74
7
2
62
6
0
5S
4
9
48
4
3
39
3
7
37
3
6
32
(+3
SD)
(+2
SlY
j
i r-
2001
p
sych
iatr
y R
epu
tati
on
al S
oore
Rep
uta
tio
nal
R
ank
Ho
spit
al
Soo
re
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
31
8
2 N
ew Y
ork
pre
sby
teri
an H
osp
ital
25
2
3 C
F
M
enni
nger
Mem
oria
l H
osp
ital
T
opek
a
Kan
2
10
4
MoL
ean
Ho
spit
al
Bel
mon
t
Mas
s
20
6
5 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mor
e 19
9
+3
SOl
6 UC
LA N
euro
PIgt
iQh
atl
ic
Hos
rgt
1al
105
Ang
eles
~8~_
Il
ifJl
7
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
10
0
8 Y
ale-
New
Hav
en
Ho
spit
al
New
Hav
en
Con
n
92
9
May
o C
lin
iC
Ro
ches
ter
M
inn
8
8
10
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
6
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
52
12
S
hepp
ard
and
Eno
ch P
ratt
Ho
spit
al
Bal
tim
ore
52
13
U
niv
ersi
ty o
f C
ali
forn
ia
san
Fra
nci
sco
Med
ical
Cen
ter
46
14
U
nv
ars
ity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
4
0
e
15
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
7
16
Mou
nt S
inai
-NY
U M
edic
al C
ente
r
New
Yor
k 3
5
17
Cle
vel
and
Cli
nic
3
1
l r-shy
2001
R
ehab
ilit
atio
n R
epu
tati
on
al S
core
Rep
uta
tio
nal
R
ank
Ho
spit
al
Soo
re
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
6
37
2
The
In
stit
ute
fo
r R
ehab
ilit
atio
n a
nd
Res
earc
h
Hou
ston
3
74
3
Un
iver
sity
of
Was
hina
ton
Med
ioal
Cen
ter
$l
I1It
tle
32
9
___j+
3 S
O)
4 K
essl
er I
nst
itu
te f
or
Reh
abil
itat
ion
W
est
Ora
nge
N
J
23
8
5 M
ayo
Cli
nic
R
och
este
r
Min
n
20
3
6 C
raig
HQ
spit
al
Eng
lew
ood
c()l~
__
__
__
_
___2
00
(+
2 SO
l 7
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 1
40
8
Ohi
o st
ate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
11
1
9 T
hom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
10
7
10
Ran
oho
Los
AlII
igos
Med
ioal
Cen
ter
D
owne
y
Cali
f
10
0
11
Un
iver
sity
of
Mio
higa
n M
edio
al C
ente
r A
nn A
rbor
9
6
12
Sp
auld
ing
Reh
abil
itat
ion
Ho
spit
al
Bos
ton
69
13
N
atio
nal
Rs
hab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
8
6
14
Mou
nt
Sin
ai M
edic
al C
ente
r
New
Yor
k 6
7
15
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
9
16
Alb
ert
Ein
stei
n M
ed
Cen
ter
(Mos
s R
ehab
H
osp
)
Ph
ilad
elp
hia
5
6
17
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
39
18
S
heph
erd
Cen
ter
A
tlan
ta
39
1
9
Un
iver
sity
Ho
spit
al
Den
ver
31
2
0
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
31
L
AppendixH
The 2001 Honor Roll
Lj
l
r
t
The Honor Roll
To lend additional perspective we have constructed a measure called the Honor Roll to
indicate excellence across a broad range ofspecialties
To be listed on the Honor Roll a hospital has to rank at least 2 standard deviations
(SD s) above the mean in at least 6 ofthe 16 specialties A hospitals ranking in the Honor
Roll is based on points assigned as follows
bull For ranking between 2 and 3 standard deviations above the mean in a specialty a
hospital receives one point
bull For ranking at least 3 standard deviations above the mean a hospital receives two
points
We chose to use a standard deviation based criteria rather than simply adding up a
hospitals rankings in individual specialties for three reasons (1) the number ofoutstanding
hospitals varies from specialty to specialty (2) setting a threshhold is more informative because
it establishes a level ofalmost excellent and (3) it gives some measure ofthe distance
between hospitals which rankings do not
f
middot1
THE 2001 HONOR ROLL
16
Mayo Clinic Rochester Minn 27 13 1
Massachusetts General Hospital Boston 26 12 2
4 Cleveland Clinic 23 11 1
5 UCLA Medical Center Los Angeles 22 8 6
6 Duke University Medical Center Durham NC 20 8 4
7 Barnes-Jewish Hospital St Louis 18 6 6
7 University of Michigan Medical Center Ann Arbor 18 6 6
7 University of California San Francisco Medical Center 18 7 4
10 Stanford University Hospital Stanford Calif 17 6 5
11 Brigham and Womens Hospital Boston 16 6 4
12 University of Washington Medical Center Seattle 12 4 4
13 New York Presbyterian Hospital 12 5 2
14 Hospital of the University of Pennsylvania Philadelphia 11 3 5
15 University of Chicago Hospitals 9 1 7
16 University QfPittsburgh Medical Center 9 2 5 1 1
l
i
i
l
r
r l
NORC 6021
1 Introduction
l
f
L
Health care providers and consumers today face a dynamic and often puzzling array of
choices with few tools to inform their critical decisions about quality of care No single
standard measure of quality of care is available for the 6116 hospitals in the United States In
1993 the National Opinion Research Center at the University of Chicago (NORC) developed
such a measure This report card is supported and published annually by U S News amp World
Report in an issue entitled Americas Best Hospitals
In the NORC report card each hospital receives a score called the Index of Hospital
Quality (IHQ) that assesses hospital quality by taking into account the three fundamental
dimensions of health care delivery process structure and outcome None of these dimensions
by itself can completely and accurately represent quality of care all three must be assessed and
combined Care starts with the structural characteristics of an institution (such as the number of
patients served and the range of medical technology available) moves through the process of
delivering care and produces results or outcomes for the patients served To be most useful to
the consumer and provider of care the IHQ--our application of the Donabedian paradigml2 of
structure process and outcomes--combines robust and sensitive measures of each of these
dimensions for the universe of tertiary-care hospitals across a wide range ofmedical and surgical
practice specialties The IHQ draws from secondary sources such as the Annual Survey of
Hospitals by the Americ~ Hospital Association (AHA) for data about various quality
dimensions We continually try to improve the specificity and sensitivity of the measures we use
to rank hospitals and to identify the best possible sources ofdata
For the 2001 rankings we made the following changes bull Introduced new procedures allowing all hospitals that do not respond to the AHA
survey to be eligible for ranking bull Completed the transition to a revised calculation ofmortality ratios bull Refined the selection of Diagnosis-Related Groups (DRGs) for the heart and
orthopedic specialties bull Tested the impact on the response rate to the annual physician survey of either an
explicit reference in the survey letter or questionnaire to the Americas Best Hospitals issue of us News amp World Report or implicitly to the 12th Annual Survey ofPhysicians for US News amp World Report
bull Redesigned the appearance of the questionnaire bull Incorporated into this report a flow chart illustrating the analytical steps of the
methodology
3
(
L
We regularly examine the impact of hospital mergers on our rankings For this release
three mergers among hospitals previously ranked as independent entities appear on the lists
Albany Medical Center NY Evanston Northwestern Medical Center Evanston Ill and
Harper Hospital Detroit These hospitals responded as new corporate entities for the first time
in the 1999 AHA database The following sections define the universe of tertiary-care
hospitals for the purpose of this project describe and define the standardized mortality ratios
and the structural components and explain how process-related data is collected As a guide
the materials on which each of the components of the index is based are outlined below
I Reputation bull The reputational score is based on cumulative infonnation from three NORC
surveys of physicians carried out in 1999 2000 and 2001 the sample design is consistent across the three years
bull The sample for the 2001 survey consists of 2550 board-certified physicians selected from the American Medical Associations (AMA) Physician Masterfile of 811000 physicians
bull StratifYing by region and by specialty within region we selected a sample of 150 physicians from each of 17 specialty areas for a total of2550 physicians
bull The final sample includes both non-federal and federal medical and osteopathic physicians residing in the 50 states and the District ofColumbia
II Structure bull The structural score is based on data related to the structural characteristics of
each specialty within each hospital bull These elements represent volume of work technology and other elements of the
hospital environment bull Most of the data comes from the 1999 AHA Annual Survey bull The volume data comes from the Health Care Financing Administrations
(HeFA) MEDP ARS database which contains information on all Medicare discharges (primarily aged over 65) in each specialty
III ()utco~e
bull The outcome measure is based on HCFAs MEDP ARS database
bull An adjusted mortality rate is computed based on predicted mortality rates bull The data and the model were provided by Solucient Inc of Evanston Ill using
the All Patient Refined Diagnosis Related Group (APR-DRG) method designed by 3M Health Infonnation Systems
bull The APR-DRG adjusts expected deaths for severity of illness by means of principal diagnosis and categories of secondary diagnoses
bull This method is applied to the pooled 1997 1998 and 1999 data set of Medicare reimbursement claims made to HCF A by hospitals
4
In the final section we outline new directions anticipated for the index For a more
exhaustive review of the foundation as well as the development and use of the individual
measures and the composite index see ItBest Hospitals A Description of the Methodology for
the Index ofHospital Quality3
shy
J
r
5
IL The Index ofHospital Quality
A Universe Defmition
We have implemented a two-stage approach to defining eligible hospitals for each of the
IHQ specialty lists
First eligible hospitals must be considered tertiary-care centers To be identified as a
tertiary-care hospital a hospital must meet at least one of the following criteria
bull COTH membership or
bull medical school affiliation or
bull a score of9 or higher on our hospital-wide high-technology index
(Appendix A)
Using these criteria we identified 1878 tertiary-care hospitals that were eligible for any of the
thirteen IHQ-based rankings Once the eligible hospitals were identified data for these hospitals
were drawn from the 1999 AHA Annual Survey As with any data collection effort the AHA
Annual Survey database is incomplete due to nonresponding hospitals Although it did not affect
the analysis this year we have a procedure to allow eligible hospitals that are nonresponders to
the current AHA Annual Survey to remain in our database First for all previously ranked
hospitals that are nonresponders to the current survey we average the two prior years ofdata and
substitute the result for the missing data Two-year non-responders that lack data both from the
current survey and from the previous two surveys are ranked without any structure data
Although nonresponding hospitals need to be treated separately for the IHQ analysis it is
unnecessary to do so for the four reputation-only lists
We then created separate analytic universes for each of the 13 IHQ-driven specialties
using criteria such as specialty-specific technology or facilities and a minimum number of
discharges across appropriate DRGs (Figure 1) However hospitals with a non-zero reputational
score were deemed eligible for ranking even if they had insufficient volume (discharges) in a
specialty
The flow chart in Figure 2 illustrates the eligibility process
6
Figure 1 1999 Universe Definition by Specialty
~pec~~ltyi bull Number ()fllospit~ Imiddotimiddotf~~ifji~t~~f~frl~~~~~~~~~fmiddot ~~ bull~~ bullbull ~ f~middot~~~~ ~ ~~)~~~~ ~~~ Imiddotmiddot~ lt IA~~~~~ri1j~(~~tl = ~-~ ~~~~~f~~-~)~~lt-)-_~- ~~ ~ ~ v~_~ ~_~~ ~~
Cancer minimum of 380 discharges for relevant DRGs or 935 non-zero reputation score
Digestive disorders minimum of734 discharges for relevant DRGs or non- 1394 zero reputation score
Ear nose and minimum of37 discharges for relevant DRGs or non- 1371 throat zero reputation score
Geriatrics score of 1 or more on the geriatrics service index and 1412 minimum of 5947 discharges for all DRGs or nonshy
zero reputation score
Gynecology minimum of 52 discharges for relevant DRGs or non- 1356 zero reputation score
have a cardiac catheterization lab or Heart offer open heart surgery or 853
offer angioplasty and minimum of 245 surgical discharges for relevant
DRGs or non-zero reputation score
Hormonal Minimum of3615 discharges for relev 944 disorders non-zero reputation score
Kidney disease Minimum of 185 discharges for relev 1389 non-zero reputation score
Neurology and Minimum of464 discharges for rete 1408 Neurosurgery non-zero reputation score Orthopedics Minimum of392 discharges for relevant DRGs or 1406
non-zero reputation score Respiratory Minimum of881 discharges for relevant DRGs or 1409
disorders non-zero reputation score Rheumatology Minimum of22 discharges for relevant DRGs or non- 1376
zero reputation score Urology Minimum of 133 discharges for relevant DRGs or 1370
non-zero reputation score
7
L c
L
Figu
re 2
A
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re f
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B Composite Measure of Structure
The structural dimension defines the tools and environment available to care providers in
treating patients It represents the possibilities of care for a patient and physician Healthcare
research overwhelmingly supports the use of a measure of structure in assessing quality of care
However no prior research has revealed a single indicator of quality that summarizes all others
or that adequately represents the structure construct on its own Thus the structural component
must be represented by a composite variable comprising different measures that are specialtyshy
specific and are weighted relative to each other
For the 2001 index all structural elements other than volume are derived from the 1999
AHA Annual Survey of Hospitals database and are described below For specific mapping of
variables to the AHA data elements see Appendix B
COTH membership This dichotomous variable indicates membership in the Council of
Teaching Hospitals
Technology indices In 2001 we added medical and surgical intensive care beds to
the list of nephrology elements All other technology elements for all other specialties are
unchanged A complete list of the technologies considered for each specialty can be found in
AppendixA
Since the 1996 version of the index we have allowed our technology indices to reflect
the real cost of high-technology services While providing a service inside the hospital is
convenient for patients the cost may be unacceptable to some hospitals Many hospitals
provide access to technology services through the hospitals health system a local community
network or a contractual arrangement or joint venture with another provider in the
community We have taken this into account by giving hospitals that provide a service such as
ultrasound on-site one full point for that element hospitals that provide the service locally
through a formal arrangement receive a half-point A hospital receives no more than one point
for each element of the index
Volume The volume measure reflects the total number of medical or surgical (or both
when appropriate) discharges in the appropriate specialty-specific ORO groupings submitted for
HCF A reimbursement In the heart specialty surgical discharges indicates volume Data from
the three most recent years is pooled The ORO groupings are shown in Appendix C
9
RNs to beds The number of beds is defined by the AHA as beds set up and staffed at
the end of the reporting period Only nurses who have graduated with RN degrees from
approved schools of nursing and who are currently registered by their state are considered
Nurses must be full-time (35 hoursweek or more) and on staff Private-duty nurses nursing
staff whose salary is financed entirely by outside sources (eg an agency or a research grant)
and LPNs are not counted Registered nurses more appropriately classified in other
occupational categories (eg supervisory nurses facility administrators) also are not counted
Trauma In 1992 the annual US News survey of board-certified physicians ranked the
presence of an emergency room and a hospitals trauma provider level high on a list of hospital
quality indicators Physicians in nine specialties ranked trauma as one of the top five indicators
of quality The indications of these specialists and resultant high factor loadings supported the
inclusion of this data for heart hormonal disorders digestive disorders gynecology kidney
disease neurology and neurosurgery orthopedics ear nose and throat respiratory disorders and
urology
The trauma indicator is dichotomous and reflects two variables from the AHA database
whether the hospital has a certified trauma center in the hospital and the level of the trauma
center To receive credit for trauma services hospitals must provide either Level 1 or Level 2
trauma services in-hospital (as opposed to providing trauma services only as part of a health
system network or joint venture) Levell trauma service is defined as a regional resource
trauma center which is capable of providing total care for every aspect of injury and plays a
leadership role in trauma research and education4 Level 2 is defined by the AHA as a
community trauma center which is capable ofproviding trauma care to all but the most severely
injured patients who require highly specialized care4
Discharge planning The three elements of discharge planning are patient-education
services case management services and patient representative services TA service must be
provided in-hospital to receive credit
Service mix This indicator ranges from 0 to 10 points and comprises alcoholdrug abuse
or dependency inpatient care hospice home health services social work services reproductive
health services psychiatric education services womens health centerservices and psychiatric
consultationlliaison services Services must be provided within the hospital We do not award a
half-point for items in this measure
10
L
Geriatric services This indicator ranges from 0 to 7 points and comprises arthritis
treatment centers adult day care programs patient representative services geriatric services
meals on wheels assisted living and transportation to health facilities Again to receive credit
for a service it must be provided in-hospital
Gynecology services This indicator was introduced in 19975 It provides a means to
better rate the quality of services a hospital provides for its gynecological and obstetric patients
High factor loadings provide support to this variables inclusion With a range of 0 to 4 the
services included are obstetric care reproductive health care birthing rooms and womens
health center The half-point scheme used for the technology indices was not employed for this
indicator
Medicalsurgical intensive care beds This indicator is new in 2001 it surfaced as an
important factor for the nephrology specialty The AHA database provides the number of
medical and surgical intensive care beds per facility To be counted beds must be physically
located within the hospital and set up and staffed at the end of the reporting period
To combine these structural variables we weight the elements to create a flnal
composite measure Using factor analysis we force a one-factor solution and use the resultant
loadings as weight values for each variable in the composite structural measure The
relative weight assigned to each element varies from specialty to specialty and from one release
to the next within specialty Figure 3 provides the factor weights assigned to each element for
the 2001 release
11
F
Fig
ure
3 F
acto
r Lo
adin
g by
Spe
cial
ty
CO
TH
Imiddot
Tec
hnic
al
V
olum
e R
Ns
lBed
s D
is-
Goomiddot
Inde
xes
chan
ze
Can
cer
73
59
70
70
Dig
esti
ve d
isor
ders
69
52
60
63
Ear
nos
e a
nd th
roat
72
54
64
63
Ger
iatr
ics
35
81
Gyn
ecol
ogy
61
71
I H
eart
72
62
65
61
I
56
Hor
mon
al d
isor
ders
71
53
56
65
I
63
Kid
ney
dise
ase
63
66
62
57
I 54
Neu
rolo
gy a
nd n
euro
surg
ery
68
54
62
66
62
Ort
hope
dics
69
46
54
66
63
Res
pira
tory
dis
orde
rs
50
73
31
51
58
Rhe
umat
olog
y 45
82
Uro
logy
73
49
C Process
The process dimension of the quality equation is the sum or net effect of physicians
clinical decision-making Physicians clinical choices about the use of medication or diagnostic
tests admission to the hospital or one ofits units and length ofstay account for a large fraction
of the outcomes experienced by patients However measurements ofprocess on a national scale
are extremely difficult to obtain In order to measure process we rely on an alternative measure
to act as a proxy for process We contend that when a qualified expert identifies a hospital as
one of the best he or she is in essence endorsing the process choices made at that hospital
Thus we use the nomination of a hospital by a board-certified specialist as a measure off process In order to collect these nominations we conduct an annual survey of board-certified
f - physicians As in past releases we have pooled nominations for the past three years [1999-2001] I to arrive at the process measure i
Survey sample The sample for the 2001 survey consists of 2550 board-certified
physicians selected from the American Medical Associations (AMA) Physician Masterfile of
811000 physicians From within the Masterfile we selected a target population of 194916
board-certified physicians who met the eligibility requirements listed in Figure 4 Stratifying by
region and by specialty within region we selected a probability (random) sample of 150
t l physicians from each of 17 specialty areas for a total of 2550 physicians The final sample
r includes both non-federal and federal medical and osteopathic physicians residing in the 50
states and the District ofColumbia Figure 4 displays the list of specialties surveyed in 2001
f Eligibility requirements We defined a probability sample of physicians who could
properly represent the 17 specialty groupings delineated by us News amp World Report We
used two rules of eligibility one related to a mapping between the 17 specialties and the AMAs
list of 85 self-designated specialties and the second related to a mapping between these 85
specialties and the 23 member boards of the American Boards ofMedical Specialties (ABMS)
Under the first rule we linked each of the 17 specialties to one or more relevant AMA
specialties from the list of AMA self-designated practice specialty codes Physicians who
designated a primary specialty in one of the 17 specialties were preliminarily eligible for the
survey Under the second rule the physicians must also be certified by the corresponding
member board of the ABMS Figure 4 displays the correspondence between the specialty [ specified for US News amp World Report AMA self-designated specialty and the corresponding
member board
13
Figure 4 Physician Sample Mapping
us NEWS SPECIALTY
Cancer
r Digestive disorders
Ear nose and throat
Eyes
Geriatrics
i
Gynecology L
Heart
Hormonal disorders
Kidney disease
Neurology and Neurosurgery
-l ~
Orthopedics
Pediatrics
Psychiatry
Rehabilitation
Respiratory disorders
Rheumatology
Urology
I AMAKEY CODE
HEMl22 ON24
GEl
OTO48
OPW46
FPG38 IMG38
GYN21 OBG42
CD08 CDS08
END14 DW12
NEP
N36 NS
ORS85
PO55 ADUOI
P63
PW62
PUD
RHU174
Ul91
AMASELF-middot DESIGNATED
Hematology Oncology
Gastroenterology
Otolaryngology
Ophthalmology
Geriatrics
Gynecology Obstetrics amp gynecology
Cardiovascular diseases Cardiovascular surgery
Endocrinology Diabetes
Nephrology
Neurology Neurological surgery
Orthopedic surgery
Pediatrics Adolescent medicine
Psychiatry
Physical medicine amp rehabilitation
Pulmonary diseases
Rheumatology
Urological surgery
14
AMERICAN BOARD OF
Internal medicine Internal medicine
almedicine
Otolaryngology
Ophthalmology
Internal medicine
Obstetrics amp gynecology Obstetrics amp gynecology
Internal medicine Surgery
Internal medicine Internal medicine
Internal Medicine
Psychiatry amp neurology
Orthopedic surgery
Pediatrics Pediatrics
Psychiatry amp neurology
Physical medicine amp rehabilitation
Internal medicine
I Internal medicine
Urology
r -
l
r
to
f -
1 bull
Stratification To compensate for the widely varying number of eligible physicians
across the targeted specialties we used different probabilities of selection for each grouping and
used proportionate stratification across the four United States Census regions (West Northeast
South and North Central) Within each of the 17 strata we achieved a sample that was also
geographically representative of the spread ofphysicians across the country
2001 physician survey Sampled physicians were mailed a three-page questionnaire (see
Appendix D) a cover letter and a prepaid return envelope We also included a token incentive
in the form of a two-dollar bilL One week after the initial survey mailing a reminder postcard
was sent to the sampled physicians Two weeks following the reminder mailing we sent a
second mailing to nonrespondents including the questionnaire a cover letter and a business reply
envelope Three weeks after the second mailing we re-sent the questionnaire to nonrespondents
This third mailing was sent by Federal Express and included the questionnaire a cover letter and
a business reply envelope
2001 questionnaire redesign In consultation with Dr Donald Dillman of Washington
State University a noted questionnaire designer we revised the physical layout of the project
questionnaire (Appendix D) so that respondents could read and complete it more easily We
believe that the redesign had appreciable impact on this years response rate (below and Figure
5)
Response rate Of the 2550 physicians surveyed for this years report 1377 physicians
returned a useable questionnaire a response rate of 547 percent (Response rate is calculated as
the ratio of completed questionnaires to the total eligible in accordance with standard practice
any member of the sample found to be ineligible was removed from the denominator of the
equation for calculation purposes) Figure 5 shows response rates by specialty for the three years
used for the 2001 index
2001 experiments NORC conducted two experiments as part of the physician survey
for 2001 Briefly the experiments were 1) a Web version of the survey permitting direct onshy
line response for physicians and 2) a comparison of explicit citations of the Americas Best
Hospitals project for US News amp World Report and implicit references to the 12th Annual
15
Survey of Physicians conducted for US News amp World Report Citations appeared on both the
cover letters and questionnaire cover As with last years experimental launching of the Web
version this years version was used successfully by a small number of respondents We plan to
evaluate the cost-effectiveness ofthis strategy before using it again next year With regard to the
project citation experiment half of the physicians in each specialty were told explicitly that their
responses would be used to rank hospitals in Americas Best Hospitals issue of US News amp
World Report and the other half were told that they were participating in an annual survey of
physicians for US News amp World Report Our comparison of the explicit and implicit project
citations indicated no difference in response rates The difference in the number of survey
questionnaires returned by each group within each specialty ranged from 1 to 8 Figure 5 [
details the total number of surveys returned for each specialty
16
r
~
r-
lt
ance
r ig
esti
ve d
isor
ders
orm
onal
dis
orde
rs
idne
y di
seas
e
euro
logy
and
esp
irat
ory
diso
rder
s gy
Fig
ure
5 R
espo
nse
Rat
e b
y Y
ear
(150
sam
pled
phy
sici
ans
per
spe
cial
ty p
erye
ar)
n 70
71
82
75
84
70
62
68
62
78
r
Weighting Weighting was carried out in two steps First weights were assigned to
physicians that reflected the probabilities of selection within specialty groups and the overall
rates ofresponse within these groups Second the weights from the first step were poststratified
using the two-dimensional contingency table of specialty (17 categories) by census region
(Northeast Midwest South and West) To check the weights we ~nfinned that the sum across
the sample of the weights in each cell of the classifications (specialty x region) equaled the
population size
D Outcome
Many healthcare professionals have decried the use of mortality rates because of
limitations in the methods used to adjust for risk Nonetheless research strongly suggests a
positive correlation between a risk-adjusted mortality rate that is better than average and overall
quality8-17 Based on these findings we used adjusted mortality rate as the outcome measure for
our quality of care model All predicted mortality rates were provided by Solucient Inc of
Evanston Ill using the All Patient Refined Diagnosis Related Group (APR-DRG) method
designed by 3M Health Information Systems The APR-DRG adjusts expected deaths for
severity of illness by means of principle diagnosis and categories of secondary diagnoses A
detailed description of the full APR-DRG methodology is provided in Appendix E Solucient
applied this method to the pooled 1997 1998 and 1999 data set of reimbursement claims made to
HCF A by hospitals These complete data sets were the most current available
2001 DRG refmements We annually review the DRG-groupings for every specialty In 2001
we chose to conduct a thorough examination of the DRG groupings in heart and orthopedics
Because we anticipated likely changes as a result we conducted two independent reviews
Solucient conducted a review of each specialty and an independent consultant shy
a cardiologist and an orthopedic surgeon--conducted a review in his specialty Where the two
reviews agreed as they did in each of the two specialties we implemented the recommended
changes Revisions for each specialty are detailed below
18
Heart DRGs Three DRGs were added
109 = Coronary bypass wlo cardiac cath
124 =Circulatory disorders except AMI w cardiac cath and complex diag
125 =Circulatory disorders except AMI w cardiac cath and wlo complex diag
Orthopedic DRGs Two DRGs were deleted and six were added
DeletedDRGs
214 =Back amp neck procedures wI CC
215 =Back amp neck procedures wlo CC
AddedDRGs
496 =Combined anteriorlposterior spinal fusion
497 = Spinal fusion wI CC r 498 = Spinal fusion wlo CC 501 =Knee proc wI pdx ofinfection wi CC
502 =Knee proc wI pdx ofinfection wlo CC
503 =Knee proc wlo pdx ofinfection
As in previous years we used an all-cases mortality rate for four specialties (geriatrics
gynecology ear nose and throat and rheumatology) rather than a specialty-specific rate either
because the number of hospitals with sufficient discharges in the particular DRG-grouping was
too low or because the DRG groupings proved to be less robust than was desired Appendix C r -
lists the DRGs for each specialty
In 2000 we modified the construction of the outcome measure The IRQ is the final
score for each hospital in the specialty rankings It gives equal weight to process (represented by
reputation) outcome (mortality) and structure (volume technology and other elements of the
hospital environment) The numbers produced for each of these three measures however differ
greatly in magnitude and in range or variability Without correcting for that the final score
even when the three measures are weighted equally would be distorted
19
Pre-2000 solution For each specialty prior to 2000 the calculated mortality ratio for each
hospital was inverted--the ratio of actual to expected deaths was divided into 1 so that as with
other measures higher meant better For example a better-than-expected mortality ratio of 08
would produce an inverted result of 125 a worse-than-expected ratio of 12 would produce an
inverted result of 083 (The published rankings continued to display the ratio of actual to
expected deaths) Then the scores for reputation mortality and structure were standardized or
adjusted so that the degree ofvariability in each measure was the same
A difficulty with this approach was that inverting caused very low mortality ratios to
distort the outcome (Inverted a mortality ratio of 025 produces a score of 4 a ratio of 005
produces a score of 20 and a ratio of 001 produces a score of 100) If instead of being divided
into 1 the mortality ratio is subtracted from I-this could be called reverse scoring-such extremes r
are eliminated Using reverse scoring a mortality ratio of 025 produces a score of 075 a ratio
of 005 produces a score of 095 and a ratio of 001 produces a mortality score of 99 This
maintains the magnitudes of the differences and avoids extreme values Accordingly the new
rankingsreflect reverse scoring in mortality To dampen the effect of year-to-year fluctuations
mortality scores will be averaged over three years
Finally scores at the extremes in mortality and in certain structural measures were
trimmed to eliminate the influence ofvery wide variation Figure 6 gives the percentile at which
each of the mortality distributions was trimmed
Lj Figure 6 Percentile at Which Each Mortality Distribution Was Trimmed
Specialty
Cancer
Digestive disorders
Ear nose and throat
Geriatrics
Gynecology
Heart
Hormonal disorders l ~
Percentile
95
99
95
99
99
95
95
Specialty Percentile
Kidney disease 99
Neurology and neurosurgery 99
Orthopedics 95
Respiratory disorders 99
Rheumatology 99
Urology 90
20
l
A second round of standardizing also was added in 2000 after trimming extremes
Previously this second standardization was not perfonned resulting in trimmed measures having
less influence on the final score than other measures did Restandardizing restores the balance so
that trimmed and untrimmed measures have the same influence
Phase-in The changes described affect the final scores so they are phased in over two
years For 2000 each hospitalts final score averaged pre-2000 and current methodologies As
before the top hospital in each specialty received a score of 100 with other hospitals scaled
down from that figure
In 2001 the phase-in is complete with the 2001 mortality ratios fully reflecting the
revised methodology
J
--
21
E Calculation of the Index
i
The calculation of the IRQ for each hospital (other than in specialties ranked solely on
reputation) considers equally the three dimensions of quality of care structure process and
outcome Although all three measures represent a specific aspect of quality a single score not
only provides an easier-to-use result but yields a more accurate portrayal of overall quality than
would the three aspects individually
Therefore in computing the final scores for a particular specialty the reputational score
mortality scores and the collective set of structural indicators receive arithmetically equivalent
importance
The total fonnula for calculation of the specialty-specific IHQs is
where
IHQi = Index for Hospital Quality for specialty i
Sl-n = Structural indicators (STRUCTURE)
F = Factor loading
P = Nomination score (PROCESS)
M = Standardized mortality ratio (OUTCOME)
The general fonnula for deriving the index scores for tertiary-level hospitals is the same
as it began in 1993 Each of the three components--structure process and outcomes--is
considered equally in determining the final overall score For presentation purposes we
standardized raw scores then equated the raw IRQ scores as computed above to a 100-point
scale where the top hospital in each specialty received a score of 100
The mean and standard deviation of each of the 17 specialties are listed in Figure 7
Note that for the four reputation-only rankings mean and standard deviation of the reputational
score are presented This data further illustrates that the spread of IRQ scores produces a very
small number of hospitals two and three standard deviations above the mean Horizontal lines
in each of the 17 specialty lists in Appendices F and G indicate the cutoff points of two and
three standard deviations above the mean
22
We could not calculate scores for hospitals that provide care in eyes pediatrics
psychiatry or rehabilitation because data for robust and meaningful structural and outcomes
measures are not available for these specialties Thus as shown in Appendix G we rank
hospitals in these specialties solely by reputation Although the four reputation-only specialties
are ranked without the Index of Hospital Quality standard deviations of the reputational scores
are still useful in identifying truly superior hospitals (in terms of statistically relevant nomination
scores)
Figure 7 Mean and Standard Deviations ofIHQ and Reputational Scores
Mean Standard deviation 1 SD above Z SDs above 3 SDs above the mean the mean the mean
~- IHQScore
Cancer 2390 652 3042 3694 4346
Digestive disorders 1514 538 2052 2590 3128
Ear nose and throat 2064 647 2711 3358 4005
Geriatrics 2049 588 2637 3225 3813 Gynecology 1857 598 2455 3053 3651
Heart 2079 674 2753 3427 4101 Hormonal disorders 2545 574 3119 3693 4267 Kidney disease 2600 758 3358 4116 4874
Neurology and 1781 562 2343 2905 3467 neurosurgery Orthopedicsmiddot 1960 539 2499 3038 3577I Respiratory disorders 1665 569 I 2234 2805 3372 Rheumatology 3768 454 4222 4676 5130 Urology 1930 502 2432 2934 3436
Reputational Score
lEyes 455 1272 1727 2999 4271 [pediatrics 299 659 958 1617 2276 psychiatry 252 524 776 1300 1824 Rehabilitation 287 777 1064 1841 2618
23
III Directions for Future Releases
The US News Index has since its inception used the most rigorous methodology
available to define measure and combine the components of quality incorporated in its
construction Over the next few years we plan to subject each of the components (process
outcome and structure) to a searching re-examination We are aware that the skewed
distribution of the reputation scores can appear to give an inappropriate advantage to hospitals
that obtain a high percentage ofnominations and we will continue to examine the way in which
the reputation scores are used to define the process score We intend to test and evaluate
different transformations of the raw scores to see whether a transformation would produce a
bull i superior measure With regard to outcome the refinement of definitions of non-fatal outcomesshy
particularly in some specialties-suggests incorporating some of these measures into outcome
scores We will continue to refine and develop our measures of technology for the structural
component Finally we will re-examine the way in which the three components are combined
into the IHQ There may be ways to maintain the principle of equal weight for the three
components while improving the method ofcombining them
We will also examine the possibility of extending the evaluation of the four specialties
that are currently ranked only on reputation to incorporate appropriate structure and outcome
measures
As in years past we welcome input from users of the index in charting new directions
Readers and users are encouraged to contact the authors with suggestions and questions
j bull
24
l
lmiddot
References 1 Donabedian A Evaluating the quality of medical care The Milbank Memorial Fund Quarterly
1966 44166-203
2 Donabedian A Promoting quality through evaluating the process of patient care Med Care 1968 6181
3 Hill CA Winfrey KL Rudolph BA Best Hospitals A description of the methodology for the index ofhospital quality Inquiry 1997 34(1)80-90
4 American Hospital Association 1996 Annual Survey of Hospitals Data Base Documentation Manual
5 Ehrlich RH Hill CA Winfrey KL 1997 Survey oBest Hospitals Chicago NORC 1997
6 Hill CA Winfrey KL1995 Survey on Best Hospitals Chicago NORC 1995
7 Palella FJ Jr Delaney KM Moorman AC Loveless MO Fuhrer J Satten GA Aschman DJ Holmberg SD Declining Morbidity and Mortality Among Patients With Advanced Human Immunodeficiency Virus Infection N Engl J Med 1998 338853-860
8 United States Department of Health and Human Services Medicare hospital mortality information HCFA publication 01-002 Report prepared by Otis R Bowen and William L Roper Washington DCUSGPO 1987
9 Blumberg MS Comments on HCFA hospital death rate statistical outliers HSR Health Services Research 1987 21715-40
10 Dubois RW Brook RH Rogers WH Adjusted hospital death rates a potential screen or the quality ofmedical care MPH 1987 771162-6
11 Gillis KD Hixson JS Efficacy of statistical outlier analysis for monitoring quality of care Journal oBusiness and Economic Statistics 1991 9241-52
12 Green J Wintfield N Sharkey P Passman LJ The importance of severity of illness in assessing hospital mortality JAMA 1990 263241-6
13 Green J Passman LJ Wintfield N Analyzing hospital mortality the consequences ofdiversity in patient mix JAMA 1991 2651849-53
14 Greenfield S Aronow HU ElashoffRM Watanabe D Flaws in mortality data the hazards of ignoring comorbid disease JAMA 1988 2602253-7
15 Rosen HM Green BA The HCFA excess mortality lists a methodological critique Hospital and Health Services Administration 1987 2119-24
16 Flood AB Scott WR Conceptual and methodological issues in measuring the quality of care in hospitals In Hospital structure and performance Baltimore Johns Hopkins University Press 1987
17 Iezzoni LI Ash AS Coffinan GA Moskowitz MA Predicting in-hospital mortality a comparison of severity measurement approaches Med Care 1992 30347-59
25
Appendix A
Technology Indices by Specialty t
1
All Hospital Index
17 elements (used to define eligible hospitals)
r
Cancer
7 Elements
AnRioplasty Cardiac Catheterization Lab
Cardiac Intensive Care Beds
Computed Tomography Scanner
Diagnostic Radioisotope Facility
Diagnostic Mammography Services
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
MedicaVSurgical Intensive Care
Neonatal Intensive Care Beds
Open Heart Surgery
Pediatric Intensive Care Beds
Positron Emission Tomography Scanner
ReprQductive Health
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraphy Scanner Magnetic Resonance Imaging
Oncology Services
Pediatric Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
I Digestive disorders
8 Elements Computed Tomography Scanner Diagnostic Radioisotope Facility
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound i
X-ray Radiation Therapy
Ear Nose and Throat
5 Elements Comouted Tomorrraohv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
Heart
9 Elements Angioplasty Cardiac Catheterization Lab
Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Open Heart Surgery
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
j
Hormonal disorders
7 Elements
Geriatrics
8 Elements
Gynecology
8 Elements
Computed TomoRraphv Scanner Diagnostic Radioisotope Facility
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Cardiac Catheterization Lab Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraDhv Scanner Diagnostic Mammography Services
Magnetic Resonance Imaging
Neonatal Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Kidney disease
5 Elements
Neurology and f Neurosurgery t j
7 Elements
t
l
Orthopedics
5 Elements I t
Respiratory disorders 4 Elements
Extracorporeal Shock Wave Lithiotripter Ultrasound
Computed Tomography Scanner
Diagnostic Radioisotope FacUity
Transplant Services
Computed Tomography Scanner Diagnostic Radioisotope FacUity
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed Tomolraphv Scanner Magnetic Resonance Imaging
Positron Emissions Tomography Scanner
Single Photon Emissions Computed Tomography
Ultrasound
Computed Tomographv Scanner Diagnostic Radioisotope FacUity
Radiation Therapy
Ultrasound
Rheumatology
5 Elements Computed TomoJraphv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
Urology
8 Elements Extracorporeal Shock Wave Lithiotripter X-ray Radiation Therapy
Computed Tomography Scanner
Diagnostic Radioisotope Facility
i Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
(
i
AppendixB
Structural Variable Map
f
L
r
t bull
r
tJ
L
The following variables used to construct structural elements of the 2001 IHQ were taken from the 1999 Annual Survey of Hospitals Data Base published by the American Hospital Association
ALL HOSP~TAL ~NDBX - used to define hospital eligibility 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ~GIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICBDHOS=l half point if CICBDSYS CICBDNET or CICBDVEN=l 1 point if CTS CNHOS=1 half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if MSICHOS=l half point if MSICSYS MSICNET or MSICVEN=l 1 point if NICBDHOS=l half point if NICBDSYS NICBDNET or NICBDVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PEDBDHOS=l half point if PEDBDSYS PEDBDNET or PEDBDVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if REPROHOS=l half point if REPROSYS REPRONET or REPROVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Cancer Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if ONCOLHOS=l half point if ONCOLSYS ONCOLNET or ONCOLVEN=l 1 point if PEDICHOS=l half point if PEDICSYS PEDICNET or PEDICVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
Digestive Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Ear I Nose and Throat Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRIVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
1
Heart Technology Index 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ANGIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNETor CICVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Hormonal Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRlHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Geriatrics Technology Index 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNET or ClCVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETROS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Gynecology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if NICHOS=l half point if NICSYS NICNET or NlCVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Kidney Disease Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=lhalf point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if TPLNTHOS=l half point if TPLNTSYS TPLNTNET or TPLNTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Neurology and Neurosurgery Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Orthopedics TeChn610gy ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Respiratory Disorders Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Rheumatology Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Urology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
r
I
Discharge Planning COTH ] point if CMNGTHOS=] Yes if MAPP8=1 ] point if PATEDHOS=] 1 point if PATRPHOS=l RN I s to Beds
Full-time Registered Nurses Geriatric Services (FTRNTF) divided by Total Hospital 1 point if ADULTHOS=l Beds (HOSPBD) ] point if ARTHCHOS=l 1 point if ASSTLHOS=l Trauma ] point if GERSVHOS=l Yes if TRAUML90=] or 2 and 1 point if MEALSHOS=l TRAUMHOS=l 1 point if PATRPHOS=l 1 point if TPORTHOS=l
Gynecology Services 1 point if BROOMHOS=l 1 point if OBLEV=2 or 3 and OBHOS=] 1 point if REPROHOS=l
l ~
1 point if WOMHCHOS=l r ~
Service Mix ] point if ALCHHOS=l ] point if COUTRHOS=l 1 point if HOMEHHOS=l ] point if HOSPCHOS=l ] point if PSYEDHOS=] 1 point if PSYLSHOS=] 1 point if REPROHOS=l ] point if SOCWKHOS=] ] point if WOMHCHOS=]
l
i
1
[ l
AppendixC
Diagnosis-Related Group (DRG) Groupings l by Specialty
r 1
DRG10 DRGll DRG64 DRG82 DRGl72 DRG173 DRG199 DRG203 DRG239
DRG257 DRG258 DRG259 DRG260 DRG274
r 1 DRG275 DRG338 DRG344 DRG346 DRG347 DRG354 DRG355 DRG357 DRG366 DRG367 DRG400 DRG401 DRG402 DRG403 DRG404 DRG405 DRG409 DRG410 DRG411 DRG412 DRG413 DRG414
r 1 DRG473 DRG492
1
U
I 1
LJ
Cancer
NERVOUS SYSTEM NEOPLASMS W CC NERVOUS SYSTEM NEOPLASMS WIO CC EAR NOSE MOUTH amp TIIROAT MALIGNANCY RESPIRATORY NEOPLASMS DIGESTIVE MALIGNANCY W CC DIGESTIVE MALIGNANCY WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS PAlHOLOGICAL FRACTURES amp MUSCULOSKELETAL amp CONN TISS MALIGNANCY TOTAL MASTECTOMY FOR MALIGNANCY W CC TOTAL MASTECTOMY FOR MALIGNANCY WIO CC SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC SUBTOTAL MASTECTOMY FOR MALIGNANCY WIO CC MALIGNANT BREAST DISORDERS W CC MALIGNANT BREAST DISORDERS WIO CC TESTES PROCEDURES FOR MALIGNANCY OTHER MALE REPRODUCTIVE SYSTEM OR PROCEDURES FOR MALIGNANCY MALIGNANCY MALE REPRODUCTIVE SYSTEM W CC MALIGNANCY MALE REPRODUCTIVE SYSTEM WIO CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG W CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG WIO CC UTERINE amp ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY MALIGNANCY FEMALE REPRODUCTIVE SYSTEM W CC_ MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WIO CC LYMPHOMA amp LEUKEMIA W MAJOR OR PROCEDURE LYMPHOMA amp NONmiddotACUTE LEUKEMIA W OTHER OR PROC W CC LYMPHOMA amp NON-ACUTE LEUKEMIA W OTHER OR PROC WIO CC LYMPHOMA amp NON-ACUTE LEUKEMIA W CC LYMPHOMA amp NON-ACUTE LEUKEMIA WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGE 0-17 RADIOlHERAPY CHEMOTHERAPY WIO ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS HISTORY OF MALIGNANCY WIO ENDOSCOPY HISTORY OF MALIGNANCY W ENDOSCOPY OlHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGEgt17 CHEMOTHERAPY W ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS
DRG146 DRG147 DRG148 DRG149 DRG150 DRG151 DRG152 DRG153 DRG154 DRG155 DRG156 DRG170
l i DRG171 DRG174 DRG175
L DRG176 DRG177 DRG178 DRG179 DRG180 DRG181 DRG182 DRG183 DRG184 DRG188
l DRG189 DRG190 DRG191
i J DRG192 DRG193 DRG194 DRG195 DRG196 DRG197
t
LeJ DRG198 DRG200 DRG201 DRG202 DRG204 DRG205 DRG206 DRG207 DRG208 DRG493 DRG494
Digestive Disorders
RECTAL RESECTION W CC RECTAL RESECTION WIO CC MAJOR SMALL amp LARGE BOWEL PROCEDURES W CC MAJOR SMALL amp LARGE BOWEL PROCEDURES WIO CC PERITONEAL ADHESIOLYSIS W CC PERITONEAL ADHESIOLYSIS WIO CC MINOR SMALL amp LARGE BOWEL PROCEDURES W CC MINOR SMALL amp LARGE BOWEL PROCEDURES WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE gt17 W CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGEgt17 WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE 0-17 OTHER DIGESTIVE SYSTEM OR PROCEDURES W CC OTHER DIGESTIVE SYSTEM OR PROCEDURES WO CC G HEMORRHAGE W CC GJ HEMORRHAGE WIO CC COMPLICATED PEPTIC ULCER UNCOMPLICATED PEPTIC ULCER W CC UNCOMPLICATED PEPTIC ULCER WIO CC INFLAMMATORY BOWEL DISEASE GI OBSTRUCTION W CC GI OBSTRUCTIONWO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 W CC ESOPHAGmS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 WIO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGE 0-17 OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 W CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 WIO CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0-17 PANCREAS LIVER amp SHUNT PROCEDURES W CC PANCREAS LIVER amp SHUNT PROCEDURES W 10 CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE W CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE WIO CC CHOLECYSTECTOMY W CDE W CC CHOLECYSTECTOMY W CDE WIO CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE W CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY OTHER HEPATOBILIARY OR PANCREAS OR PROCEDURES CIRRHOSIS amp ALCOHOLIC HEPATITIS DISORDERS OF PANCREAS EXCEPT MALIGNANCY DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEP A W CC DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEPA WIO CC DISORDERS OF THE BILIARY TRACT W CC DISORDERS OF THE BILIARY TRACT WO CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE W CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE WO CC
DRG49 DRG50 DRG51 DRG55 DRG57 DRG58 DRG61 DRG62 DRG63 DRG65 DRG66 DRG67
DRG68
DRG69 DRG70 DRG71 DRG72 DRG73 DRG74
DRG353 DRG356 DRG358 DRG359 DRG360 DRG361 DRG362 DRG363 DRG364 DRG365 DRG368 DRG369
Ear Nose and Throat
MAJOR HEAD amp NECK PROCEDURES SIALOADENECTOMY SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY MISCELLANEOUS EAR NOSE MOUTH amp TIiROAT PROCEDURES TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGEgt17 TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGE 0-17 MYRINGOTOMY W TUBE INSERTION AGE gt17 MYRINGOTOMY W TUBE INSERTION AGE 0-17 OTHER EAR NOSE MOUTH amp TIiROAT OR PROCEDURES DYSEQUILIBRIUM EPISTAXIS EPIGLOTTITIS
OTITIS MEDIA amp URI AGEgt17 W CC OTITIS MEDIA amp URI AGEgt17 WIO CC OTITIS MEDIA amp URI AGE 0-17 LARYNGOTRACHEITIS NASAL TRAUMA amp DEFORMITY OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE gt17 OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE 0-17
Geriatrics ALL CASES
Gynecology
PELVIC EVISCERATION RADICAL HYSTERECTOMY amp RADICAL VULVECTOMY FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY W CC UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY WIO CC VAGINA CERVIX amp VULVA PROCEDURES LAP AROSCOPY amp INCISIONAL TUBAL INTERRUPTION ENDOSCOPIC TUBAL INTERRUPTION DampC CONIZATION amp RADIO-IMPLANT FOR MALIGNANCY DampC CONIZATION EXCEPT FOR MALIGNANCY OrnER FEMALE REPRODUCTIVE SYSTEM OR PROCEDURES INFECTIONS FEMALE REPRODUCTIVE SYSTEM MENSTRUAL amp OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
DRG103 DRGl04 DRG105 DRG106 DRG107 DRG108 DRG109
DRG1l0 DRG1l1 DRG112 DRG115 DRG1l6 DRG117 DRG118 DRG121 DRG122 DRG123 DRG124 DRG125 DRG126 DRG127 DRG128 DRG129 DRG130 DRG131 DRG132 DRG133 DRG135 DRG136 DRG137 DRG138 DRG139 DRG140 DRG141middot DRG142 DRG 144 DRG145
r i
f ~
Heart
HEART TRANSPLANT CARDIAC VALVE PROCEDURES W CARDIAC CATH CARDIAC VALVE PROCEDURES WIO CARDIAC CATH CORONARY BYPASS W CARDIAC CATH CORONARY BYPASS WIO CARDIAC CATH OTHER CARDIOTHORACIC PROCEDURES CORONARY BYPASS WIO CARDIAC CATH
MAJOR CARDIOVASCULAR PROCEDURES W CC MAJOR CARDIOVASCULAR PROCEDURES WIO CC PERCUTANEOUS CARDIOVASCULAR PROCEDURES PERM CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK OTH PERM CARDIAC PACEMAKER IMPLANT OR AICD LEAD OR GENERATOR PRO
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT CARDIAC PACEMAKER DEVICE REPLACEMENT CIRCULATORY DISORDERS W AMI amp CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI WIO CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI EXPIRED CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH AND CMPLX DIAG CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH WIO CMPLX DIAG ACUTE amp SUBACUTE ENDOCARDmS HEART FAILURE amp SHOCK DEEP VEIN THROMBOPHLEBITIS CARDIAC ARREST UNEXPLAINED PERIPHERAL VASCULAR DISORDERS W CC PERIPHERAL VASCULAR DISORDERS WIO CC ATHEROSCLEROSIS W CC ATHEROSCLEROSIS WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 W CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGE 0-17 CARDIAC ARRHYTIIMIA amp CONDUCTION DISORDERS W CC CARDIAC ARRHYTHMIA amp CONDUCTION DISORDERS WIO CC ANGINA PECTORIS SYNCOPE amp COLLAPSE W CC SYNCOPE amp COLLAPSE WIO CC OTHER CIRCULATORY SYSTEM DIAGNOSES W CC OTHER CIRCULATORY SYSTEM DIAGNOSES WIO CC
1
DRG286 DRG287 DRG288 DRG289 DRG290 DRG292 DRG293 DRG294 DRG295 DRG296 DRG297
t DRG298 DRG299
DRG300 DRG301
~- --j
DRG316 DRG317 DRG320 DRG321 DRG322 DRG325 DRG326 DRG327 DRG 331 DRG332 DRG333
f
Hormonal Disorders
ADRENAL amp PITUITARY PROCEDURES SKIN GRAFTS amp WOUND DEBRID FOR ENDOC NUTRlT amp METAB DISORDERS OR PROCEDURES FOR OBESITY P ARA1HYROID PROCEDURES 1HYROIDPROCEDURES OrnER ENDOCRINE NUTRIT amp METAB OR PROC W CC 01HER ENDOCRINE NUTRIT amp METAB OR PROC WIO CC DIABETES AGE gt35 DIABETES AGE 0-35 NUTRlTIONAL amp MISC METABOLIC DISORDERS AGEgt17 W CC NUTRITIONAL amp MISC METABOLIC DISORDERS AGE gt17 WIO CC NUTRlTIONAL amp MISC METABOLIC DISORDERS AGE 0-17 INBORN ERRORS OF METABOLISM ENDOCRINE DISORDERS W CC ENDOCRINE DISORDERS WIO CC
Kidney Disease
RENAL FAILURE ADMIT FOR RENAL DISEASE KIDNEY amp URINARY TRACT INFECTIONS AGE gt17 W CC KIDNEY amp URINARY TRACT INFECTIONS AGEgt17 WIO CC KIDNEY amp URINARY TRACT INFECTIONS AGE 0-17 KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 W CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 WIO CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMS AGE 0-17 01HERKIDNEY amp URINARY TRACT DIAGNOSES AGE gt17 W CC 01HER KIDNEY amp URINARY TRACT DIAGNOSESgt 17 WIO CC 01HER KIDNEY amp URINARY TRACT DIAGNOSES AGE 0-17
Neurology and Neurosurgery
DRGl CRANIOTOMY AGE gt17 EXCEPT FOR TRAUMA DRG2 CRANIOTOMY FOR TRAUMA AGEgt17 DRG3 CRANIOTOMY AGE 0-17 DRG4 SPINAL PROCEDURES DRG5 EXTRACRANIAL VASCULAR PROCEDURES DRG6 CARPAL TUNNEL RELEASE DRG7 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC W CC DRG8 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC WIO CC DRG9 SPINAL DISORDERS amp INJURIES DRG12 DEGENERATIVE NERVOUS SYSTEM DISORDERS
j DRG13 MULTIPLE SCLEROSIS amp CEREBELLAR ATAXIA DRG14 SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA DRG15 TRANSIENT ISCHEMIC ArrACK amp PRECEREBRAL OCCLUSIONS DRG16 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC DRG17 NONSPECIFIC CEREBROVASCULAR DISORDERS WIO CC DRG18 CRANIAL amp PERIPHERAL NERVE DISORDERS W CC DRG19 CRANIAL amp PERIPHERAL NERVE DISORDERS WIO CC DRG20 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGmS DRG21 VIRAL MENlNGITIS DRG22 HYPERTENSIVE ENCEPHALOPATHY DRG23 NONTRAUMATICSTUPORampCOMA DRG24 SEIZURE amp HEADACHE AGEgt17 W CC DRG25 SEIZURE amp HEADACHE AGEgt17 WIO CC DRG26 SEIZURE amp HEADACHE AGE 0-17 DRG27 TRAUMATIC STUPOR amp COMA COMA gt1 HR DRG28 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGEgt17 W CC DRG29 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE gt17 WIO CC
imiddot DRG30 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE 0-17 DRG31 CONCUSSION AGEgt17 W CC DRG32 CONCUSSION AGEgt17 WIO CC DRG33 CONCUSSION AGE 0-17 DRG34 OTHER DISORDERS OF NERVOUS SYSTEM W CC DRG35 OTHER DISORDERS OF NERVOUS SYSTEM WIO CC
(
DRG209 DRG210 DRG211 DRG212 DRG213 DRG216 DRG217 DRG218 DRG219 DRG220 DRG221 DRG222 DRG223 DRG224 DRG225 DRG226 DRG227 DRG228 DRG229 DRG230 DRG231 DRG232 DRG233 DRG234 DRG235
j DRG236 DRG237 DRG238 DRG240 DRG241 DRG471 DRG485
DRG491 DRG496 DRG497 DRG498
f DRG501 DRG502 DRG503
Orthopedics
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 W CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 WIO CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0-17 AMPUTATION FOR MUSCULOSKELETAL SYSTEM amp CONN TISSUE DISORDERS BIOPSIES OF MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE WND DEBRID amp SKN GRFT EXCEPT HANDFOR MUSCSKELET amp CONN TISS DIS LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 W CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 WIO CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGE 0-17 KNEE PROCEDURES W CC KNEE PROCEDURES WO CC MAJOR SHOULDERIELBOW PROC OR OTHER UPPER EXTREMITY PROC W CC SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC WIO CC FOOT PROCEDURES SOFT TISSUE PROCEDURES W CC SOFT TISSUE PROCEDURES WIO CC MAJOR THUMB OR JOINT PROCOR OTH HAND OR WRIST PROC W CC HAND OR WRIST PROC EXCEPT MAJOR JOINT PROC WIO CC LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES OF HIP amp FEMUR LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES EXCEPT HIP amp FEMUR ARTHROSCOPY OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC W CC OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC WIO CC FRACTURES OF FEMUR FRACTURES OF HIP amp PELVIS SPRAINS STRAINS amp DISLOCATIONS OF HIP PELVIS amp THIGH OSTEOMYELmS CONNECTIVE TISSUE DISORDERS W CC CONNECTIVE TISSUE DISORDERS WIO CC BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY LIMB REATTACHMENT HIP AND FEMUR PROC FOR MULT SIGNIFICANT
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY COMBINED ANTERIORIPOSTERIOR SPINAL FUSION SPINAL FUSION WI CC SPINAL FUSION WIO CC KNEE PROC WI PDX OF INFECTION WI CC KNEE PROC WI PDX OF INFECTION WOCC KNEE PROC WOPDX OF INFECTION WI CC
~ t L ~
l
DRG76 DRG77 DRG78 DRG79 DRG80 DRG81 DRG85 DRG86 DRG87 DRG88 DRG89 DRG90 DRG91 DRG92 DRG93 DRG94 DRG95 DRG96 DRG97 DRG98 DRG99 DRG100 DRG101 DRG102 DRG475
DRG242 DRG244 DRG245 DRG246 DRG247 DRG256
i_J
Respiratory Disorders
OTHER RESP SYSTEM OR PROCEDURES W CC OTHER RESP SYSTEM OR PROCEDURES WO CC PULMONARYEMBOUSM RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 W CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 WO CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGE 0-17 PLEURAL EFFUSION W CC PLEURAL EFFUSION WO CC PULMONARY EDEMA amp RESPIRATORY F AlLURE CHRONIC OBSTRUCTIVE PULMONARY DISEASE SIMPLE PNEUMONIA amp PLEURISY AGEgt17 W CC SIMPLE PNEUMONIA amp PLEURISY AGEgt17 WO CC SIMPLE PNEUMONIA amp PLEURISY AGE 0-17 INTERSTITIAL LUNG DISEASE W CC INTERSTITIAL LUNG DISEASE W 10 CC PNEUMOTIIORAX W CC PNEUMOTIIORAX WO CC BRONCHmS amp ASTIIMA AGEgt17 W CC BRONCHmS amp ASTIIMA AGEgt17 WO CC BRONCIDTIS amp ASTIIMA AGE 0-17 RESPIRATORY SIGNS amp SYMPTOMS W CC RESPIRATORY SIGNS amp SYMPTOMS WO CC OTHER RESPIRATORY SYSTEM DIAGNOSES W CC OTHER RESPIRATORY SYSTEM DIAGNOSES WO CC RESPIRATORY SYSTEM DIAGNOSIS WITII VENTILATOR SUPPORT
Rheumatology
SEPTIC ARTHRITIS BONE DISEASES amp SPECIFIC ARTHROPATIIIES W CC BONE DISEASES amp SPECIFIC ARTHROPATIDES WO CC NON-SPECIFIC ARTHROPATHIES SIGNS amp SYMPTOMS OF MUSCULOSKELETAL SYSTEM amp CONN TISSUE OTIIER MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE DIAGNOSES
DRG302 DRG303 DRG304 DRG305 DRG306 DRG307 DRG308 DRG309 DRG31O DRG311 DRG312 DRG313 DRG314
DRG315 DRG323 DRG324 DRG328 DRG329 DRG330 DRG334 DRG335 DRG336 DRG337 DRG339 DRG340 DRG341 DRG342 DRG343 DRG348 DRG349 DRG350 DRG351 DRG352
Urology
KIDNEY TRANSPLANT KIDNEYURETER amp MAJOR BLADDER PROCEDURES FOR NEOPLASM KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL W CC KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL WIO CC PROSTATECTOMY W CC PROSTATECTOMY WIO CC MINOR BLADDER PROCEDURES W CC MINOR BLADDER PROCEDURES WIO CC TRANSURETHRAL PROCEDURES W CC TRANSURETHRAL PROCEDURES WIO CC URETHRAL PROCEDURES AGE gt17 W CC URETHRAL PROCEDURES AGEgt17 WIO CC URETHRAL PROCEDURES AGE 0-17 OTHER KIDNEY amp URINARY TRACT OR PROCEDURES URINARY STONES W CC amplOR ESW LTIHOTRIPSY URINARY STONES WIO CC URETHRAL STRICTURE AGEgt17 W CC URETHRAL STRICTURE AGE gt17 WIO CC URETHRAL STRICTURE AGE 0-17 MAJOR MALE PELVIC PROCEDURES W CC MAJOR MALE PELVIC PROCEDURES WIO CC TRANSURETHRAL PROSTATECTOMY W CC TRANSURETHRAL PROSTATECTOMY WIO CC TESTES PROCEDURES NON-MALIGNANCY AGEgt17 TESTES PROCEDURES NON-MALIGNANCY AGE 0-17 PENIS PROCEDURES CIRCUMCISION AGEgt17 CIRCUMCISION AGE 0-17 BENIGN PROSTATIC HYPERTROPHY W CC BENIGN PROSTATIC HYPERTROPHY WIO CC INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM STERILIZATION MALE OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES
AppendixD
f 2001 Sample Physician Questionnaire
( Americas Best Hospitals)
This survey of physicians judgments provides the
basis for the reputation component of the annual
ranking of hospitals for U S News amp World Report
c
Conducted by the National Opinion Research Center at the University of Ctlicago 1155 East 60th Street Chicago IL 60637
( THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with rehabilitation regardless of location or expense (weve provided space for both hospital andlor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
l L Answers to these questions will help Have your patients been helped ormiddot
us to understand the impact of the hindered by the information they have Internet on medica practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions
D Neith~imiddoto Yes
D BothONo D Does notapply
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
D Helped
D Hindered
D Neither
D Both
D I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D A day or two a week
l D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical L company web sites
DYes D No
D Does not apply
Do you ever access medical association web sites
DYes D No
ri D Does not apply L
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet isbullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes D No
Do you allow your patients to communicate with you via electronic mail
DYes o No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes D No
D Does not apply
Thank you again for your participation
r I
l~
National Opinion Research Center at the University of Chicago 1155 East 60th Street Chicago IL 60637
Jbullbullbull
(12th Annual Survey of PhysiciansJ Direct input from physicians is
crucial in evaluating hospital quality_ f
Conducted by the National Opinion Research Center at the University of Chicago 1155 East 60th Street Chica9o IL 60637
l J
(THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with cancer regardless of location or expense (weve provided space for both hospital andor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
Answers to these questions will help Have your patients been helped or us to understand the Impact of the hindered by the information they have Internet on medical practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions o NeitherOmiddotYes o BothD No o Does not apply
-Continued
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
HelpedD HinderedD NeitherD BothD
0 I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D Aday or two a week
D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical company web sites
DYes
D No
D Does not apply
Do you ever access medical association web sites
DYes
D No
D Does not apply
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet is bullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes
D No
Do you allow your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Thank you again for your participation
r
r
1 National Opinion Research Center at th~ University of Chicagobull 0 __ bull bull
1155 East 60th Street Chicago IL 60637
AppendixE
Predicted Mortality APR-DRG Methodology
r
shyi
Introduction to DRGs
The All Patient Refined Diagnosis Related Groups (APR-DRGs) were developed by 3M Health
Information Systems (3M-HIS) in conjunction with the National Association of Childrens Hospitals and
Related Institutions (NACHRI) APR-DRGs expand the basic diagnosis-related group (DRG) structure to
address patient severity of illness risk ofmorta1ity and resource intensity The APR-DRG Version 140
uses the Health Care Financing Administration (HCFA) Version 140 DRG methodology Because APRshy
DRGs are based on DRGs and All Patient DRGs (AP-DRGs) a brief explanation of both structures will
be useful
Current HCFA DRG Structure
Created from Adjacent Diagnosis Related Groups (ADGs) which combine patients into groups
with common characteristics DRGs were developed by Yale University in the 1970s to relate a
hospitals case mix index to the resource demands and associated costs experienced by the hospital
ADGs were created by subdividing an MDC1 into two groups based on the presence or absence of
an operating room procedure Surgical patients identified as those having an operating room procedure
were then classified by type ofprocedure to form surgical ADGs Patients with multiple procedures were
assigned to the highest surgical class Medical patients were divided into smaller groups based on their
principal diagnosis to form medical ADGs
DRGs use ADGs as a base and then further classify patients into selected disease and procedure
categories based on whether or not they have substantial comorbidities or complications (CC)
Approximately 3000 diagnosis codes have been designated by HCFA as substantial CCs (defined by a
list of additional diagnosis codes that a panel of physicians felt would increase the length of stay by at
least one day for 75 percent of the patients) This list covers a broad range of disease conditions and no
differentiation in severity or complexity level was made among the additional diagnoses The patients
age and discharge status were sometimes used in the definition ofDRGs
r
1 Major Diagnostic Categories (MDCs) are broad medical and surgical categories one step hierarchically higher than DRGs (several DRGs roll-up into an MDC) MDCs are divided by body systems such as nervous ear nose and throat and respiratory
Current AP-DRG Structure
In 1987 the New York State Department of Health entered into an agreement with 3M-HIS to
evaluate the applicability of DRGs to a non-Medicare population with a specific focus on neonates and
patients with Human Immunodeficiency Virus (HIV) infections The DRG definitions developed by this
relationship are referred to as the AP-DRGs
The AP-DRGs are modeled after the HCF A DRGs and attempt to improve the DRGs in an effort
to more accurately predict a hospitals resource demands and associated costs for all acute care patients
In the creation ofAP-DRGs the modifications made to the DRG structure can be summarized as follows
bull Except for neonates who die or are transferred within the first few days of life AP-DRGs define six ranges ofbirth weight that represent distinct demands on hospital resources Within each birth weight range neonates are then subdivided based on the presence of a significant operating room procedure and then further subdivided based on presence ofmultiple major minor or other problems
bull Assignment to neonatal MDC is based on age Specifically the AP-DRGs assign a patient to the neonatal MDC when the age of the patient is less than 29 days at admission regardless of the principal diagnosis
bull MDC 25 was created to account for the highly specialized treatment of multiple trauma patients Patients assigned to MDC 25 have at least two significant trauma diagnoses from different body sites
bull MDC 20 for alcohol and substance abuse was restructured to differentiate patients based on the substance being abused
bull Across all MDCs patient with a tracheostomy were put into either of two tracheostomy AP-DRGs tracheostomy performed for therapeutic reasons and tracheostomy representing long-term ventilation
bull All liver bone marrow heart kidney and lung transplant patients were assigned to an AP-DRG independent of the MDC ofthe principal diagnosis
bull For several MDCs a single major comorbidity and complication (CC) AP-DRG was formed across all surgical patients within an MDC and a single major CC AP-DRG was formed across all medical patients within an MDC
I I The AP-DRGs introduced changes to the HCF A DRGs in an attempt tomiddot depart from using the
LJ principal diagnosis as the initial variable for assignment The AP-DRGs were designed to more
accurately group patients into like groups that provide an operational means of defining and measuring a
hospitals case mix complexity
r
All Patient Refined DRGs
APR-DRG Objectives
The primary objective of the RCF A DRG and AP-DRG patient classification systems was to
relate the type ofpatients treated to the hospital resources they consumed This limited focus on resource
intensity does not allow providers to classify patients into other groups for meaningful analysis The
APR-DRG patient classification system goes beyond traditional resource intensity measures and was
designed with the ability to address the following needs
bull Compare hospitals across a wide range ofresource and outcome measures
bull Evaluate differences in inpatient mortality rates
bull Implement and support critical pathways
bull Identify continuous quality improvement initiatives
bull Support internal management and planning systems
bull Manage capitated payment arrangements
To meet these needs the APR-DRG system classifies patients according to severity of illness risk
of mortality and resource intensity Therefore in the APR-DRG classification system a patient is
assigned three distinct descriptors base APR-DRG severity of illness subclass and risk of mortality
subclass
Severity of illness can be defined as the extent of physiologic decompensation or organ system
loss of function experienced by the patient In contrast risk of mortality is defined as the patients
likelihood ofdying
For analyses such as evaluating resource intensity or patient care outcomes the base APR-DRGs
in conjunction with the severity of illness subclass is used For evaluating patient mortality the base
APR-DRGs in conjunction with the risk ofmortality subclass is used
Development of the APR-DRGs
The AP-DRGs were used as the base DRGs in the development of the APR-DRGs because they
were representative of the entire inpatient population and accounted for populations not included in DRGs
at the time of development Several consolidations additions and modifications were made to the APshy
DRGs to form the list of APR-DRGs used in the severity of illness and risk of mortality subclass
assignments
The following list summarizes the revisions made to the AP-DRGs in the creation ofthe APR-DRGs
bull All age CC and major CC splits were consolidated
bull Splits based on discharge status or death were consolidated
bull Definitions based on the presence or absence ofa complicated principal diagnosis were consolidated
bull Additional APR-DRGs were created for pediatric patients
bull APR-DRGs for newborns were completely restructured to create medical and surgical hierarchies within each birth weight range
bull Low volume APR-DRGs were consolidated into other related APR-DRGs
bull APR-DRGs that could be explained by the severity of illness subclasses were consolidated into one APR-DRG
bull Due to risk ofmortality subclasses several APR-DRGs were split to account for significant differences in mortality between patient groups
APR-DRG Severity oflllness Subclass Assignment
With the exception of neonatal patients after a patient has been given an APR-DRG code a
Severity of Illness Subclass is assigned based on the level of the secondary diagnoses presence of certain
non-OR procedures and the interaction among secondary diagnoses age APR-DRG and principal
diagnosis Neonatal patients have their own hierarchical method for determining severity of illness and
will be discussed later The four severity ofillness subclasses are
t l
~~~~~i~~ 1 Minor (Includes non CC)
2 Moderate
3 Major
i L 4 Extreme
The severity of illness subclass is used in conjunction with the patients base APR-DRG for
analysis such as evaluating resource intensity or patient care outcomes A patients severity of illness
subclass should not be used with their DRG because several DRGs may form one APR-DRG Therefore
since severity of illness subclasses correspond to the APR-DRG number and not the DRG it is important
to use the APR-DRG number to accurately interpret data
The process for assigning a patient a severity of illness subclass is a three phase process and is
summarized as follows
Phase
bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further analysis
bull Remaining secondary diagnoses are assigned one of four distinct Standard Severity of lllness Levels Figure 1 presents examples of secondary diagnoses in each severity ofillness leveL
Figure 1 Examples of Secondary Diagnoses by Severity of Illness Level
Minor Benign hypertension acute bronchitis lumbago
Moderate Chronic renal failure viral pneumonia diverticulitis
Major Diabetic ketoacidosis chronic heart failure acute cholecystitis
Extreme Septicemia acute myocardial infarction cerebral vascular accident
bull The Standard Severity of Illness Level is modified for some secondary diagnoses based on age APRshyDRG and presence of non-OR procedures Figure 2 displays an example of modifications to the standard severity ofillness level based on the APR-DRG
Bronchitis and asthma Minor
Chronic renal failure Moderate Diabetes Major LJ
Cardiomegaly Moderate Chronic heart failure Minor
Uncomplicated Minor Vaginal delivery Moderate LJ diabetes
f
f
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Severity of Illness Level is retained This prevents double counting clinically similar diagnoses
bull The Base Severity of Illness Subclass of the patient is set to the highest Standard Severity of lllness Level ofany of the secondary diagnoses
bull Patients with a Base Severity of Illness Subclass of major (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Standard Severity of Illness Level Figure 3 displays the requirements for keeping a severity of illness subclass ofmajor or extreme
Major
Extreme Two or more secondary diagnoses that are extreme or one secondary diagnosis that is extreme and at least two second dia oses that are maor
Phase III bull A minimum Severity of Illness Subclass is established based on the patients principal diagnosis This
accounts for patients assigned to codes that contain both the underlying disease and an associated manifestation of the disease (ie diabetes with hyperosmolar coma) but is only assigned to the APRshyDRG that accounts for the underlying disease
bull A minimum Severity of Illness Subclass is established based on combinations of principal diagnosis and age for specific APR-DRGs
bull A minimum Severity of Illness Subclass is established for some APR-DRGs with certain APR-DRG and non-OR procedure combinations as well as principal diagnosis and non-OR procedure combinations
bull A minimum Severity of Illness Subclass is established based on the presence of certain combinations ofsecondary diagnoses Figure 4 shows the combination of secondary diagnoses necessary to increase the severity of illness subclass to a minimum severity of illness level For example a type 1 combination would be a major bacterial infection with pleural effusion If a diagnosis from both of these categories is present plus at least one other secondary diagnosis that is at least a major severity of illness level then the minimum patient severity of illness subclass will be extreme
Figure 4 Minimum Severity of Illness Requirements
maor second dia osis 2 At least one additional Major
moderate secondary dia osis
3 Specified combinations of At least one additional Major a moderate and a minor moderate secondary cate 0 dia osis
4 Specified combinations of At least two additional Moderate r--1 Two minor cate ories minor second i Ii 5 Specified combinations of
Two moderate cate ories None Major
bull The final patient Severity of Illness Subclass is selected based on the maximum of the Phase II Base Patient Severity of Illness Subclass and the Phase III minimum Severity of Illness Subclass
Both medical and surgical patients are assigned a severity of illness level of 1-4 based on the
assignment process outlined previously
f
r-
I
l
r f
~
l
r 1
APR-DRG Risk of Mortality Subclass Assignment
Similar to the Severity ofIllness Subclass assignment the Risk ofMortality Subclass assignment
is based on the level ofthe secondary diagnoses and the interaction among secondary diagnoses age
APR-DRG and principal diagnosis In general the patients Risk ofMortality Level and Subclass will be
lower than the Severity ofIllness Level and Subclass respectively Neonatal patients have their own
hierarchical method for determining risk ofmortality and will be discussed later The four severity of
illness subclasses are
~~~~~~~G~~pound~) bull~~~~~~~~S~rs~~2bullbullmiddott~ 1 Minor (includes non CC)
2 Moderate
3 Major
4 Extreme
The risk ofmortality subclass is used in conjunction with the patients base APR-DRG for
evaluating patient mortality Like the severity of illness subclass a patients risk ofmortality subclass
should not be used with their DRG because several DRGs may form one APR-DRG Therefore since
risk ofmortality subclasses correspond to the APR-DRG number and not the DRG it is important to use
the APR-DRG number to accurately interpret data
The process for assigning a patient a risk ofmortality subclass is a three phase process and is
summarized as follows
Phase I bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further
analysis
bull Remaining secondary diagnoses are assigned one of four distinct Risk ofMortality Levels
bull The Risk ofMortality Level is modified for some secondary diagnosis based on the patients age and APR-DRG
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Risk ofMortality Level is retained This prevents double counting clinically-similar diagnoses
bull The Base Risk ofMortality Subclass of the patient is set to the highest Risk ofMortality Level ofany of the secondary diagnoses
bull Patients with a Base Risk ofMortality Subclass ofmajor (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Risk ofMortality Level
Phase III
bull A minimum Risk ofMortality Subclass is established based on the patients principal diagnosis This accounts for specific APR-DRGs that have a principal diagnosis indicative of a higher risk ofmortality relative to the other principal diagnoses in the APR-DRG r
i
l ~ bull A minimum Risk ofMortality Subclass is established based on the presence ofcertain combinations of secondary diagnoses
bull The final patient Risk ofMortality Subclass is selected based on the maximum ofthe Phase II Base l
Risk ofMortality Subclass and the Phase III minimum Risk ofMortality Subclass
J
r
AppendixF
f Index of Hospital Quality (lHQ) Scores by Specialty
i
i L
F-~
f laquo
2001
C
ance
r B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
con
sc
ore
R
N s
R
ank
Ho
spit
al
10
0
sco
re
rate
M
embe
r (o
f 7
) D
isch
arg
es
to b
eds
Mem
oria
l S
loan
-Ket
teri
ng
can
cer
Cen
ter
N
ew Y
ork
10
00
7
18
0
93
Y
es
60
51
67
21
2
2 U
niv
ersi
ty 0
1 T
exas
M
D
A
nder
son
Cen
cer
Cen
ter
H
oust
on
98
2
68
5
07
7
Yes
5
0
5103
2
68
3
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
78
3
59
0
69
Y
es
70
15
78
14
2
4 D
ana-
farb
er C
ance
r In
stit
ute
B
osto
n 6
37
3
88
0
81
No
60
21
8 2
27
5
May
o C
lin
ic
Ro
ches
ter
M
inn
5
81
2
50
0
60
Y
es
70
37
11
13
1
(+3
SO)
6 UC
LA M
edic
al C
ente
r
los
Ang
eles
41
0
79
0
56
Y
es
70
12
19
10
8 7
Un
iver
sity
01
Chi
cago
Ho
spit
als
40
6
65
0
66
Y
es
70
14
69
19
4
8 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
401
7
1
07
5
Yes
7
0
3494
1
81
9
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
40
0
91
0
82
Y
es
60
18
44
16
1
10
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
38
5
10
7
09
2
Yes
4
0
1105
1
61
11
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r
Ann
Arb
or
38
4
31
0
42
Y
es
70
16
56
17
9
12
Un
iver
sity
01
was
hing
ton
Med
ical
Cen
ter
S
eatt
le
38
3
79
0
66
Y
es
60
92
6 1
10
13
M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 3
80
8
8
09
5
Yes
7
0
2022
1
38
14
C
lari
an H
ealt
h P
art
ners
In
dia
nap
oli
s 3
78
5
2
07
5
Yes
7
0
2149
1
67
15
U
niv
ersi
ty o
f P
ittS
bu
rgh
Med
ical
Cen
ter
37
4
26
0
56
Y
es
65
23
10
16
7
(+2
SO)
16
Cle
vel
and
Cli
nic
3
62
3
1
07
4
Yes
7
0
2018
1
94
17
R
osw
ell
Par
k C
ance
r In
stit
ute
B
uff
alo
36
1
55
0
85
Y
es
50
16
76
28
7
18
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
35
5
37
0
73
Y
es
60
14
15
14
3
19
Un
iver
sity
of
Ken
tuck
y H
osp
ital
le
xin
gto
n
351
0
5
05
6
Yes
7
0
1047
2
20
20
fo
x C
hase
can
cer
Cen
ter
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35
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83
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Un
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Van
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34
8
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67
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24
S
hand
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iver
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Gei
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34
7
14
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46
Y
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23
15
7
25
All
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h
34
6
00
0
57
Y
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12
22
191
26
U
niv
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laba
ma
Ho
spit
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t B
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34
4
17
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67
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80
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151
27
B
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edic
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34
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66
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55
14
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8
28
Un
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Ho
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43
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3
Yes
5
5
1287
2
54
29
U
niv
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D
enve
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42
2
7
05
7
Yes
5
0
431
24
0
30
Un
iver
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Med
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Cen
ter
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34
2
23
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49
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72
lt
31
Yal
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aven
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New
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34
2
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0
61
Y
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70
15
55
15
3
32
Art
hu
r G
Ja
mes
Can
cer
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spit
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Col
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s
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41
0
0
04
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Yes
5
5
2147
1
56
33
U
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Ho
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lin
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34
0
19
0
69
Y
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70
11
42
13
6
34
Sum
ma
Hea
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Sys
tem
A
kron
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hio
33
9
00
0
50
Y
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55
14
81
14
9
35
New
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k P
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rian
HO
spit
al
33
7
34
0
86
Y
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70
31
03
13
2
36
Un
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sity
of
cali
forn
ia
San
Fra
nci
soo
Med
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Cen
ter
33
5
30
0
71
Yes
6
0
573
17
5
37
fG
M
cGaw
Ho
spit
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t lo
yo
la U
niv
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ty
May
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33
1
6
07
0
Yes
6
0
1023
1
62
38
U
niv
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ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
33
3
00
0
62
Y
es
60
12
79
15
2
39
Nor
th C
aro
lin
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ap
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spit
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Win
ston
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33
3
19
0
84
Y
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70
20
21
181
40
fa
irv
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iver
sity
Med
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Cen
ter
M
inn
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32
0
4
06
2
Yes
5
0
1248
1
56
41
G
reat
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alti
mo
re M
edic
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ente
r B
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mo
re
33
2
00
0
58
Y
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35
12
39
20
0
42
Un
iver
sity
Ho
spit
als
of
Cle
vel
and
3
30
0
0
06
4
YampS
70
19
71
12
1
43
Un
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sity
of
Iow
a H
osp
ital
s an
d C
lin
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lo
we
Cit
y
32
9
04
0
70
Y
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70
13
05
13
4
44
St
Jo
hn
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pri
ng
fiel
d
Ill
3
29
0
0
05
5
Yes
6
0
996
13
3
45
Hen
ry F
ord
Ho
spit
al
Detr
oit
3
27
0
0
07
6
Yes
6
5
1473
1
92
46
B
arn
es-J
ewis
h H
osp
ital
S
t
lou
is
32
6
05
0
74
Y
es
85
27
56
14
9
47
luth
era
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ealt
hSys
tem
P
ark
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ge
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3
26
0
0
06
2
Ves
6
0
1420
1
14
48
G
eorg
etow
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niv
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ty H
osp
ital
W
ashi
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DC
3
24
0
5
05
0
Yes
7
0
776
10
9
49
Coo
k C
ount
y H
osp
ital
C
hica
go
32
3
04
0
49
Y
es
50
49
1 2
10
50
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
32
2
09
0
90
Y
es
50
13
24
19
2
1
2001
D
iges
tiv
e D
iso
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est
Ho
spit
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Teo
hnol
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Rep
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nal
M
ort
alit
y
COTH
sc
ore
R
N
s
Tra
uma
Ran
k H
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IH
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sco
re
rate
M
embe
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to
beds
C
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r
May
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lin
ic
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ches
ter
M
inn
1
00
0
59
8
05
9
Yes
8
0
7660
1
31
Yes
2
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
82
3
50
0
63
Y
es
75
31
28
14
2
Yes
3
Cle
vel
and
Cli
nic
6
27
3
05
0
57
Y
es
80
44
75
19
4 N
o 4
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
58
9
29
9
08
7
Yes
8
0
4403
1
38
Y
es
5 M
ount
Sin
ai
Med
ical
Cen
ter
N
ew Y
ork
49
5
23
2
09
8
Yes
8
0
5220
1
57
Y
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6 UC
LA M
edic
al C
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r
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es
44
5
18
5
081
Y
es
80
25
40
10
8
Yes
7
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
39
7
14
3
09
0
Yes
8
0
3787
1
81
Yes
8
un
ivers
ity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
37
9
13
2
07
0
Yes
7
0
1596
1
75
N
o 9
Un
iver
sity
of
Chi
oago
Ho
spit
als
37
0
131
0
93
Y
es
80
19
84
19
4
Yes
(+
3 SO
) 10
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
30
6
57
0
61
Y
es
80
91
3 1
98
Y
es
11
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 2
99
5
2
07
5
Yes
8
0
4048
1
67
Y
es
12
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
2
95
7
7
09
9
Yes
8
0
2348
1
61
Yes
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
29
2
47
0
72
Y
es
80
56
89
14
9
Yes
14
U
niv
ersi
ty o
f M
iohi
gan
Med
ical
Cen
ter
Ann
Arb
or
291
3
8
06
8
Yes
8_
0 28
16
17
9
Yes
15
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 2
90
4
9
07
4
Yes
8
0
2636
1
43
Y
es
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
28
0
50
0
74
Y
es
50
20
34
161
Y
es
17
Cla
rian
Hea
lth
part
ners
In
dia
nap
oli
s 2
78
5
2
09
2
Yes
8
0
5286
1
67
Y
es
18
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
27
6
45
0
84
Y
es
80
28
28
15
3
Yes
19
B
eth
Isra
el
Dea
cone
ss M
edio
al C
ente
r
Bos
ton
21
4
34
0
73
Y
es
70
45
27
15
8
Yes
20
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
27
1
30
0
45
Y
es
80
99
2 1
09
Y
es
21
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
N
ew Y
ork
26
5
16
0
49
Y
es
70
26
18
21
2
No
22
New
Yor
k P
resb
yte
rian
Ho
spit
al
26
2
52
1
01
Yes
8
0
4884
1
32
Yes
23
U
niv
ers
ttv o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
26
0
20
0
65
Y
es
80
21
84
13
6 Y
es
(+2
SOI
24
Med
ical
Un
iver
sity
of
Sou
th C
aro
lin
a C
har
lest
on
2
58
6
9
12
0
Yes
7
0
2202
2
09
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
25
1 2
2
07
5
Yes
6
5
2472
1
57
Y
es
26
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
oak
M
ich
2
50
0
8
07
0
Yes
8
0
5809
1
88
Y
es
27
8ay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
49
2
6
07
8
Yes
6
0
4673
1
22
y
es
28
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
24
8
00
0
60
Y
es
70
26
48
191
Y
es
29
St
L
ou
is U
niv
ersi
ty H
osp
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2
42
1
4
06
9
Yes
7
5
1677
1
47
Y
es
30
Los
A
ngel
es C
ount
y-U
Sc
Med
ical
Cen
ter
24
2
08
0
37
Y
es
60
39
5 1
67
Y
es
31
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
24
0
18
0
79
Y
es
70
18
25
24
0
Yes
32
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
24
0
39
0
78
y
es
80
11
34
11
0
No
33
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Il
l
23
8
00
0
59
Y
es
60
31
21
11
4
Yes
34
U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
oer
Cen
ter
H
oust
on
23
7
33
0
80
Y
es
60
13
61
26
8
No
35
Lah
ey H
itch
coo
k C
lin
io
Bu
rlin
gto
n
Mas
s
23
6
00
0
67
Y
es
70
26
77
15
2
Yes
36
C
edar
s-S
inai
Med
ical
Cen
ter
L
os A
ngel
es
23
4
27
0
94
Y
es
80
47
95
10
6
Yes
37
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
Sit
y
May
woo
d
Ill
2
34
0
0
06
6
Yes
7
0
2180
1
62
Y
es
38
Mar
y H
itch
coo
k M
emor
ial
Ho
sp
ital
le
ban
on
N
H
23
4
04
0
68
Y
es
70
15
58
19
4
Yes
39
U
niv
ersi
ty o
f C
ali
forn
ie
Dav
is M
edio
al C
ente
r
Sac
ram
ento
2
33
0
0
06
8
Yes
8
0
1751
2
79
Y
es
40
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
iCS
Io
wa
Cit
y
23
3
13
0
77
Y
es
80
19
31
13
4
Yes
41
N
ew E
ngla
nd M
edic
al C
ente
r
Bos
ton
23
3
20
0
82
Y
es
10
11
88
24
2
Yes
42
F
roed
tert
Mem
oria
l L
uth
eran
Ho
spit
al
Mil
wau
kee
23
2
00
0
63
Y
es
70
19
29
14
6
Yes
43
T
hom
as J
eff
ers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
32
0
8
07
6
Yes
1
0
3206
1
23
Y
es
44
Tem
ple
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
30
1
7
01
0
Yes
7
5
1450
1
46
N
o 45
G
reat
er B
alti
mo
re M
edic
al C
ente
r
Bal
tim
ore
2
30
1
2
071
Y
es
SO
24
95
20
0
No
46
Hen
ry F
ord
Ho
spit
al
Detr
oit
2
29
0
8
08
6
Yes
7
5
3475
1
82
Y
es
47
Un
iver
sity
Of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pal
Hil
l 2
29
1
0
081
Y
es
60
29
86
15
2
Yes
48
O
chsn
er F
ou
nd
atio
n H
osp
1ta
l
New
Orl
ean
s 2
28
1
5
07
4
Yes
6
5
2465
1
40
N
o 49
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
F
la
22
S
00
0
62
14
0 7
0
5778
1
67
Y
es
SO
Un
iVer
sity
Ho
spit
al
Den
ver
22
7
11
0
81
Yes
6
0
1151
2
40
Y
es
L r
middotmiddot
2001
E
ar
Nos
e
and
Thr
oat
Bes
t H
osp
ital
Lis
t
Hos
pita
lwid
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echn
olog
y R
eput
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nal
mo
rtal
ity
C
OTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
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sc
ore
rate
M
embe
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D
isch
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bed
s C
ente
r
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opki
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osp
ital
B
alti
mor
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00
0
40
2
08
2
Ves
5
0
26
4
14
2
Yes
2
Un
iver
sity
of
Iow
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osp
ital
s an
d C
lin
ics
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wa
Cit
y
8S
4
32
4
08
6
Yes
5
0
219
13
4
Ves
3
Mas
saoh
uset
ts E
ye
and
Ear
In
firm
ary
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osto
n 7
66
2
71
0
11
No
3
0
26
8
18
7
Ves
4
May
o C
lin
io
Roo
hest
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Min
n
68
2
21
0
07
2
Ves
5
0
502
13
1
Ves
5
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
6
39
1
90
0
82
Y
es
50
28
3 1
79
Y
es
6 U
niv
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ty o
f P
itts
bUrg
h M
edic
al C
ente
r 6
23
1
85
0
84
V
es
50
36
3 1
67
Y
es
7 UC
LA M
edic
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ente
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los
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eles
6
21
1
89
0
83
Y
es
50
2
88
1
08
Y
es
8 U
niv
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ty o
f T
exas
M
D
A
nder
son
cano
er C
ente
r H
oust
on
51
6
14
7
08
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Ves
4
0
124
26
8
No
9 H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
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hia
5
05
1
36
1
02
Y
es
50
26
7 1
61
Y
es
10
Cle
vela
nd C
lin
ic
49
5
10
6
06
7
Yes
5
0
23
6
19
4
No
11
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nio
N
ashv
ille
4
64
9
3
09
4
Yes
5
0
28
4
24
0
Yes
12
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
caU
f
46
1
10
8
08
6
Yes
3
0
13
4
16
1
Yes
1
3
Bar
nesmiddot
Jew
ish
Ho
spit
al
St
lo
uis
4
68
9
0
08
2
Yes
5
0
39B
1
49
Y
es
14
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
42
6
10
1
0middot8
7 Y
es
50
8
6
11
0
No
15
M
etho
dist
Ho
spit
al
Hou
ston
4
09
1
02
1
07
Y
es
40
2
30
1
33
No
(+
3 SO
l 16
M
emor
ial
Slo
anmiddotK
ette
rin
g e
ence
r C
ente
r
New
Vor
k 3
91
5
4
07
9
Yes
5
0
24
9
21
2
No
17
Mou
nt S
lnai
Med
ioal
Cen
ter
New
Vor
k 3
86
7
8
11
1
Yes
5
0
31
2
15
7
Yes
18
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
37
9
45
0
79
Y
es
50
16
6 1
57
Y
es
19
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
oo M
edio
al C
ente
r 3
78
6
3
08
5
Ves
4
0
131
17
5
No
20
Duk
e U
niv
ersi
ty M
edio
al C
ente
r D
urha
m
NC
3
50
4
3
09
3
Yes
5
0
15
3
18
1
Ves
21
U
niv
ersi
ty o
f W
isoo
nsin
Ho
spit
al a
nd C
lin
ios
Med
ison
3
40
1
9
07
7
Yes
5
0
23
2
13
6
Yes
22
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
enoe
s C
ente
r C
har
lott
esv
ille
3
39
3
0
08
1
Ves
4
0
195
22
7
No
23
un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 3
37
2
2
07
9
Ves
4
0
18
9
15
2
Yes
(+
2 SO
l 2
4
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
33
4
26
0
77
V
es
50
4
4
19
8
Ves
2
5
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty O
f F
lori
da
Gai
nes
vil
le
33
3
18
0
76
V
es
40
16
7 1
57
Y
es
26
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middot Sal
em
33
1
26
0
92
Y
es
50
2
43
1
61
Y
es
27
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
33
0
29
0
76
Y
es
35
11
2 1
01
V
es
28
H
enry
For
d H
osp
ital
D
etro
it
32
9
05
0
73
Y
es
45
2
14
1
82
V
es
29
st
lo
uis
Un
iver
sity
Ho
spit
al
32
5
12
0
71
Y
es
50
1
13
1
47
Y
es
30
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
w
ashi
ngto
n
DC
3
24
1
7
05
3
Ves
5
0
89
1
0
9middot
Yes
31
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hioa
go
32
3
26
0
92
V
es
40
18
4 1
70
ve
s 32
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
C
hica
go
32
3
20
0
70
V
es
50
14
5 1
14
No
3
3
Fai
rvie
w-U
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
32
3
23
0
79
Y
es
30
3
57
1
56
No
3
4
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
25
0
90
Y
es
50
1
00
1
94
Y
es
35
Un
iver
sity
Ho
spit
al
Den
ver
31
7
15
0
74
Y
es
40
52
2
40
Y
es
36
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
3
17
1
9
08
5
Yes
4
0
19
9
12
3
Yes
3
7
Sum
ma
Hea
lth
syst
em
Akr
on
Ohi
o 3
16
0
0
06
9
Ves
4
0
28
7
14
9
Yes
3
8
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
sa
cram
ento
3
15
0
5
07
6
Ves
5
0
14
3
27
9
Ves
3
9
lOS
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
31
2
13
0
20
Y
es
35
42
1
67
Y
es
40
Val
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
31
2
16
0
92
Y
es
50
2
43
1
53
V
es
41
Un
iver
sity
of
Tex
as M
edio
al B
rano
h H
osp
ital
s
Gal
vest
on
31
1
27
0
91
Yes
4
0
118
15
3
Yes
4
2
Lut
hera
n G
ener
al H
ealt
hsys
tem
P
ark
Rid
ge
Ill
3
09
0
0
07
0
Yes
4
0
212
11
4
Yes
4
3
Un
iver
sity
of
Illi
no
is
Ho
spit
al a
nd C
lin
iCs
Chi
cago
3
06
1
2
06
6
Yes
2
5
87
1
29
Y
es
44
lah
ey H
itoh
oook
Cli
nic
B
url
ing
ton
M
ass
3
05
0
5
07
6
Yes
4
0
138
15
2
Yes
4
5
Art
hur
G
Jam
es C
anoe
I H
osp
ital
C
olum
bus
O
hio
30
4
00
0
57
V
es
40
13
1 1
56
Y
es
46
w
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
30
3
05
0
86
Y
es
40
2
16
1
92
V
es
47
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 3
02
0
4
08
7
Yes
5
0
35
5
16
7
Ves
4
8
wil
liam
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
3
02
0
0
08
5
Yes
5
0
29
6
18
8
Yes
4
9
New
Vor
k Ey
e an
d E
ar
Infi
rmar
y
New
Yor
k 3
02
1
7
00
0
No
35
50
2
63
Y
es
50
F
G
McG
aw H
osp
ital
at
lOll
ola
Un
iver
sity
M
ayw
ood
Il
l
30
0
10
0
87
Y
es
40
16
6 1
62
Y
es
L L
2001
G
eria
tric
s B
est
Ho
spit
al L
ist
Hos
ptta
lwid
e T
echn
olog
y D
isch
arge
S
erv
ice
Ger
iatr
ic
Rep
utat
iona
l m
ort
alit
y
COTH
sc
ore
R
N
s
plan
ning
m
ix
serv
ices
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 8
) to
bed
s (o
f 3
) (o
f 1
0)
(of
7)
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
10
00
3
97
0
83
Y
es
80
1
08
3
6 5
2 JO
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
89
5
33
6
08
2
Yes
8
0
14
2
3 9
4 3
Mou
nt
Sin
ai M
edic
al C
ente
r N
ew Y
ork
73
3
27
6
11
1
Yes
8
0
15
7
3 8
4 4
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
6
11
1
98
0
93
Y
es
80
1
81
3
7 3
5 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
59
4
18
5
09
3
Yes
8
0
13
8
3 8
4 6
May
o C
11ni
c
Roo
hest
er
Min
n
51
1
11
2
07
2
Yes
8
0
13
1
3 1
0
8 7
St
L
ouis
Un
iver
sity
Ho
spit
al
45
2
95
0
71
Y
es
80
1
47
3
4 3
8 Y
alemiddot
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
4
33
1
00
0
92
Y
es
80
1
53
3
1 3
9 C
leve
land
lt1
1nio
4
28
7
0
06
7
Yes
8
0
19
4
3 8
4 10
U
niv
ersi
ty o
f M
ichI
gan
Med
ical
Cen
ter
Ann
Arb
or
42
2
79
0
82
Y
es
80
1
79
3
9 4
11
Bet
h Is
rael
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
11
7
7
08
4
Yes
7
0
15
8
3 9
4 (+
3 SO
) 12
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
68
7
3
08
7
Yes
7
0
11
0
2 6
2 1
3
Un
iver
sity
01
Chi
cago
Ho
spit
als
35
4
50
0
90
Y
es
80
1
94
3
8 4
14
B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
33
6
32
0
82
Y
es
80
1
49
3
9 4
15
U
niv
ersi
ty H
osp
ital
D
enve
r 3
34
2
5
07
4
Yes
7
0
24
0
3 8
5 16
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
28
3
0
08
1
Yes
8
0
14
3
3 7
4 17
R
ush
middotPre
sby
teri
anmiddotS
t L
uke
s M
edic
al C
ente
r C
hica
go
32
5
14
0
70
Y
es
80
1
14
3
9 5
19
u
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co l
led
ical
Cen
ter
32
5
36
0
85
Y
es
70
1
75
3
6 4
(+2
SO)
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
0
34
0
86
Y
es
60
1
61
3
9 3
20
Ho
spit
al o
f th
e U
niv
ersi
ty o
f pe
nnsy
lvan
ia
Ph
ilad
elp
hia
3
16
4
4
10
2
Yes
8
0
16
1
I 8
3 21
U
niv
ersi
ty H
osp
ital
s o
f C
leve
land
3
13
2
5
07
9
Yes
8
0
12
1
2 8
4 2
2
Par
klan
d ll
emor
ial
Ho
spit
al
Dal
las
31
3
1S
0
77
Y
es
80
1
98
3
7 4
23
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middotSai
em
31
1
20
0
92
Y
es
80
1
61
3
10
6
24
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
30
8
05
0
53
Y
es
70
1
09
3
8 4
25
U
niv
ersi
ty o
f Il
lin
Ois
Ho
spit
al a
nd C
lin
ios
C
hioa
go
30
7
11
0
66
Y
es
55
1
29
3
7 4
26
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 3
04
4
1
10
5
Yes
8
0
11
8
3 1
4 2
7
Fai
rvie
wmiddotu
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
30
4
14
0
19
Y
es
60
1
56
3
9 5
28
Sos
ton
Med
ioal
Cen
ter
30
4
16
0
75
Y
es
60
2
10
3
7 4
29
Fra
nci
s S
cott
Key
Med
ical
Cen
ter
Bal
tim
ore
30
4
18
0
80
Y
es
70
0
79
3
8 5
30
S
parr
ow H
osp
ital
and
Hea
lth
Sys
tem
L
anS
ing
M
ich
3
04
0
0
06
5
No
70
1
13
3
10
6
31
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
02
0
8
08
4
Yes
8
0
16
7
3 9
7 3
2
Los
Ang
eles
cou
ntymiddot
uSC
lle
dica
l C
ente
r 3
01
0
3
02
0
Yes
6
5
16
7
3 8
3 3
3
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
98
2
3
09
2
Yes
7
0
17
0
3 9
4 3
4
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
29
7
03
0
68
Y
es
70
1
49
3 9
3 3
5
Coo
k C
ount
y H
osp
ital
C
hica
go
28
6
00
0
55
Y
es
60
2
10
3
7 4
36
U
niv
ersi
ty o
f C
onne
ctic
ut H
ealt
h C
ente
r
Far
min
gton
2
94
4
6
10
0
Yes
6
0
26
0
3 3
2 3
7
Ho
spit
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 2
91
0
0
01
0
Yes
6
0
15
1
3 5
4 3
8
Un
iver
sity
Med
ioal
Cen
ter
Tuc
son
A
riz
2
90
0
0
06
6
Yes
7
0
17
2
3 7
3 3
9
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
28
9
07
0
79
Y
es
70
1
52
3
10
3
40
Thom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
28
9
13
0
85
Y
es
70
1
23
3
9 4
41
Hen
nepi
n C
ount
y M
edic
al C
ente
r
Min
neap
olis
2
89
0
0
06
1
Yes
6
5
10
5
3 7
3 4
2
St
L
uk
es
Ho
spit
al
Ch
este
rfie
ld
Mo
2
88
0
0
06
7
No
70
1
06
3
8 8
43
Aug
usta
Hea
lth
Car
e
Fis
her
svil
le
Va
2
87
0
0
06
5
No
50
1
35
3
8 5
44
John
D
Arc
hbol
d M
emor
ial
Ho
spit
al
Tho
maS
Vil
le
Ga
2
86
0
0
06
3
No
70
0
93
3
7 4
45
F
G
McG
aw H
osp
ital
at
Loy
ola
un
iver
sity
M
ayw
ood
Il
l
28
5
14
0
87
Y
es
70
1
62
3
9 3
46
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
Sac
ralll
ampnt
o 2
84
0
4
07
6
Yes
8
0
27
9
3 6
4 4
7
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
28
4
00
0
70
Y
es
70
1
14
3
7 4
49
Hen
ry F
ord
Ho
spit
al
Det
roit
2
83
0
4
07
3
Yes
7
5
18
2
3 4
4 4
9
Un
iver
sity
of
Vir
gin
ia H
ealt
h Sc
ienc
amps
Cen
ter
Ch
arlo
ttes
vil
le
282
0
3
08
1
Yes
7
0
22
7
3 9
4 50
S
t
Jose
ph H
osp
ital
D
enve
r 2
80
0
0
06
3
No
70
1
03
3
6 3
2001
G
ynec
olog
y B
est
Ho
spit
al L
ist
Hos
p1ta
lwid
e T
echn
olog
y G
ynec
olog
y R
eput
atio
nal
mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
serv
ices
R
ank
Ho
spit
al
IHQ
sc
ore
ra
te
Mem
ber
(of
8)
Dis
char
ges
to b
eds
Cen
ter
(of
4)
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
32
5
0B
2
Yes
8
0
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43
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UCLA
Med
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58
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72
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Un
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49
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18
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11
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8
Yes
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89
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8
Yes
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11 Ne
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37
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Un
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11
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loan
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cer
Cen
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03
7
4
07
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Yes
7
0
179
21
2
No
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2
Sta
nfo
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niv
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tan
ford
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alif
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87
6
7
08
6
Yes
5
0
274
16
1
Yes
2
13
M
agee
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spit
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Pit
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urg
h
38
4
50
0
67
Y
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65
55
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53
No
3
14
U
niv
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ichi
gan
Med
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Cen
ter
Ann
Arb
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38
3
52
0
82
Y
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80
3
90
1
79
Y
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N
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Mem
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l H
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C
hica
go
36
5
52
0
92
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29
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70
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3 SD
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aven
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spit
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36
3
50
0
92
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80
34
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53
Y
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4 17
C
leve
land
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nic
3
59
3
7
06
7
Yes
7
0
711
19
4
No
3 18
H
osp
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of
the
Un
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of
Pen
nsyl
vani
a
Ph
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3
54
5
5
10
2
Yes
8
0
222
16
1
Yes
4
19
Un
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sity
of
Chi
cago
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spit
als
35
1
43
0
90
Y
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80
2
33
1
94
Y
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4 2
0
Un
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sity
of
Cal
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rnia
Sa
n F
ranc
isco
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Cen
ter
34
3
50
0
85
Y
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70
51
1
75
No
3
21
Van
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bil
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niv
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ty H
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and
Cli
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N
ash
vil
le
33
B
35
0
84
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30
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40
Y
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2
Geo
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own
Un
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spit
al
Was
hing
ton
D
C
32
2
12
0
S3
Y
es
80
16
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09
Y
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4 2
3
Los
Ang
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Cou
nty-
uSC
Med
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Cen
ter
31
7
12
0
20
Y
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65
4
0
16
7
Yes
4
24
Bar
nes-
Jew
ish
Ho
spit
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St
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ouis
3
16
2
3
08
2
Yes
7
5
62
3
14
9
Yes
4
25
R
ush
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sby
teri
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t
Luk
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Med
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Cen
ter
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oago
3
15
2
2
07
0
Yes
8
0
30
3
114
No
3
26
U
niv
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ty o
f A
laba
ma
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spit
al a
t B
irmin
gham
3
14
3
1
09
6
Yes
8
0
411
15
1
Yes
4
(+2
SO)
27
Th
omas
Jef
fers
on
Un
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sity
Ho
spit
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Ph
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2
97
1
9
08
5
Yes
7
0
33
7
12
3
Yes
4
28
U
niv
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ty M
edic
al C
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r T
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riz
2
95
0
8
06
6
Yes
7
0
150
17
2
Yes
3
29
U
niv
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ty H
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enve
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92
1
3
07
4
Ves
6
0
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2
40
Y
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0
Mou
nt S
inai
Med
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ter
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92
3
2
11
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8
0
317
15
7
Yes
4
31
Art
hur
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Jam
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r H
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1
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0
57
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70
1
73
1
56
Y
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C
ook
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Ho
spit
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cago
2
90
0
0
05
5
Yes
6
0
69
21
0
Yes
4
33
U
niv
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ty o
f C
alif
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Med
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Cen
ter
Ora
nge
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9
30
0
82
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60
69
1
05
Y
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4
Un
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sity
of
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hing
ton
Med
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Cen
ter
S
eatt
le
28
8
24
0
87
Y
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80
2
07
1
10
No
4
35
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tbull
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ph H
osp
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enve
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88
0
8
05
3
No
70
2
89
1
03
No
4
36
C
edar
smiddotS
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Med
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Cen
ter
Lo
s A
ngel
es
29
4
29
1
07
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es
BO
S
02
10
6
Yes
4
37
Su
mm
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ealt
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m
Akr
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83
0
0
06
8
Yes
6
5
37
6
14
9
Yes
4
38
B
aylo
r U
niv
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ty M
edic
al C
ente
r D
alla
s 2
8S
1
6
08
8
Yes
6
5
559
12
2
Yes
4
39
M
ary
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chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
28
2
12
0
86
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70
2
34
1
94
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0
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niv
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ty H
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28
1
38
0
90
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80
2
09
0
93
No
0
41
Wom
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nd
Infa
nts
Ho
spit
al O
f R
hode
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lan
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Pro
vide
nce
28
1
04
0
29
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50
5
19
0
63
No
4
42
B
eth
Isra
el
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cone
ss M
edic
al C
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80
1
2
08
4
Yes
7
0
286
15
8
Yes
3
43
C
lari
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artn
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dia
nap
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79
1
1
08
7
Yes
8
0
55
8
16
7
Yes
3
44
Ohi
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tate
un
iver
sity
Med
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Cen
ter
Col
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77
1
0
07
6
Yes
6
5
157
10
1
Yes
4
45
W
illi
am
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umon
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osp
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ich
2
75
0
4
08
5
Yes
9
0
59
5
18
9
Yes
4
46
L
uthe
ran
Gen
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Hea
lths
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m
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k R
idge
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l
27
4
00
0
70
Y
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70
2
60
1
14
Y
es
4 4
7
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nic
s
Mad
ison
2
12
1
2
07
7
Yes
7
0
20
7
13
6
Yes
1
48
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
27
1
05
0
76
Y
es
70
2
62
1
57
Y
es
2 4
9
Gre
ater
Bal
tim
ore
Med
ical
Cen
ter
Bal
tim
ore
27
0
00
0
69
Y
es
55
46
0 2
00
No
4
50
FG
M
oGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
70
1
0
08
7
Yes
7
0
186
16
2
Yes
4
rmiddot--
I
i L
L
2001
H
eart
Bes
t H
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Lis
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Ran
k H
osp
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1 C
leve
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May
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3 M
assa
chus
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Ho
spit
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4 Jo
hns
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kins
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spit
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tim
ore
5 B
righ
am a
nd W
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s H
osp
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osto
n 8
Duk
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niv
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edic
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NC
7
Tex
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stit
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scop
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osp
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niv
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11
B
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12
W
illi
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13
Un
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Thom
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niv
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20
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ma
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tem
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21
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9
UCLA
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Un
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44
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48
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95
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0
07
6
Ves
9
0
15
10
00
00
1
36
Y
es
29
3
00
0
72
Y
es
80
1
70
90
00
0
11
4
Yes
2
93
0
3
07
5
No
80
1
09
16
00
00
1
61
Y
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29
3
14
0
89
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90
1
73
80
00
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24
0
Yes
2
92
1
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1
16
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1
20
80
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No
29
2
14
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76
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41
50
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0
11
4
No
29
1
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76
Y
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80
3
29
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7
Yes
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91
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2
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8
0
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75
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51
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28
9
06
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8
04
80
00
0
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7
Yes
2
89
0
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06
5
Yes
9
0
25
60
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0
11
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Yes
2
89
3
5
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9
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9
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64
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1
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28
9
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2
03
30
00
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1
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2
89
0
0
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9
Yes
8
0
28
37
00
00
1
06
Y
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28
9
06
0
87
Y
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90
4
71
00
00
0
12
7
Yes
2
88
0
0
08
6
Yes
8
0
89
54
00
00
1
92
Y
es
28
7
00
0
84
Y
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80
2
44
50
00
0
19
4
YeS
2
86
0
0
06
0
Yes
8
0
79
90
00
0
10
9
Yes
2
85
0
0
08
7
Yes
8
0
40
88
00
00
1
15
Y
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28
4
00
0
70
N
o 8
5
45
27
00
00
1
59
N
o 2
83
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6
07
6
No
80
8
15
10
00
0
19
9
No
28
3
00
0
71
No
8
0
31
45
00
00
1
10
N
o
2001
H
oroo
nal
Dis
ord
ers
Bes
t H
osp
ital
lis
t
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
RN
s
T
raum
a R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
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f 7
) D
isch
arge
s to
bed
s C
ente
r
May
o C
lin
ic
Roc
hest
er
Min
n
10
00
6
12
0
66
Y
es
70
14
59
13
1
Yes
2
Mas
sach
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ts G
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al H
OSp
tal
B
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n 9
89
5
27
0
91
Y
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70
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13
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Yes
3
John
s H
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ital
B
alti
mor
e 5
96
2
52
0
64
Y
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70
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07
14
2
Yes
4
Bri
gham
and
Wom
en s
H
osp
ital
B
osto
n 5
36
2
05
0
72
Y
es
70
6
17
1
43
Y
es
I
Bet
h Is
rael
Dee
cone
ss M
edic
al C
ente
r B
osto
n 4
55
1
13
0
62
Y
es
60
11
46
15
8
Ves
6
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
oien
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Cen
ter
Ch
arlo
ttes
vil
le
45
4
11
5
04
9
Yes
6
0
1029
2
27
No
7
Un
iver
sity
of
Cal
ifo
rnia
Se
n F
ranc
isco
Med
ical
Cen
ter
45
3
14
5
07
2
Yes
6
0
416
17
5
No
9 B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
45
3
11
6
09
5
Yes
7
0
1968
1
49
Y
es
9 C
leve
land
Cli
nic
4
37
9
3
04
6
Ves
7
0
1133
1
94
No
(+
3 11
m
10
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
41
6
82
0
66
Y
es
10
8
13
1
19
Y
es
11
Un
iver
sity
of
Chi
cago
Ho
spit
als
41
1
89
0
B2
Y
es
70
00
1 1
94
Y
es
12
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
41
0
10
4
00
4
Yes
7
0
752
10
8
Yes
13
u
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
B8
0
4
05
6
Yes
1
0
31
9
11
0
No
14
Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
3
83
1
11
1
54
Y
es
70
15
52
13
2
Yes
15
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
78
3
9
05
5
Ves
7
0
757
24
0
Yes
16
N
orth
Wes
tern
Mem
oria
l H
osp
ital
C
hica
go
37
5
51
0
73
Y
es
60
97
5 1
70
Y
es
17
Hen
ry F
ord
Ho
spit
al
Det
roit
3
75
1
2
05
6
Yes
6
5
19
45
1
82
Y
es
(+2
SD)
18
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
st
anfo
rd
Ca1
1f
36
1
68
0
83
Y
es
50
47
2 1
61
Y
es
19
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 3
64
3
6
05
6
Yes
7
0
328
19
8
Yes
2
0
Duk
e U
nive
rSit
y M
edic
al C
ente
r D
urha
m
NC
3
59
2
7
06
8
Yes
7
0
91
6
18
1
Yes
21
U
niv
ersi
ty H
osp
ital
D
enve
r 3
58
2
5
04
5
Yes
8
0
320
24
0
Yes
2
2
was
hing
ton
Ho
spit
al C
ente
r W
ashi
ngto
n
DC
3
57
2
0
07
6
Yas
6
0
1658
1
92
Y
es
23
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
35
4
16
0
65
Y
es
70
12
59
16
7
Yes
2
4
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 3
47
2
7
05
1
Yes
5
5
719
10
1
Yes
2
5
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
34
5
23
0
13
Y
es
70
86
6 1
61
Y
es
26
S
t
lou
is U
niv
ersi
ty H
osp
ital
3
43
0
7
04
0
Yes
1
0
637
14
1
Yes
2
7
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
3
43
1
1
06
4
Yes
1
0
1080
1
51
Y
es
28
U
niv
ersi
ty H
osp
ital
P
ort
lan
d
ore
3
42
2
8
048
Y
es
60
32
8 0
111
Yes
2
9
Un
iver
sity
of
Tex
as M
edic
al B
ranc
h H
osp
ital
s
Gal
vest
on
33
9
05
0
4B
Y
es
60
81
8 1
53
Y
es
30
G
ood
Sam
arit
an R
egio
nal
Med
ioal
Cen
ter
Pho
enix
3
38
1
0
01
7
Yes
7
0
58
0
10
7
Yes
31
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
Cha
pel
Hil
l 3
37
0
6
05
2
Yes
6
0
791
15
2
Yes
32
U
niv
ersi
ty o
f W
isco
nsin
Hos
pita
l an
d C
Hn
ics
Mad
ison
3
37
0
5
03
3
Yes
7
0
519
13
6
Yes
33
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al O
ak
Mio
h
33
7
06
0
80
Y
es
70
14
14
18
8
Yes
3
4
Flo
rid
a H
osp
ital
Med
ical
Cen
ter
Orl
ando
F
la
33
7
00
0
51
No
6
0
1698
1
67
Y
es
35
U
niv
ersi
ty o
f M
aryl
and
Med
ical
sys
tem
B
alti
mor
e 3
36
0
6
05
1
Ves
7
0
55
3
111
4 Y
es
36
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edic
al C
ente
r S
acra
men
to
33
4
06
0
59
Y
es
70
55
7 2
19
Y
es
37
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
33
3
05
0
50
Y
es
60
56
0 1
57
Y
es
38
Yal
emiddotN
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
33
2
38
1
03
Y
es
10
8
10
1
53
Y
es
39
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
9
00
0
38
Y
es
60
76
8 1
14
Y
es
40
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
3
29
0
0
04
9
Yes
5
5
656
13
5
Yes
41
A
lleg
heny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
32
8
00
0
66
Y
es
60
6
10
1
91
Y
es
42
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 3
27
6
4
16
7
Yes
7
0
1555
1
57
Y
es
43
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
6
05
0
20
Y
es
70
32
9 1
09
Y
es
44
M
emor
ial
Med
ical
Cen
ter
Sav
anna
h G
a
32
6
00
0
48
Y
es
60
5
52
1
42
V
es
45
Med
ical
Col
lege
of
Geo
rgia
Ho
spit
al a
nd C
lin
iC
Aug
usta
3
23
0
0
03
1
Yes
5
0
381
15
0
Yes
46
S
t L
uk
es
Med
ioal
Cen
ter
Milw
auke
e W
is
32
3
00
0
62
Y
es
60
13
70
08
6
Yes
4
1
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
trd
ty
May
woo
d
Ill
3
23
1
0
07
1
Yes
6
0
64
3
16
2
Yes
4
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
32
3
07
0
68
Y
es
70
6
85
1
34
Y
es
49
M
edic
al C
ente
r o
f D
elaw
are
Wil
min
gton
3
21
0
0
08
1
ves
60
12
35
17
5
Ves
50
u
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
32
1
00
0
68
Y
es
70
77
3 1
51
Y
es
- L
2001
K
idne
y D
isea
se B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Dis
char
ge
Med
ical
l R
epu
tati
on
al
Mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
pla
nn
ing
S
urg
ical
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 5
) D
isch
arg
es
to
beds
C
ente
r (o
f 3
) B
eds
Mas
sach
use
tts
Gen
eral
Ho
spit
al
B
osto
n 1
00
0
27
6
09
5
Yes
5
0
1091
1
36
Y
es
3 83
2
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
95
6
25
6
061
Y
es
50
74
2 1
43
Y
es
3 30
3
May
o C
lin
iC
Ro
ches
ter
M
inn
82
B
18
5
06
3
Yes
5
0
1217
1
31
Y
es
3 94
4
Cle
vel
and
Cli
nic
8
28
1
94
0
53
Y
es
50
11
24
19
4
No
3 44
5
New
Yor
k P
resb
yte
rian
Ho
spit
al
80
6
19
6
12
2
Yes
5
0
1617
1
32
Y
es
3 11
1
6 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
77
3
17
4
05
4
Yes
4
5
811
14
2
Yes
3
41
7 UC
LA M
edic
al C
ente
r
Los
Ang
eles
7
26
1
53
0
60
Y
es
50
97
5 1
08
Y
es
3 54
8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
69
6
14
3
07
8
Yes
5
0
1108
1
81
Y
es
3 57
9
Bar
nes
-Jew
ish
Ho
spit
al
S
t
Lou
is
88
7
12
0
05
9
Yes
5
0
1863
1
49
Y
es
3 76
10
U
niv
ersi
ty H
osp
ital
D
enve
r 6
58
1
41
0
61
Yes
4
0
408
24
0
Yes
3
0 11
U
niv
ersi
ty O
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbor
5
89
8
8
05
4
Yes
5
0
922
17
9
Yes
3
60
12
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
iC
Nas
hv
ille
5
78
9
1
04
9
Yes
4
0
850
24
0
Yes
3
28
13
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
56
6
89
0
63
Y
es
40
52
8 1
61
Y
es
3 67
14
P
ark
lan
d M
emor
ial
Ho
spit
al
D
alla
s 56
1
73
0
31
Yes
5
0
660
19
8
Yes
3
39
15
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
41
6
6
06
2
Yes
5
0
1128
1
67
Y
es
3 80
16
U
niv
ersi
ty o
f C
ali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
53
4
74
0
45
Y
es
50
63
1 1
75
N
o 3
35
17
Ho
spit
al o
f th
e U
niv
ersi
ty O
f P
enn
sylv
ania
P
hil
adel
ph
ia
52
8
75
0
73
Y
es
50
96
2 1
61
Yes
3
44
18
Em
ory
Un
iver
sity
Ho
spit
al
A
tlan
ta
52
1
77
0
58
Y
es
45
78
4 0
93
N
o 3
48
19
un
ivers
ity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
51
6
78
0
55
Y
es
50
42
1 1
10
N
o 2
46
(+3
SO)
20
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
47
3
56
0
93
Y
es
40
12
02
15
1
Yes
2
86
21
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
45
3
47
0
61
Yes
5
0
1013
1
58
Y
es
3 0
22
Hen
ry F
ord
Ho
spit
al
Detr
oit
4
47
2
1
05
8
Yes
5
0
1459
1
82
Y
es
3 76
2
3
Un
iver
sity
of
No
rth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
44
5
37
0
48
Y
es
40
10
33
15
2
Yes
3
16
24
F
airv
ieW
-Un
iver
sity
Med
ical
Cen
ter
Min
neap
Oli
s 4
44
5
2
07
2
Yamp
s 5
0
690
15
6
No
3 24
2
5
Un
iver
sity
of
Chi
cago
Ho
spit
als
44
2
31
0
47
Y
es
50
75
8 1
94
Y
es
3 3
0
26
H
erm
ann
Ho
spit
al
Hou
ston
4
24
1
7
03
0
Yes
4
5
668
11
4
Yes
3
54
27
Ru
sh-P
resb
yte
rian
-St
L
uke
s
Med
ical
Cen
ter
C
hica
go
41
8
16
0
37
Y
es
50
12
73
11
4
No
3 49
2
8
New
Eng
land
Med
ical
Cen
ter
8
0st
on
4
16
4
2
07
9
Yes
5
0
330
24
2
Yes
2
30
2
9
Un
iver
sity
of
Cali
forn
ia
Dav
iS M
edic
al C
ente
r
Sac
ram
ento
4
16
2
2
05
5
Yes
5
0
681
27
9
Yes
3
40
30
Yal
e-N
ew H
aven
H
osp
ital
N
ew H
aven
C
onn
4
12
3
8
09
9
Yes
5
0
943
15
3
Yes
3
52
(+2
SO)
31
Los
An
gel
es C
ount
y-U
SC
Med
ical
Cen
ter
40
9
04
0
08
Y
es
45
21
3 1
67
Y
es
3 43
32
S
hand
s H
osp
ital
et
the U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
40
6
34
0
74
Y
es
45
69
9 1
57
Y
es
2 3
0
33
St
L
ou
is U
niv
ersi
ty H
osp
ital
3
99
1
2
041
Y
es
45
58
7 1
47
Y
es
3 43
3
4
Bos
ton
Med
ical
Cen
ter
39
4
15
0
44
Y
es
40
40
5 2
10
Y
es
3 36
35
U
niv
ersi
ty o
f T
exes
Med
ical
Bra
nch
Ho
spit
als
G
alv
esto
n
39
0
05
0
41
Yes
5
0
890
15
3
Yes
3
38
36
Un
iver
sity
Ho
spit
al
Po
rtla
nd
are
3
90
3
4
07
2
Yes
4
5
356
091
Y
es
3 18
37
M
eth
od
ist
Ho
spit
al
Hou
ston
3
89
3
3
10
0
Yes
4
6
796
13
3
No
3 69
38
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
88
0
6
06
0
Yes
5
0
935
17
0 Y
es
3 6
3
39
Fro
edte
rt M
emor
ial
Lu
ther
an H
osp
ital
M
ilw
auke
e 3
87
1
2
05
5
Yes
5
0
784
14
6
Yes
3
35
40
Un
iver
sity
Ho
spit
els
and
Cli
niC
S
Col
umbi
a
Mo
3
87
2
6
06
6
Yes
4
5
374
15
1
Yes
2
30
41
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
niC
S
Chi
cago
3
85
0
0
01
9
Yes
4
5
382
12
9
Yes
3
42
42
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
Ari
z
38
3
00
0
29
Y
es
45
37
6 1
72
Y
es
3 46
43
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
38
3
12
0
41
Y
es
00
81
4 1
68
N
o 91
44
W
illi
am B
eaum
ont
Ho
spit
el
Roy
al O
ak
Mic
h
38
3
03
0
74
Y
es
50
16
88
18
8
Yes
3
60
45
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
3
81
0
5
06
1
Yes
4
5
941
19
4
Yes
3
63
46
Un
iver
sity
01
Wis
con
sin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
7
22
0
82
Y
es
50
82
0 1
36
Y
es
3 32
4
7
Sax
ar C
ount
y H
osp
ital
Dis
tric
t
San
An
ton
io
37
7
16
0
64
Y
es
45
36
8 1
21
Y
es
3 51
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
WaS
hing
ton
D
C
37
7
05
0
43
Y
es
50
39
5 1
09
Y
es
3 53
49
U
niv
ersi
ty 0
1 V
irg
inie
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
3
77
1
4
06
4
Yes
5
0
930
22
7
No
3 34
50
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r
Dal
las
31
5
05
0
72
Y
es
45
97
6 1
22
Y
es
3 86
j r
l
~
2001
N
euro
logy
and
Neu
rosu
rger
y B
est
Ho
spit
al L
ist
Tec
hnol
ogy
Re p
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
so
ore
rate
M
embe
r (o
f 7)
D
isoh
arge
s to
bed
s C
ente
r
1 M
ayo
Cli
nic
R
oche
ster
M
inn
1
00
0
57
5
09
1
Yes
7
0
4763
1
31
Y
es
2 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
83
7
46
0
09
5
Yes
7
0
3705
1
38
Y
es
3 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
74
6
37
2
07
0
Yes
7
0
2641
1
42
Y
es
4 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
7
27
3
73
0
95
Y
as
70
40
78
13
2
Yes
5
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
51
6
24
1
10
0
Yes
6
0
1503
1
75
No
6 C
leve
land
Cli
nic
5
12
1
88
0
65
Y
es
70
33
38
19
4
No
7 B
arne
smiddotJe
wis
h H
osp
ital
S
t l
ou
is
38
9
92
0
81
Y
es
70
46
67
14
9
Yes
8
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
37
4
10
5
09
1
Yes
7
0
22
86
1
61
Y
es
(+3
SD)
9 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
32
4
70
1
02
Y
es
70
29
21
18
1
Yes
1
0
UCLA
Med
ioal
Cen
ter
lo
s A
ngel
es
32
2
64
0
80
Y
es
70
19
67
10
8
Yes
11
M
ount
S
inai
Med
ical
Cen
ter
Ne
w Y
ork
31
7
55
0
85
Y
es
70
23
83
15
7
Yes
12
M
etho
dist
Ho
spit
al
Hou
ston
3
15
6
2
08
6
Yes
6
0
3768
1
33
No
13
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
15
6
6
09
3
Yes
7
0
1925
1
43
Y
es
14
Un
iver
sity
of
Mic
higa
n M
edic
al C
arot
er
Ann
Arb
or
30
4
68
1
06
Y
es
70
17
02
17
9 Y
es
15
S
t J
ose
ph
s H
osp
ital
and
Med
ical
Cen
ter
Pho
enix
3
04
5
2
09
2
Yes
6
0
3336
1
27
Y
es
16
Los
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
29
9
04
0
29
Y
es
55
39
9 1
67
Y
es
17
H
enry
F
ord
Ho
spit
al
Det
roit
2
99
1
3
06
4
Yes
6
5
3299
1
82
Y
es
18
Den
ver
Hea
lth
and
Ho
spit
als
29
5
04
0
16
No
5
5
353
17
0
Yes
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
29
4
49
0
89
Y
es
50
19
06
16
1
Yes
2
0
Dan
amiddotF
arbe
r C
ence
r In
stit
ute
B
osto
n 2
94
0
3
00
0
No
85
6
22
7
No
21
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
29
3
15
0
46
Y
es
70
11
51
10
9
Yes
2
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
29
1
37
0
82
Y
es
70
21
86
13
4
Yes
(+
2 SD
) 2
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
28
8
13
0
36
V
es
60
33
6 2
68
No
2
4
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 2
88
1
8
07
0
Yes
7
0
3234
1
18
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
28
8
27
0
70
Y
es
60
15
98
15
7
Yes
2
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
87
2
1
07
0
Yes
6
0
1970
1
70
Y
es
27
u
niv
ersi
ty H
osp
ital
D
enve
r 2
87
3
3
07
3
Yes
6
0
613
24
0
Yes
2
8
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
28
6
08
0
19
Y
es
70
44
69
16
7
Yes
2
9
Un
iver
sity
of
Vir
gIn
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
28
5
34
0
83
Y
es
60
32
29
22
7
No
30
D
ooto
rs C
Onm
luni
ty H
osp
ital
la
nham
M
d
28
0
00
0
05
No
5
5
901
09
7
No
31
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
2
78
0
0
00
0
Yes
3
0
870
03
4
Ho
32
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 2
77
1
8
07
0
Yes
7
0
896
19
8
Yes
3
3
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
O
ak
Mic
h
27
6
00
0
82
V
es
70
48
44
18
8
Yes
3
4
St
L
uke
s H
osp
ital
N
ewbu
rgh
N
Y
27
5
00
0
02
No
5
0
82
6
08
0
No
35
B
osto
n M
edio
al C
ente
r 2
74
2
5
07
7
Ves
5
0
1255
2
10
Y
es
36
F
airv
ieW
-Uni
vers
ity
Med
ical
Cen
ter
Min
neap
olis
2
74
2
0
06
1
Ves
5
0
1685
1
56
No
37
U
nIv
ersi
ty M
edic
al C
ente
r T
ucso
n
Ari
z
27
4
00
0
50
Y
es
60
86
5 1
72
Y
es
38
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
73
0
0
06
6
Yes
6
0
3299
1
49
Y
es
39
Sc
hwab
Reh
abil
itat
ion
Ho
spit
al
Chi
cago
2
70
0
0
02
3
Yes
2
5
769
04
1 Y
es
40
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
68
0
0
04
9
Yes
5
0
498
21
0
Yes
41
S
t V
ince
nt H
ospI
tal
and
Hea
lth
Cen
ter
In
dia
nap
olb
2
66
0
0
07
0
Yes
6
0
32
89
1
37
Y
es
42
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
Chi
cago
2
65
0
6
05
4
Yes
7
0
1848
1
14
No
4
3
Bet
h Is
rael
Dea
oone
ss M
edio
al C
ente
r B
osto
n 2
65
1
4
08
5
Yes
6
0
2838
1
58
Y
es
44
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
2
64
0
0
00
6
No
35
12
64
03
8
No
45
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
2
63
1
8
08
8
Yes
7
0
1659
2
40
Y
es
46
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
nic
s C
hioa
go
26
2
13
0
62
Y
es
45
83
0 1
29
Y
es
47
H
arpe
r H
osp
ital
D
etro
it
26
1
04
0
55
Y
es
60
20
72
12
6
No
48
E
vans
ton
Nor
thw
este
rn H
ealt
h C
are
E
vans
ton
Il
l
28
1
09
0
75
Y
es
60
29
33
10
2
Yes
4
9
was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
2
59
0
4
07
7
Yes
6
0
2269
1
92
Y
es
50
Car
din
al H
ill
Reh
abil
itat
ion
Ho
spit
al
lex
ing
ton
K
y
25
8
00
0
02
No
0
5
1313
0
55
No
t
2001
O
rth
op
edio
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
GOTH
so
ore
R
N
$
Tra
uma
Ran
k H
osp
ital
IH
O
sco
re
rate
M
embe
r (o
f 5)
D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
49
2
05B
Y
es
50
77
52
13
1
Yes
2
Ho
spit
al f
or
Sp
ecia
l S
urg
ery
N
ew Y
ork
88
3
40
6
01
3
Yes
4
5
6837
1
57
Y
es
3 M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 7
13
3
20
1
01
Y
es
50
34
89
13
8
Yes
4
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
43
1
90
0
73
Y
es
50
16
28
14
2
Yes
5
Cle
vel
and
Cli
nic
5
19
1
73
0
63
Y
es
50
36
20
19
4
No
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
40
1
34
1
07
Y
es
50
28
63
18
1
Yes
7
Har
borv
iew
Med
ical
Cen
ter
S
eatt
le
37
2
101
1
05
Yes
3
5
820
23
3
Yes
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
37
0
75
0
74
Y
es
50
15
09
13
4
Yes
9
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
36
0
84
0
99
Y
es
50
17
57
10
8
Yes
(+
3 SO
) 10
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
2
68
0
56
Y
es
50
97
3 1
10
No
11
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
A
rbor
3
29
3
9
06
8
Yes
5
0
1586
1
79
Y
es
12
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
32
7
43
0
80
Y
es
50
26
80
14
3
Yes
13
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
32
6
48
0
92
Y
es
50
28
72
16
7
Yes
14
B
exar
Cou
nty
Ho
spit
al D
istr
ict
San
Ant
onio
3
24
3
9
04
8
Yes
4
0
645
12
1
Yes
15
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
3
49
0
87
Y
es
30
21
43
161
Y
es
16
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
35
0
67
Y
es
50
11
56
19
4
Yes
17
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
31
8
71
1
23
Y
es
50
58
7 1
98
Y
es
18
Un
iver
sity
Ho
spit
al
Den
ver
31
7
31
0
44
Y
es
40
63
3 2
40
Y
es
19
Bar
nes
middotJew
ish
Ho
spit
al
St
lo
uis
3
11
3
6
08
9
Yes
5
0
2911
1
49
Y
es
20
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f fl
ori
da
Gai
nes
vil
le
30
7
21
05
9
Yes
4
0
1781
1
57
Y
es
21
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
30
5
62
1
04
Y
es
40
92
7 1
75
No
(+
2 SO
) 22
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
03
1
6
05
9
Yes
5
0
1608
2
40
Y
es
23
Ho
spit
al o
f th
e U
niv
ersi
ty o
f p
enn
sylv
ania
P
hil
adel
ph
ia
30
1
45
1
04
Y
es
50
10
76
161
Y
es
24
U
niv
ersi
ty o
f A
labe
ma
Ho
spit
al a
t B
irm
ingh
am
29
9
22
0
73
Y
es
50
15
94
151
Y
es
25
Ho
spit
al f
or
Join
t D
isea
sesmiddot
Ort
ho
ped
ic I
nst
itu
te
New
Yor
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97
4
0
02
5
No
30
21
10
09
3
No
26
SUl1
l1la
Hea
lth
sy
stem
A
kron
O
hio
29
5
05
0
49
Y
es
40
38
99
14
9
Yes
27
Y
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
Onn
2
93
1
2
061
Y
es
50
14
62
15
3
Yes
28
N
ew Y
ork
Pre
sby
teri
an H
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ital
2
92
4
5
12
2
Yes
5
0
2394
1
32
Y
es
29
Un
iver
sity
of
Ten
ness
ee M
edic
al C
ente
r
Mem
phis
2
92
4
2
05
4
No
46
90
1
50
No
30
U
niv
ersi
ty o
f W
isco
nsi
n H
osp
ital
and
Cli
nic
s
Mad
ison
2
89
1
1
061
Y
es
50
14
42
13
6
Yes
31
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
sacr
amen
to
28
6
24
0
87
Y
es
50
11
56
27
9
Yes
32
S
t
lou
is U
niv
ersi
ty H
osp
ital
2
83
0
4
04
8
Yes
5
0
819
14
7
Yes
33
R
ushmiddot
Pre
sby
teri
an
-St
lu
kes
Med
ical
Cen
ter
Chi
cago
28
1
25
0
79
Y
es
50
21
23
11
4
No
34
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Ill
28
0
00
0
46
Y
es
40
25
63
11
4
Yes
35
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
2
80
0
6
04
7
Yes
5
0
952
10
9
Yes
36
C
aro
lin
as M
edic
al C
ente
r
Ch
arlo
tte
N
C
28
0
23
1
03
Y
es
50
29
00
18
4
Yes
37
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
27
9
06
0
71
Yes
4
0
2274
1
58
Y
es
38
Coo
k C
ount
y H
osp
ital
C
hica
go
27 _
7 1
2
05
5
Yes
3
0
184
21
0
Yes
39
U
niv
ersi
ty o
f lo
uis
vil
le H
osp
ital
lo
uis
vil
le
Ky
2
76
0
5
04
2
Yes
4
0
317
19
0
Yes
40
A
lleg
hen
y G
ener
al H
osp
ital
P
itts
bu
rgh
2
76
0
0
06
4
Yes
4
0
2161
1
91
Yes
41
H
enry
For
d H
osp
ital
D
etro
it
27
6
00
0_
63
Yes
4
5
1834
1
82
Y
es
42
Un
iver
sity
of
Mia
mi
Jack
son
Mem
oria
l H
osp
ital
2
78
3
0
06
2
Yes
0
0
748
16
8
No
43
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 2
75
0
5
06
6
Yes
4
0
1518
1
52
Y
es
44
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
27
5
00
0
32
Y
es
40
87
1 1
72
Y
es
45
Mar
y H
itch
cock
Mem
oria
l H
osp
ital
le
ban
on
N
H
27
4
00
0
57
Y
es
40
14
30
19
4
Yes
46
B
apti
st M
emor
ial
Ho
spit
al
Mem
phis
2
74
4
5
11
2
No
50
29
14
09
3
Yes
47
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
2
73
1
2
08
6
Yes
4
0
2025
1
70
Yes
48
L
os A
ngel
es C
ou
nty
USC
Med
ical
Cen
ter
27
3
05
0
00
Y
es
35
23
6 1
Il7
Yes
49
M
edic
al C
ente
r o
f C
entr
al M
assa
chu
sett
s W
orc
este
r 2
73
0
0
06
0
Yes
4
5
1285
1
89
Y
es
60
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
middotSal
em
27
3
11
0
92
Y
es
50
21
20
1I
II
Yes
r-
-
2001
R
esp
irat
ory
Dis
ord
ers
Bes
t H
osp
ital
Lis
t Tec
hnol
ogy
Dis
char
ge
Rep
uta
tio
nal
M
ort
ali
ty
COTH
sc
ore
R
N
s T
raum
a p
lan
nin
g
Ran
k H
osp
Ital
IH
Q
sco
re
rate
M
embe
r (o
f 4
) D
isch
arg
es
to b
eds
Cen
ter
(of
3)
1 N
atio
nal
Jew
ish
Cen
ter
D
enve
r 1
00
0
501
0
22
N
o 3
0
121
37
5
No
3 2
May
o C
lin
ic
Ro
ches
ter
M
inn
8
S2
41
1
08
1
Yes
4
0
4391
1
31
Yes
3
3 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
63
3
2B0
0
95
Y
es
40
14
61
14
2
Yes
3
4 B
arn
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ewis
h H
osp
ital
S
t
Lou
is
54
6
21
2
08
9
Yes
4
0
5329
1
49
Y
es
3 5
Un
iver
sity
Ho
spit
al
Den
ver
45
7
151
0
83
Y
es
40
9
80
2
40
Y
es
3 6
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
43
2
15
0
09
0
Yes
4
0
1015
1
75
N
o 3
7 M
assa
chu
sett
s G
ener
al H
osp
Ital
B
osto
n 43
1
16
4
11
4
Yes
4
0
3306
1
38
V
es
3 8
Cle
vel
and
Cli
nic
4
20
1
24
0
77
Y
es
40
27
32
19
4
No
3 9
Bri
gham
and
WO
men
s H
osp
ital
B
osto
n 3
69
9
0
08
2
Yes
4
0
2526
1
43
V
es
3 10
U
CSIl
Med
ical
Cen
ter
S
an D
iego
3
68
9
1
08
0
Yes
4
0
1130
1
48
Y
es
3 11
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
4
12
0
09
8
Yes
4
0
720
11
0
110
2 12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbo
r 3
48
8
1
08
7
Yes
4
0
1927
1
79
Ves
3
(+3
SO)
13
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
II
C
33
7
96
1
12
Y
es
40
29
49
18
1
Yes
3
14
Bo
sto
n M
edic
al C
ente
r 3
25
3
8
05
7
Yes
4
0
1105
2
10
Y
es
3 15
H
osp
ital
of
the U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
32
3
96
1
15
Y
es
40
15
07
16
1
Ves
3
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
32
2
74
0
95
Y
es
40
16
20
161
Y
es
3 1
7
Un
ivers
ity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
05
6
0
09
7
Yes
4
0
2957
1
67
Y
es
3 18
UC
LA M
edic
al C
ente
r
Los
Ang
eles
2
97
4
1
07
5
Yes
4
0
1910
1
08
Y
es
3 19
V
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
onn
2
95
5
3
09
3
Ves
4
0
2355
1
53
Y
es
3 20
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
85
5
5
10
0
Yes
4
0
1432
1
94
Y
es
3 21
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
28
5
25
0
74
V
es
40
27
79
15
2
Yes
3
(+2
SO)
22
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
27
9
35
0
87
V
es
40
20
51
24
0
Yes
3
23
Los
A
ng
eles
Cou
nty-
USC
Med
ical
Cen
ter
27
5
04
0
18
Y
es
40
46
9 1
67
Y
es
3 24
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
Sac
ram
ento
2
73
1
2
06
7
Yes
4
0
1820
2
79
V
es
3 2
5
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
73
1
0
06
2
Yes
4
0
1475
1
47
Y
es
3 26
C
ook
Cou
nty
Ho
spit
al
C
hica
go
27
3
00
0
49
Y
es
40
11
45
21
0
Yes
3
27
San
Fra
nci
sco
Gen
eral
Ho
spit
al M
edio
al C
ente
r 2
70
5
6
08
7
Yes
2
0
899
11
0
No
3 28
H
enne
pin
Cou
nty
Med
ical
Cen
ter
M
inn
eap
oli
s 2
67
0
0
05
2
Yes
4
0
1959
1
05
Y
es
3 29
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
26
4
07
0
66
Y
es
40
17
63
15
7
Yes
3
30
Geo
r-ge
tow
n U
niv
ersi
ty H
osp
ital
w
ash
ing
ton
D
C
26
2
04
0
59
Y
es
40
99
3 1
09
Y
es
3 31
C
lar-
ian
Hea
lth
Part
ners
In
dia
nap
Oli
S
26
0
12
0
79
Y
es
40
42
95
16
7
Yes
3
32
Ru
sh-P
resb
yte
rian
-St
L
uk
es
Med
ical
Cen
ter
C
hica
go
25
4
28
0
82
Y
es
40
18
56
11
4
No
3 33
H
enry
Fo
rd H
osp
ital
D
etr
oit
2
54
1
4
08
5
Yes
4
0
3875
1
82
Y
es
3 34
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
2
53
2
2
08
3
Yes
4
0
2302
2
27
No
3
35
W
est
Jeff
ers
on
Med
ical
Cen
ter
M
arre
ro
La
2
52
0
0
05
3
No
40
14
94
11
3
Ves
3
36
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
251
0
0
07
1
Yes
4
0
6185
1
49
Y
es
3 37
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
iCS
M
adis
on
25
0
05
0
70
Y
es
40
14
28
13
6
Yes
3
38
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
50
0
4
07
2
Yes
4
0
1071
1
72
Y
es
3 39
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
sity
M
ayw
ood
Ill
2
49
1
8
08
6
Yes
4
0
1415
1
62
V
es
3 40
U
niv
ersi
ty o
f Il
lin
ois
Ho
spit
al a
nd C
11
nic
s
Chi
cago
2
49
0
5
06
6
Yes
3
5
779
12
9
Yes
3
41
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
46
0
0
06
3
Yes
3
5
1677
1
01
Yes
3
42
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
2
45
3
7
10
3
Yes
4
0
2116
1
51
Ves
2
43
Har
bo
rvie
w M
edic
al C
ente
r
Seett
le
24
4
24
0
89
Y
es
30
80
5 2
33
Y
es
3 44
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
2
44
2
3
09
2
Ves
4
0
1334
1
34
Y
es
3 45
T
rum
an M
adic
al C
ente
r-W
est
K
ansa
s C
ity
M
o
24
4
00
0
64
Y
es
35
99
1 1
14
Y
es
3 46
M
emor
ial
Med
ical
Cen
ter
S
avan
nah
G
a
24
2
00
0
71
Y
es
40
14
03
14
2
Yes
3
47
Tou
ro
Infi
rmar
y
lew
Orl
ean
s 24
1
00
0
65
V
es
40
14
07
06
5
Ves
3
48
St
Jo
sep
h H
osp
ital
D
enve
r 2
41
0
0
05
5
No
40
25
11
10
3
No
3 49
L
os A
ng
eles
Cou
nty-
Har
bor-
UC
LA
Med
ical
Cen
ter
24
0
13
0
10
No
4
0
420
16
5
Yes
2
50
Bay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
40
1
2
08
7
Ves
4
0
3026
1
22
V
es
3
-
J 1
2001
R
heum
atol
ogy
Bes
t H
osp
ital
lis
t
Hos
pita
lwid
e T
echn
olog
y D
isch
arge
R
epu
tati
on
al
mo
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CO
TH
sco
re
RN
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plan
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R
ank
Ho
spit
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IHQ
sco
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M
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) to
bed
s (o
f 3
)
May
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lin
ic
Roo
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Min
n
10
00
4
96
0
72
Y
es
50
1
31
3
2 Jo
hns
Hop
kins
Has
p ta
l 8
alti
mo
rs
85
9
38
0
08
2
Yes
5
0
14
2
3 3
Ho
spt
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 8
09
2
70
0
10
Y
es
45
1
57
3
4 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 7
17
2
54
0
81
Y
es
50
1
43
3
5 C
leve
land
Cli
nic
6
76
2
03
0
67
Y
es
50
1
94
3
6 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
66
4
22
1
09
3
Yes
5
0
1 3
8
3 7
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
66
2
21
2
08
3
Yes
5
0
10
8
3 B
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
64
1
20
8
09
6
Yes
5
0
15
1
2 9
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
5
68
1
34
0
93
Y
es
50
1
81
3
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co M
edic
al C
ente
r 5
58
1
23
0
85
Y
es
40
1
75
3
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
5
37
1
12
0
86
Y
es
30
1
61
3
12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
52
1
82
0
82
Y
es
50
1
79
3
(+3
SD)
13
B
arne
s-Je
wis
h H
osp
ital
S
t
lou
is
49
2
57
0
82
Y
es
50
1
49
3
14
H
osp
ital
fo
r Jo
int
Dis
ease
s-O
rtho
pedi
c In
stit
ute
N
ew Y
ork
48
9
59
0
55
No
3
0
09
3
3 1
5
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 4
86
7
8
10
5
Yes
5
0
11
8
3 1
6
los
Ang
eles
Cou
nty-
USC
Med
ical
can
ter
48
4
00
0
20
Y
es
35
1
S7
3
17
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
47
7
46
0
84
Y
es
50
1
67
3
la
St
lu
kes
Ho
spit
al
New
burg
h
NY
4
74
0
0
00
1
No
35
0
80
3
19
U
niv
ersi
ty H
osp
ital
D
enve
r 4
70
3
6
07
4
Yes
-4
0
24
0
3 2
0
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
46
9
32
0
77
Y
es
50
1
98
3
21
Doc
tors
Com
mun
ity H
osp
ital
L
anha
m
Md
4
69
0
0
00
7
No
35
0
97
2
(+2
SO)
22
Den
ver
Hea
lth
and
Ho
spit
als
48
1
00
0
21
No
4
0
17
0
2 2
3
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
46
6
53
1
02
Y
es
50
1
61
3
24
R
ehab
ilit
atio
n I
nst
itu
te o
f C
hica
go
46
3
00
0
03
Y
es
25
0
34
2
25
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
DC
4
62
0
9
05
3
Yes
5
0
10
9
3 2
6
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
4
58
0
0
00
9
No
25
0
38
3
27
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
45
4
39
0
92
Y
es
40
1
70
3
28
T
he
Inst
itu
te f
or
Reh
abil
itat
ion
and
Res
earc
h H
oust
on
45
3
00
0
13
No
1
5
06
9
3 2
9
Un
iver
sity
of
Chi
cago
Ho
spit
als
45
2
29
0
90
Y
es
50
1
94
3
30
C
ard
inal
Hil
l R
ehab
ilit
atio
n H
osp
ital
L
exin
gton
K
y
44
9
00
0
01
No
0
5
05
5
3 31
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
47
2
6
08
4
Yes
4
0
15
8
3 3
2
Reh
abil
itat
ion
In
stit
ute
of
Mic
higa
n
Det
roit
4
47
0
0
01
2
No
25
0
39
2
33
S
t
lou
is U
niv
ersi
ty H
osp
ital
4
44
0
4
07
1
Yes
5
0
14
7
3 3
4
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
44
4
05
0
66
Y
es
40
1
72
3
35
Coo
k C
ount
y H
osp
ital
C
hica
go
44
3
00
0
55
Y
es
30
2
10
)
36
Su
nnyv
iew
Ho
spit
al a
nd R
ehab
ilit
atio
n C
ente
r S
chen
ecta
dy
NY
4
42
0
0
00
7
No
10
0
43
2
37
B
osto
n M
edic
al C
ente
r 4
39
1
6
07
5
Yes
3
0
21
0
3 3
8
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
niC
S
Mad
ison
4
39
0
8
07
7
Yes
5
0
13
6
3 3
9
Hil
lsid
e R
ehab
ilit
atio
n H
osp
ital
W
arre
n
Ohi
o 4
38
0
0
01
2
No
15
0
30
2
40
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
4
36
1
4
08
6
Yes
5
0
13
4
3 41
U
niv
ersi
ty o
f M
aryl
and
Med
ical
Sys
tem
B
alti
mor
e 4
35
1
6
09
2
Yes
5
0
19
4
3 4
2
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hiO
4
35
0
0
06
8
Yes
4
0
14
9
3 4
3
UCSD
Med
ical
Cen
ter
San
Die
go
43
5
26
0
90
Y
es
30
1
48
3
44
R
ush
-pre
sby
teri
an-S
t
luk
es
Med
ical
can
ter
Chi
cago
4
34
0
0
07
0
Yes
5
0
11
4
3 4
5
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
43
4
15
0
92
Y
es
50
1
53
3 4
6
Hen
ry F
ord
Ho
spit
al
Det
roit
4
34
0
0
07
3
Yes
4
5
18
2
3 4
7
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
can
ter
S
acra
men
to
43
4
00
0
76
Y
es
50
2
19
3
48
H
enne
pin
coun
ty M
edic
al c
ante
r M
inne
apol
is
43
2
00
0
61
Y
es
35
1
05
3
49
W
est
Jeff
erso
n M
edic
al C
ente
r M
arre
ro
lao
43
2
00
0
55
No
4
0
11
3
3 5
0
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
43
2
09
0
87
Y
es
50
1
67
3
~
-
2001
U
rolo
gy B
est
Has
pi ta
l li
st
Tec
hnol
ogy
Rep
uta
tio
nal
M
Ort
alit
y CO
TH
sco
re
RN
s
Tra
uma
Ran
k H
osp
ital
IH
O so
ore
rate
M
embe
r (o
f 8
) D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
70
7
07
8
Yes
7
5
1231
1
42
Y
es
2 C
leve
land
Cli
nio
6
94
4
14
0
50
Y
es
80
1
61
8
19
4
No
3 M
ayo
Cli
nic
R
oche
ster
M
inn
6
80
3
92
0
50
Y
es
80
3
81
8
13
1
Yes
4
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
50
0
25
7
12
3
Yes
8
0
14
50
1
08
Y
es
5 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
4
41
1
79
0
79
Y
es
80
30
61
13
2
Yes
6
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
35
1
73
0
56
Y
es
70
11
61
21
2
No
1 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
13
1
49
0
81
Y
es
80
1
75
8
18
1
Yes
8 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
40
7
15
3
09
6
Yes
8
0
1401
1
38
Y
es
9 B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
iS
39
0
12
9
08
2
Yes
8
0
1778
1
49
Y
es
10
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
38
5
15
2
12
9
Yes
5
0
973
16
1
Yes
11
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
co M
edic
al C
ente
r 3
57
1
07
0
62
Y
es
70
78
3 1
75
No
(+
3 SO
) 1
2
Met
hodi
st H
osp
ital
H
oust
on
33
8
10
9
11
0
Yes
6
5
1381
1
33
No
1
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
33
0
10
8
11
1
Yes
6
0
69
0
26
8
No
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
32
0
60
0
78
Y
es
80
1
28
5
17
9
Yes
1
5
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
31
0
54
0
86
Y
es
80
14
97
16
7
Yes
1
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
07
3
7
04
8
Yas
7
0
95
9
17
0
Yes
1
7
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
30
0
31
0
55
Y
es
80
12
74
16
1
Yes
(+
2 SD
) 1
6
Van
der
bil
t U
niv
ersi
ty H
osp
ital
an
d C
11ni
c
Nas
hv
ille
2
92
5
6
11
5
Yes
7
0
83
3
24
0
Yes
1
9
Lah
ey H
itch
cock
Cli
nic
B
url
ing
ton
M
ass
2
91
2
7
05
4
Yes
7
0
886
15
2
Yes
2
0
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
28
7
51
1
09
Y
es
80
69
7 1
43
Y
as
21
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
28
8
41
0
65
Y
es
80
2
83
1
98
Y
es
22
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
seatt
le
27
9
27
0
24
Y
es
80
5
32
1
10
No
2
3
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
cen
ter
Ch
arlo
ttes
vil
le
27
7
28
0
51
Y
es
70
73
2 2
27
No
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddot S
alem
2
77
1
8
07
7
Yes
8
0
957
16
1
Yes
2
5
Shan
ds H
osp
ital
at
the
Un
iver
sity
of
Flo
rid
a
Gai
nes
vil
le
27
7
15
0
57
Y
es
65
90
5 1
57
Y
es
26
Car
oli
nas
Med
ical
Cen
ter
C
har
lott
e
N C
2
78
0
0
03
3
Yes
8
0
908
18
4
Yes
27
U
niv
ersl
ty o
f W
isco
nsin
Hos
pita
l an
d C
lin
ios
Mad
ison
2
74
0
5
04
5
Yes
8
0
1151
1
36
Y
es
28
Ne
w Y
ork
Un
iver
sity
Med
ioal
Cen
ter
27
3
16
0
66
Y
es
80
16
70
11
8
Yes
2
9
Hen
ry F
ord
Ho
spit
al
Det
roit
2
72
0
0
04
3
Yes
7
5
1079
1
82
Y
es
30
U
niv
ersi
ty H
osp
ital
D
enve
r 2
70
1
0
00
0
Yes
6
0
371
24
0
Y9$
31
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
67
1
4
06
9
Yes
7
0
1011
1
23
Y
es
32
Y
ale-
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
2
67
0
5
06
8
Yes
8
0
98
4
15
3
Yes
33
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
26
7
00
0
42
Y
es
60
9
17
1
92
Y
es
34
A
lban
y M
adic
al C
ente
r A
lban
y
NY
2
66
0
5
04
7
Yes
6
0
77
3
16
7
Yes
3
5
36
Lo
s A
ngel
es C
ount
ymiddotU
SC M
edic
al C
ente
r W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
26
5
26
4
14
0
0
00
0
06
2
Yes
Y
es
60
8
0
65
1
73
0
16
7
18
8
Yes
Y
es
37
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edio
al C
ente
r
Sao
ram
ento
2
64
1
0
05
1
Yes
8
0
412
27
9
Yes
3
8
Nor
th S
hore
Un
iver
sity
Ho
spit
al
Man
hass
et
NY
2
63
0
0
05
5
Yes
8
0
35
4
12
7
Yes
3
9
Sum
ma
Ilea
lth
Sys
tem
A
kron
O
hio
26
2
00
0
04
5
Yes
6
5
775
14
9
Yes
4
0
St
L
ouis
Un
iver
sity
Ho
spit
al
26
1
18
0
72
Y
es
75
4
25
1
47
Y
es
41
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
26
0
21
0
66
Y
es
70
1
12
9
09
3
No
42
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
25
9
00
0
26
Y
es
65
3
56
1
72
Y
es
43
U
niv
ersi
ty o
f L
ou
isv
ille
Ho
spit
al
Lo
uis
vil
le
Ky
2
58
0
8
00
0
Yes
6
0
28
1
90
Y
es
44
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
2
57
0
0
05
9
Yes
6
0
96
5
13
5
Yes
4
5
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
57
1
4
09
9
Yes
7
0
84B
1
62
Y
es
46
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
25
6
04
0
77
Y
es
75
83
3 1
94
Y
es
47
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
25
6
09
0
78
Y
es
60
80
1 1
52
Y
es
48
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
56
2
0
10
9
Yes
8
0
701
19
4
Yes
4
9
Bex
ar C
ount
y H
osp
ital
Dis
trio
t
San
Ant
onio
2
56
0
5
00
0
Yes
8
5
229
12
1
Yes
5
0
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
25
5
13
0
57
Y
es
80
34
9 1
09
Yes
~
l
i i
f
AppendixG
r bull Reputational Rankings for Special-Service Hospitals
i
I
I L
1~
r-
2001
E
yes
Rep
uta
tio
nal
Sco
re
Rep
uta
tio
nal
R
ank
Ho
spit
al
soo
re
Joh
ns
Hop
kins
Ho
spit
al
(Wilm
er
Eye
In
stit
ute
)
Bal
tim
ore
71
2
2 U
niv
ersi
ty o
f M
iam
i (B
asC
om
Pal
mer
Ey
e In
stit
ute
) 6
46
3
Wil
ls E
VQ
Hos
pita
l--
h
ilad
llip
hia
57
0
(+3
l
4 M
assa
chu
sett
s E
ye
and
Ear
In
firm
ary
B
osto
n 4
00
5
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L
AppendixH
The 2001 Honor Roll
Lj
l
r
t
The Honor Roll
To lend additional perspective we have constructed a measure called the Honor Roll to
indicate excellence across a broad range ofspecialties
To be listed on the Honor Roll a hospital has to rank at least 2 standard deviations
(SD s) above the mean in at least 6 ofthe 16 specialties A hospitals ranking in the Honor
Roll is based on points assigned as follows
bull For ranking between 2 and 3 standard deviations above the mean in a specialty a
hospital receives one point
bull For ranking at least 3 standard deviations above the mean a hospital receives two
points
We chose to use a standard deviation based criteria rather than simply adding up a
hospitals rankings in individual specialties for three reasons (1) the number ofoutstanding
hospitals varies from specialty to specialty (2) setting a threshhold is more informative because
it establishes a level ofalmost excellent and (3) it gives some measure ofthe distance
between hospitals which rankings do not
f
middot1
THE 2001 HONOR ROLL
16
Mayo Clinic Rochester Minn 27 13 1
Massachusetts General Hospital Boston 26 12 2
4 Cleveland Clinic 23 11 1
5 UCLA Medical Center Los Angeles 22 8 6
6 Duke University Medical Center Durham NC 20 8 4
7 Barnes-Jewish Hospital St Louis 18 6 6
7 University of Michigan Medical Center Ann Arbor 18 6 6
7 University of California San Francisco Medical Center 18 7 4
10 Stanford University Hospital Stanford Calif 17 6 5
11 Brigham and Womens Hospital Boston 16 6 4
12 University of Washington Medical Center Seattle 12 4 4
13 New York Presbyterian Hospital 12 5 2
14 Hospital of the University of Pennsylvania Philadelphia 11 3 5
15 University of Chicago Hospitals 9 1 7
16 University QfPittsburgh Medical Center 9 2 5 1 1
l
i
1 Introduction
l
f
L
Health care providers and consumers today face a dynamic and often puzzling array of
choices with few tools to inform their critical decisions about quality of care No single
standard measure of quality of care is available for the 6116 hospitals in the United States In
1993 the National Opinion Research Center at the University of Chicago (NORC) developed
such a measure This report card is supported and published annually by U S News amp World
Report in an issue entitled Americas Best Hospitals
In the NORC report card each hospital receives a score called the Index of Hospital
Quality (IHQ) that assesses hospital quality by taking into account the three fundamental
dimensions of health care delivery process structure and outcome None of these dimensions
by itself can completely and accurately represent quality of care all three must be assessed and
combined Care starts with the structural characteristics of an institution (such as the number of
patients served and the range of medical technology available) moves through the process of
delivering care and produces results or outcomes for the patients served To be most useful to
the consumer and provider of care the IHQ--our application of the Donabedian paradigml2 of
structure process and outcomes--combines robust and sensitive measures of each of these
dimensions for the universe of tertiary-care hospitals across a wide range ofmedical and surgical
practice specialties The IHQ draws from secondary sources such as the Annual Survey of
Hospitals by the Americ~ Hospital Association (AHA) for data about various quality
dimensions We continually try to improve the specificity and sensitivity of the measures we use
to rank hospitals and to identify the best possible sources ofdata
For the 2001 rankings we made the following changes bull Introduced new procedures allowing all hospitals that do not respond to the AHA
survey to be eligible for ranking bull Completed the transition to a revised calculation ofmortality ratios bull Refined the selection of Diagnosis-Related Groups (DRGs) for the heart and
orthopedic specialties bull Tested the impact on the response rate to the annual physician survey of either an
explicit reference in the survey letter or questionnaire to the Americas Best Hospitals issue of us News amp World Report or implicitly to the 12th Annual Survey ofPhysicians for US News amp World Report
bull Redesigned the appearance of the questionnaire bull Incorporated into this report a flow chart illustrating the analytical steps of the
methodology
3
(
L
We regularly examine the impact of hospital mergers on our rankings For this release
three mergers among hospitals previously ranked as independent entities appear on the lists
Albany Medical Center NY Evanston Northwestern Medical Center Evanston Ill and
Harper Hospital Detroit These hospitals responded as new corporate entities for the first time
in the 1999 AHA database The following sections define the universe of tertiary-care
hospitals for the purpose of this project describe and define the standardized mortality ratios
and the structural components and explain how process-related data is collected As a guide
the materials on which each of the components of the index is based are outlined below
I Reputation bull The reputational score is based on cumulative infonnation from three NORC
surveys of physicians carried out in 1999 2000 and 2001 the sample design is consistent across the three years
bull The sample for the 2001 survey consists of 2550 board-certified physicians selected from the American Medical Associations (AMA) Physician Masterfile of 811000 physicians
bull StratifYing by region and by specialty within region we selected a sample of 150 physicians from each of 17 specialty areas for a total of2550 physicians
bull The final sample includes both non-federal and federal medical and osteopathic physicians residing in the 50 states and the District ofColumbia
II Structure bull The structural score is based on data related to the structural characteristics of
each specialty within each hospital bull These elements represent volume of work technology and other elements of the
hospital environment bull Most of the data comes from the 1999 AHA Annual Survey bull The volume data comes from the Health Care Financing Administrations
(HeFA) MEDP ARS database which contains information on all Medicare discharges (primarily aged over 65) in each specialty
III ()utco~e
bull The outcome measure is based on HCFAs MEDP ARS database
bull An adjusted mortality rate is computed based on predicted mortality rates bull The data and the model were provided by Solucient Inc of Evanston Ill using
the All Patient Refined Diagnosis Related Group (APR-DRG) method designed by 3M Health Infonnation Systems
bull The APR-DRG adjusts expected deaths for severity of illness by means of principal diagnosis and categories of secondary diagnoses
bull This method is applied to the pooled 1997 1998 and 1999 data set of Medicare reimbursement claims made to HCF A by hospitals
4
In the final section we outline new directions anticipated for the index For a more
exhaustive review of the foundation as well as the development and use of the individual
measures and the composite index see ItBest Hospitals A Description of the Methodology for
the Index ofHospital Quality3
shy
J
r
5
IL The Index ofHospital Quality
A Universe Defmition
We have implemented a two-stage approach to defining eligible hospitals for each of the
IHQ specialty lists
First eligible hospitals must be considered tertiary-care centers To be identified as a
tertiary-care hospital a hospital must meet at least one of the following criteria
bull COTH membership or
bull medical school affiliation or
bull a score of9 or higher on our hospital-wide high-technology index
(Appendix A)
Using these criteria we identified 1878 tertiary-care hospitals that were eligible for any of the
thirteen IHQ-based rankings Once the eligible hospitals were identified data for these hospitals
were drawn from the 1999 AHA Annual Survey As with any data collection effort the AHA
Annual Survey database is incomplete due to nonresponding hospitals Although it did not affect
the analysis this year we have a procedure to allow eligible hospitals that are nonresponders to
the current AHA Annual Survey to remain in our database First for all previously ranked
hospitals that are nonresponders to the current survey we average the two prior years ofdata and
substitute the result for the missing data Two-year non-responders that lack data both from the
current survey and from the previous two surveys are ranked without any structure data
Although nonresponding hospitals need to be treated separately for the IHQ analysis it is
unnecessary to do so for the four reputation-only lists
We then created separate analytic universes for each of the 13 IHQ-driven specialties
using criteria such as specialty-specific technology or facilities and a minimum number of
discharges across appropriate DRGs (Figure 1) However hospitals with a non-zero reputational
score were deemed eligible for ranking even if they had insufficient volume (discharges) in a
specialty
The flow chart in Figure 2 illustrates the eligibility process
6
Figure 1 1999 Universe Definition by Specialty
~pec~~ltyi bull Number ()fllospit~ Imiddotimiddotf~~ifji~t~~f~frl~~~~~~~~~fmiddot ~~ bull~~ bullbull ~ f~middot~~~~ ~ ~~)~~~~ ~~~ Imiddotmiddot~ lt IA~~~~~ri1j~(~~tl = ~-~ ~~~~~f~~-~)~~lt-)-_~- ~~ ~ ~ v~_~ ~_~~ ~~
Cancer minimum of 380 discharges for relevant DRGs or 935 non-zero reputation score
Digestive disorders minimum of734 discharges for relevant DRGs or non- 1394 zero reputation score
Ear nose and minimum of37 discharges for relevant DRGs or non- 1371 throat zero reputation score
Geriatrics score of 1 or more on the geriatrics service index and 1412 minimum of 5947 discharges for all DRGs or nonshy
zero reputation score
Gynecology minimum of 52 discharges for relevant DRGs or non- 1356 zero reputation score
have a cardiac catheterization lab or Heart offer open heart surgery or 853
offer angioplasty and minimum of 245 surgical discharges for relevant
DRGs or non-zero reputation score
Hormonal Minimum of3615 discharges for relev 944 disorders non-zero reputation score
Kidney disease Minimum of 185 discharges for relev 1389 non-zero reputation score
Neurology and Minimum of464 discharges for rete 1408 Neurosurgery non-zero reputation score Orthopedics Minimum of392 discharges for relevant DRGs or 1406
non-zero reputation score Respiratory Minimum of881 discharges for relevant DRGs or 1409
disorders non-zero reputation score Rheumatology Minimum of22 discharges for relevant DRGs or non- 1376
zero reputation score Urology Minimum of 133 discharges for relevant DRGs or 1370
non-zero reputation score
7
L c
L
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B Composite Measure of Structure
The structural dimension defines the tools and environment available to care providers in
treating patients It represents the possibilities of care for a patient and physician Healthcare
research overwhelmingly supports the use of a measure of structure in assessing quality of care
However no prior research has revealed a single indicator of quality that summarizes all others
or that adequately represents the structure construct on its own Thus the structural component
must be represented by a composite variable comprising different measures that are specialtyshy
specific and are weighted relative to each other
For the 2001 index all structural elements other than volume are derived from the 1999
AHA Annual Survey of Hospitals database and are described below For specific mapping of
variables to the AHA data elements see Appendix B
COTH membership This dichotomous variable indicates membership in the Council of
Teaching Hospitals
Technology indices In 2001 we added medical and surgical intensive care beds to
the list of nephrology elements All other technology elements for all other specialties are
unchanged A complete list of the technologies considered for each specialty can be found in
AppendixA
Since the 1996 version of the index we have allowed our technology indices to reflect
the real cost of high-technology services While providing a service inside the hospital is
convenient for patients the cost may be unacceptable to some hospitals Many hospitals
provide access to technology services through the hospitals health system a local community
network or a contractual arrangement or joint venture with another provider in the
community We have taken this into account by giving hospitals that provide a service such as
ultrasound on-site one full point for that element hospitals that provide the service locally
through a formal arrangement receive a half-point A hospital receives no more than one point
for each element of the index
Volume The volume measure reflects the total number of medical or surgical (or both
when appropriate) discharges in the appropriate specialty-specific ORO groupings submitted for
HCF A reimbursement In the heart specialty surgical discharges indicates volume Data from
the three most recent years is pooled The ORO groupings are shown in Appendix C
9
RNs to beds The number of beds is defined by the AHA as beds set up and staffed at
the end of the reporting period Only nurses who have graduated with RN degrees from
approved schools of nursing and who are currently registered by their state are considered
Nurses must be full-time (35 hoursweek or more) and on staff Private-duty nurses nursing
staff whose salary is financed entirely by outside sources (eg an agency or a research grant)
and LPNs are not counted Registered nurses more appropriately classified in other
occupational categories (eg supervisory nurses facility administrators) also are not counted
Trauma In 1992 the annual US News survey of board-certified physicians ranked the
presence of an emergency room and a hospitals trauma provider level high on a list of hospital
quality indicators Physicians in nine specialties ranked trauma as one of the top five indicators
of quality The indications of these specialists and resultant high factor loadings supported the
inclusion of this data for heart hormonal disorders digestive disorders gynecology kidney
disease neurology and neurosurgery orthopedics ear nose and throat respiratory disorders and
urology
The trauma indicator is dichotomous and reflects two variables from the AHA database
whether the hospital has a certified trauma center in the hospital and the level of the trauma
center To receive credit for trauma services hospitals must provide either Level 1 or Level 2
trauma services in-hospital (as opposed to providing trauma services only as part of a health
system network or joint venture) Levell trauma service is defined as a regional resource
trauma center which is capable of providing total care for every aspect of injury and plays a
leadership role in trauma research and education4 Level 2 is defined by the AHA as a
community trauma center which is capable ofproviding trauma care to all but the most severely
injured patients who require highly specialized care4
Discharge planning The three elements of discharge planning are patient-education
services case management services and patient representative services TA service must be
provided in-hospital to receive credit
Service mix This indicator ranges from 0 to 10 points and comprises alcoholdrug abuse
or dependency inpatient care hospice home health services social work services reproductive
health services psychiatric education services womens health centerservices and psychiatric
consultationlliaison services Services must be provided within the hospital We do not award a
half-point for items in this measure
10
L
Geriatric services This indicator ranges from 0 to 7 points and comprises arthritis
treatment centers adult day care programs patient representative services geriatric services
meals on wheels assisted living and transportation to health facilities Again to receive credit
for a service it must be provided in-hospital
Gynecology services This indicator was introduced in 19975 It provides a means to
better rate the quality of services a hospital provides for its gynecological and obstetric patients
High factor loadings provide support to this variables inclusion With a range of 0 to 4 the
services included are obstetric care reproductive health care birthing rooms and womens
health center The half-point scheme used for the technology indices was not employed for this
indicator
Medicalsurgical intensive care beds This indicator is new in 2001 it surfaced as an
important factor for the nephrology specialty The AHA database provides the number of
medical and surgical intensive care beds per facility To be counted beds must be physically
located within the hospital and set up and staffed at the end of the reporting period
To combine these structural variables we weight the elements to create a flnal
composite measure Using factor analysis we force a one-factor solution and use the resultant
loadings as weight values for each variable in the composite structural measure The
relative weight assigned to each element varies from specialty to specialty and from one release
to the next within specialty Figure 3 provides the factor weights assigned to each element for
the 2001 release
11
F
Fig
ure
3 F
acto
r Lo
adin
g by
Spe
cial
ty
CO
TH
Imiddot
Tec
hnic
al
V
olum
e R
Ns
lBed
s D
is-
Goomiddot
Inde
xes
chan
ze
Can
cer
73
59
70
70
Dig
esti
ve d
isor
ders
69
52
60
63
Ear
nos
e a
nd th
roat
72
54
64
63
Ger
iatr
ics
35
81
Gyn
ecol
ogy
61
71
I H
eart
72
62
65
61
I
56
Hor
mon
al d
isor
ders
71
53
56
65
I
63
Kid
ney
dise
ase
63
66
62
57
I 54
Neu
rolo
gy a
nd n
euro
surg
ery
68
54
62
66
62
Ort
hope
dics
69
46
54
66
63
Res
pira
tory
dis
orde
rs
50
73
31
51
58
Rhe
umat
olog
y 45
82
Uro
logy
73
49
C Process
The process dimension of the quality equation is the sum or net effect of physicians
clinical decision-making Physicians clinical choices about the use of medication or diagnostic
tests admission to the hospital or one ofits units and length ofstay account for a large fraction
of the outcomes experienced by patients However measurements ofprocess on a national scale
are extremely difficult to obtain In order to measure process we rely on an alternative measure
to act as a proxy for process We contend that when a qualified expert identifies a hospital as
one of the best he or she is in essence endorsing the process choices made at that hospital
Thus we use the nomination of a hospital by a board-certified specialist as a measure off process In order to collect these nominations we conduct an annual survey of board-certified
f - physicians As in past releases we have pooled nominations for the past three years [1999-2001] I to arrive at the process measure i
Survey sample The sample for the 2001 survey consists of 2550 board-certified
physicians selected from the American Medical Associations (AMA) Physician Masterfile of
811000 physicians From within the Masterfile we selected a target population of 194916
board-certified physicians who met the eligibility requirements listed in Figure 4 Stratifying by
region and by specialty within region we selected a probability (random) sample of 150
t l physicians from each of 17 specialty areas for a total of 2550 physicians The final sample
r includes both non-federal and federal medical and osteopathic physicians residing in the 50
states and the District ofColumbia Figure 4 displays the list of specialties surveyed in 2001
f Eligibility requirements We defined a probability sample of physicians who could
properly represent the 17 specialty groupings delineated by us News amp World Report We
used two rules of eligibility one related to a mapping between the 17 specialties and the AMAs
list of 85 self-designated specialties and the second related to a mapping between these 85
specialties and the 23 member boards of the American Boards ofMedical Specialties (ABMS)
Under the first rule we linked each of the 17 specialties to one or more relevant AMA
specialties from the list of AMA self-designated practice specialty codes Physicians who
designated a primary specialty in one of the 17 specialties were preliminarily eligible for the
survey Under the second rule the physicians must also be certified by the corresponding
member board of the ABMS Figure 4 displays the correspondence between the specialty [ specified for US News amp World Report AMA self-designated specialty and the corresponding
member board
13
Figure 4 Physician Sample Mapping
us NEWS SPECIALTY
Cancer
r Digestive disorders
Ear nose and throat
Eyes
Geriatrics
i
Gynecology L
Heart
Hormonal disorders
Kidney disease
Neurology and Neurosurgery
-l ~
Orthopedics
Pediatrics
Psychiatry
Rehabilitation
Respiratory disorders
Rheumatology
Urology
I AMAKEY CODE
HEMl22 ON24
GEl
OTO48
OPW46
FPG38 IMG38
GYN21 OBG42
CD08 CDS08
END14 DW12
NEP
N36 NS
ORS85
PO55 ADUOI
P63
PW62
PUD
RHU174
Ul91
AMASELF-middot DESIGNATED
Hematology Oncology
Gastroenterology
Otolaryngology
Ophthalmology
Geriatrics
Gynecology Obstetrics amp gynecology
Cardiovascular diseases Cardiovascular surgery
Endocrinology Diabetes
Nephrology
Neurology Neurological surgery
Orthopedic surgery
Pediatrics Adolescent medicine
Psychiatry
Physical medicine amp rehabilitation
Pulmonary diseases
Rheumatology
Urological surgery
14
AMERICAN BOARD OF
Internal medicine Internal medicine
almedicine
Otolaryngology
Ophthalmology
Internal medicine
Obstetrics amp gynecology Obstetrics amp gynecology
Internal medicine Surgery
Internal medicine Internal medicine
Internal Medicine
Psychiatry amp neurology
Orthopedic surgery
Pediatrics Pediatrics
Psychiatry amp neurology
Physical medicine amp rehabilitation
Internal medicine
I Internal medicine
Urology
r -
l
r
to
f -
1 bull
Stratification To compensate for the widely varying number of eligible physicians
across the targeted specialties we used different probabilities of selection for each grouping and
used proportionate stratification across the four United States Census regions (West Northeast
South and North Central) Within each of the 17 strata we achieved a sample that was also
geographically representative of the spread ofphysicians across the country
2001 physician survey Sampled physicians were mailed a three-page questionnaire (see
Appendix D) a cover letter and a prepaid return envelope We also included a token incentive
in the form of a two-dollar bilL One week after the initial survey mailing a reminder postcard
was sent to the sampled physicians Two weeks following the reminder mailing we sent a
second mailing to nonrespondents including the questionnaire a cover letter and a business reply
envelope Three weeks after the second mailing we re-sent the questionnaire to nonrespondents
This third mailing was sent by Federal Express and included the questionnaire a cover letter and
a business reply envelope
2001 questionnaire redesign In consultation with Dr Donald Dillman of Washington
State University a noted questionnaire designer we revised the physical layout of the project
questionnaire (Appendix D) so that respondents could read and complete it more easily We
believe that the redesign had appreciable impact on this years response rate (below and Figure
5)
Response rate Of the 2550 physicians surveyed for this years report 1377 physicians
returned a useable questionnaire a response rate of 547 percent (Response rate is calculated as
the ratio of completed questionnaires to the total eligible in accordance with standard practice
any member of the sample found to be ineligible was removed from the denominator of the
equation for calculation purposes) Figure 5 shows response rates by specialty for the three years
used for the 2001 index
2001 experiments NORC conducted two experiments as part of the physician survey
for 2001 Briefly the experiments were 1) a Web version of the survey permitting direct onshy
line response for physicians and 2) a comparison of explicit citations of the Americas Best
Hospitals project for US News amp World Report and implicit references to the 12th Annual
15
Survey of Physicians conducted for US News amp World Report Citations appeared on both the
cover letters and questionnaire cover As with last years experimental launching of the Web
version this years version was used successfully by a small number of respondents We plan to
evaluate the cost-effectiveness ofthis strategy before using it again next year With regard to the
project citation experiment half of the physicians in each specialty were told explicitly that their
responses would be used to rank hospitals in Americas Best Hospitals issue of US News amp
World Report and the other half were told that they were participating in an annual survey of
physicians for US News amp World Report Our comparison of the explicit and implicit project
citations indicated no difference in response rates The difference in the number of survey
questionnaires returned by each group within each specialty ranged from 1 to 8 Figure 5 [
details the total number of surveys returned for each specialty
16
r
~
r-
lt
ance
r ig
esti
ve d
isor
ders
orm
onal
dis
orde
rs
idne
y di
seas
e
euro
logy
and
esp
irat
ory
diso
rder
s gy
Fig
ure
5 R
espo
nse
Rat
e b
y Y
ear
(150
sam
pled
phy
sici
ans
per
spe
cial
ty p
erye
ar)
n 70
71
82
75
84
70
62
68
62
78
r
Weighting Weighting was carried out in two steps First weights were assigned to
physicians that reflected the probabilities of selection within specialty groups and the overall
rates ofresponse within these groups Second the weights from the first step were poststratified
using the two-dimensional contingency table of specialty (17 categories) by census region
(Northeast Midwest South and West) To check the weights we ~nfinned that the sum across
the sample of the weights in each cell of the classifications (specialty x region) equaled the
population size
D Outcome
Many healthcare professionals have decried the use of mortality rates because of
limitations in the methods used to adjust for risk Nonetheless research strongly suggests a
positive correlation between a risk-adjusted mortality rate that is better than average and overall
quality8-17 Based on these findings we used adjusted mortality rate as the outcome measure for
our quality of care model All predicted mortality rates were provided by Solucient Inc of
Evanston Ill using the All Patient Refined Diagnosis Related Group (APR-DRG) method
designed by 3M Health Information Systems The APR-DRG adjusts expected deaths for
severity of illness by means of principle diagnosis and categories of secondary diagnoses A
detailed description of the full APR-DRG methodology is provided in Appendix E Solucient
applied this method to the pooled 1997 1998 and 1999 data set of reimbursement claims made to
HCF A by hospitals These complete data sets were the most current available
2001 DRG refmements We annually review the DRG-groupings for every specialty In 2001
we chose to conduct a thorough examination of the DRG groupings in heart and orthopedics
Because we anticipated likely changes as a result we conducted two independent reviews
Solucient conducted a review of each specialty and an independent consultant shy
a cardiologist and an orthopedic surgeon--conducted a review in his specialty Where the two
reviews agreed as they did in each of the two specialties we implemented the recommended
changes Revisions for each specialty are detailed below
18
Heart DRGs Three DRGs were added
109 = Coronary bypass wlo cardiac cath
124 =Circulatory disorders except AMI w cardiac cath and complex diag
125 =Circulatory disorders except AMI w cardiac cath and wlo complex diag
Orthopedic DRGs Two DRGs were deleted and six were added
DeletedDRGs
214 =Back amp neck procedures wI CC
215 =Back amp neck procedures wlo CC
AddedDRGs
496 =Combined anteriorlposterior spinal fusion
497 = Spinal fusion wI CC r 498 = Spinal fusion wlo CC 501 =Knee proc wI pdx ofinfection wi CC
502 =Knee proc wI pdx ofinfection wlo CC
503 =Knee proc wlo pdx ofinfection
As in previous years we used an all-cases mortality rate for four specialties (geriatrics
gynecology ear nose and throat and rheumatology) rather than a specialty-specific rate either
because the number of hospitals with sufficient discharges in the particular DRG-grouping was
too low or because the DRG groupings proved to be less robust than was desired Appendix C r -
lists the DRGs for each specialty
In 2000 we modified the construction of the outcome measure The IRQ is the final
score for each hospital in the specialty rankings It gives equal weight to process (represented by
reputation) outcome (mortality) and structure (volume technology and other elements of the
hospital environment) The numbers produced for each of these three measures however differ
greatly in magnitude and in range or variability Without correcting for that the final score
even when the three measures are weighted equally would be distorted
19
Pre-2000 solution For each specialty prior to 2000 the calculated mortality ratio for each
hospital was inverted--the ratio of actual to expected deaths was divided into 1 so that as with
other measures higher meant better For example a better-than-expected mortality ratio of 08
would produce an inverted result of 125 a worse-than-expected ratio of 12 would produce an
inverted result of 083 (The published rankings continued to display the ratio of actual to
expected deaths) Then the scores for reputation mortality and structure were standardized or
adjusted so that the degree ofvariability in each measure was the same
A difficulty with this approach was that inverting caused very low mortality ratios to
distort the outcome (Inverted a mortality ratio of 025 produces a score of 4 a ratio of 005
produces a score of 20 and a ratio of 001 produces a score of 100) If instead of being divided
into 1 the mortality ratio is subtracted from I-this could be called reverse scoring-such extremes r
are eliminated Using reverse scoring a mortality ratio of 025 produces a score of 075 a ratio
of 005 produces a score of 095 and a ratio of 001 produces a mortality score of 99 This
maintains the magnitudes of the differences and avoids extreme values Accordingly the new
rankingsreflect reverse scoring in mortality To dampen the effect of year-to-year fluctuations
mortality scores will be averaged over three years
Finally scores at the extremes in mortality and in certain structural measures were
trimmed to eliminate the influence ofvery wide variation Figure 6 gives the percentile at which
each of the mortality distributions was trimmed
Lj Figure 6 Percentile at Which Each Mortality Distribution Was Trimmed
Specialty
Cancer
Digestive disorders
Ear nose and throat
Geriatrics
Gynecology
Heart
Hormonal disorders l ~
Percentile
95
99
95
99
99
95
95
Specialty Percentile
Kidney disease 99
Neurology and neurosurgery 99
Orthopedics 95
Respiratory disorders 99
Rheumatology 99
Urology 90
20
l
A second round of standardizing also was added in 2000 after trimming extremes
Previously this second standardization was not perfonned resulting in trimmed measures having
less influence on the final score than other measures did Restandardizing restores the balance so
that trimmed and untrimmed measures have the same influence
Phase-in The changes described affect the final scores so they are phased in over two
years For 2000 each hospitalts final score averaged pre-2000 and current methodologies As
before the top hospital in each specialty received a score of 100 with other hospitals scaled
down from that figure
In 2001 the phase-in is complete with the 2001 mortality ratios fully reflecting the
revised methodology
J
--
21
E Calculation of the Index
i
The calculation of the IRQ for each hospital (other than in specialties ranked solely on
reputation) considers equally the three dimensions of quality of care structure process and
outcome Although all three measures represent a specific aspect of quality a single score not
only provides an easier-to-use result but yields a more accurate portrayal of overall quality than
would the three aspects individually
Therefore in computing the final scores for a particular specialty the reputational score
mortality scores and the collective set of structural indicators receive arithmetically equivalent
importance
The total fonnula for calculation of the specialty-specific IHQs is
where
IHQi = Index for Hospital Quality for specialty i
Sl-n = Structural indicators (STRUCTURE)
F = Factor loading
P = Nomination score (PROCESS)
M = Standardized mortality ratio (OUTCOME)
The general fonnula for deriving the index scores for tertiary-level hospitals is the same
as it began in 1993 Each of the three components--structure process and outcomes--is
considered equally in determining the final overall score For presentation purposes we
standardized raw scores then equated the raw IRQ scores as computed above to a 100-point
scale where the top hospital in each specialty received a score of 100
The mean and standard deviation of each of the 17 specialties are listed in Figure 7
Note that for the four reputation-only rankings mean and standard deviation of the reputational
score are presented This data further illustrates that the spread of IRQ scores produces a very
small number of hospitals two and three standard deviations above the mean Horizontal lines
in each of the 17 specialty lists in Appendices F and G indicate the cutoff points of two and
three standard deviations above the mean
22
We could not calculate scores for hospitals that provide care in eyes pediatrics
psychiatry or rehabilitation because data for robust and meaningful structural and outcomes
measures are not available for these specialties Thus as shown in Appendix G we rank
hospitals in these specialties solely by reputation Although the four reputation-only specialties
are ranked without the Index of Hospital Quality standard deviations of the reputational scores
are still useful in identifying truly superior hospitals (in terms of statistically relevant nomination
scores)
Figure 7 Mean and Standard Deviations ofIHQ and Reputational Scores
Mean Standard deviation 1 SD above Z SDs above 3 SDs above the mean the mean the mean
~- IHQScore
Cancer 2390 652 3042 3694 4346
Digestive disorders 1514 538 2052 2590 3128
Ear nose and throat 2064 647 2711 3358 4005
Geriatrics 2049 588 2637 3225 3813 Gynecology 1857 598 2455 3053 3651
Heart 2079 674 2753 3427 4101 Hormonal disorders 2545 574 3119 3693 4267 Kidney disease 2600 758 3358 4116 4874
Neurology and 1781 562 2343 2905 3467 neurosurgery Orthopedicsmiddot 1960 539 2499 3038 3577I Respiratory disorders 1665 569 I 2234 2805 3372 Rheumatology 3768 454 4222 4676 5130 Urology 1930 502 2432 2934 3436
Reputational Score
lEyes 455 1272 1727 2999 4271 [pediatrics 299 659 958 1617 2276 psychiatry 252 524 776 1300 1824 Rehabilitation 287 777 1064 1841 2618
23
III Directions for Future Releases
The US News Index has since its inception used the most rigorous methodology
available to define measure and combine the components of quality incorporated in its
construction Over the next few years we plan to subject each of the components (process
outcome and structure) to a searching re-examination We are aware that the skewed
distribution of the reputation scores can appear to give an inappropriate advantage to hospitals
that obtain a high percentage ofnominations and we will continue to examine the way in which
the reputation scores are used to define the process score We intend to test and evaluate
different transformations of the raw scores to see whether a transformation would produce a
bull i superior measure With regard to outcome the refinement of definitions of non-fatal outcomesshy
particularly in some specialties-suggests incorporating some of these measures into outcome
scores We will continue to refine and develop our measures of technology for the structural
component Finally we will re-examine the way in which the three components are combined
into the IHQ There may be ways to maintain the principle of equal weight for the three
components while improving the method ofcombining them
We will also examine the possibility of extending the evaluation of the four specialties
that are currently ranked only on reputation to incorporate appropriate structure and outcome
measures
As in years past we welcome input from users of the index in charting new directions
Readers and users are encouraged to contact the authors with suggestions and questions
j bull
24
l
lmiddot
References 1 Donabedian A Evaluating the quality of medical care The Milbank Memorial Fund Quarterly
1966 44166-203
2 Donabedian A Promoting quality through evaluating the process of patient care Med Care 1968 6181
3 Hill CA Winfrey KL Rudolph BA Best Hospitals A description of the methodology for the index ofhospital quality Inquiry 1997 34(1)80-90
4 American Hospital Association 1996 Annual Survey of Hospitals Data Base Documentation Manual
5 Ehrlich RH Hill CA Winfrey KL 1997 Survey oBest Hospitals Chicago NORC 1997
6 Hill CA Winfrey KL1995 Survey on Best Hospitals Chicago NORC 1995
7 Palella FJ Jr Delaney KM Moorman AC Loveless MO Fuhrer J Satten GA Aschman DJ Holmberg SD Declining Morbidity and Mortality Among Patients With Advanced Human Immunodeficiency Virus Infection N Engl J Med 1998 338853-860
8 United States Department of Health and Human Services Medicare hospital mortality information HCFA publication 01-002 Report prepared by Otis R Bowen and William L Roper Washington DCUSGPO 1987
9 Blumberg MS Comments on HCFA hospital death rate statistical outliers HSR Health Services Research 1987 21715-40
10 Dubois RW Brook RH Rogers WH Adjusted hospital death rates a potential screen or the quality ofmedical care MPH 1987 771162-6
11 Gillis KD Hixson JS Efficacy of statistical outlier analysis for monitoring quality of care Journal oBusiness and Economic Statistics 1991 9241-52
12 Green J Wintfield N Sharkey P Passman LJ The importance of severity of illness in assessing hospital mortality JAMA 1990 263241-6
13 Green J Passman LJ Wintfield N Analyzing hospital mortality the consequences ofdiversity in patient mix JAMA 1991 2651849-53
14 Greenfield S Aronow HU ElashoffRM Watanabe D Flaws in mortality data the hazards of ignoring comorbid disease JAMA 1988 2602253-7
15 Rosen HM Green BA The HCFA excess mortality lists a methodological critique Hospital and Health Services Administration 1987 2119-24
16 Flood AB Scott WR Conceptual and methodological issues in measuring the quality of care in hospitals In Hospital structure and performance Baltimore Johns Hopkins University Press 1987
17 Iezzoni LI Ash AS Coffinan GA Moskowitz MA Predicting in-hospital mortality a comparison of severity measurement approaches Med Care 1992 30347-59
25
Appendix A
Technology Indices by Specialty t
1
All Hospital Index
17 elements (used to define eligible hospitals)
r
Cancer
7 Elements
AnRioplasty Cardiac Catheterization Lab
Cardiac Intensive Care Beds
Computed Tomography Scanner
Diagnostic Radioisotope Facility
Diagnostic Mammography Services
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
MedicaVSurgical Intensive Care
Neonatal Intensive Care Beds
Open Heart Surgery
Pediatric Intensive Care Beds
Positron Emission Tomography Scanner
ReprQductive Health
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraphy Scanner Magnetic Resonance Imaging
Oncology Services
Pediatric Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
I Digestive disorders
8 Elements Computed Tomography Scanner Diagnostic Radioisotope Facility
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound i
X-ray Radiation Therapy
Ear Nose and Throat
5 Elements Comouted Tomorrraohv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
Heart
9 Elements Angioplasty Cardiac Catheterization Lab
Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Open Heart Surgery
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
j
Hormonal disorders
7 Elements
Geriatrics
8 Elements
Gynecology
8 Elements
Computed TomoRraphv Scanner Diagnostic Radioisotope Facility
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Cardiac Catheterization Lab Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraDhv Scanner Diagnostic Mammography Services
Magnetic Resonance Imaging
Neonatal Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Kidney disease
5 Elements
Neurology and f Neurosurgery t j
7 Elements
t
l
Orthopedics
5 Elements I t
Respiratory disorders 4 Elements
Extracorporeal Shock Wave Lithiotripter Ultrasound
Computed Tomography Scanner
Diagnostic Radioisotope FacUity
Transplant Services
Computed Tomography Scanner Diagnostic Radioisotope FacUity
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed Tomolraphv Scanner Magnetic Resonance Imaging
Positron Emissions Tomography Scanner
Single Photon Emissions Computed Tomography
Ultrasound
Computed Tomographv Scanner Diagnostic Radioisotope FacUity
Radiation Therapy
Ultrasound
Rheumatology
5 Elements Computed TomoJraphv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
Urology
8 Elements Extracorporeal Shock Wave Lithiotripter X-ray Radiation Therapy
Computed Tomography Scanner
Diagnostic Radioisotope Facility
i Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
(
i
AppendixB
Structural Variable Map
f
L
r
t bull
r
tJ
L
The following variables used to construct structural elements of the 2001 IHQ were taken from the 1999 Annual Survey of Hospitals Data Base published by the American Hospital Association
ALL HOSP~TAL ~NDBX - used to define hospital eligibility 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ~GIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICBDHOS=l half point if CICBDSYS CICBDNET or CICBDVEN=l 1 point if CTS CNHOS=1 half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if MSICHOS=l half point if MSICSYS MSICNET or MSICVEN=l 1 point if NICBDHOS=l half point if NICBDSYS NICBDNET or NICBDVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PEDBDHOS=l half point if PEDBDSYS PEDBDNET or PEDBDVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if REPROHOS=l half point if REPROSYS REPRONET or REPROVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Cancer Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if ONCOLHOS=l half point if ONCOLSYS ONCOLNET or ONCOLVEN=l 1 point if PEDICHOS=l half point if PEDICSYS PEDICNET or PEDICVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
Digestive Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Ear I Nose and Throat Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRIVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
1
Heart Technology Index 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ANGIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNETor CICVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Hormonal Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRlHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Geriatrics Technology Index 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNET or ClCVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETROS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Gynecology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if NICHOS=l half point if NICSYS NICNET or NlCVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Kidney Disease Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=lhalf point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if TPLNTHOS=l half point if TPLNTSYS TPLNTNET or TPLNTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Neurology and Neurosurgery Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Orthopedics TeChn610gy ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Respiratory Disorders Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Rheumatology Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Urology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
r
I
Discharge Planning COTH ] point if CMNGTHOS=] Yes if MAPP8=1 ] point if PATEDHOS=] 1 point if PATRPHOS=l RN I s to Beds
Full-time Registered Nurses Geriatric Services (FTRNTF) divided by Total Hospital 1 point if ADULTHOS=l Beds (HOSPBD) ] point if ARTHCHOS=l 1 point if ASSTLHOS=l Trauma ] point if GERSVHOS=l Yes if TRAUML90=] or 2 and 1 point if MEALSHOS=l TRAUMHOS=l 1 point if PATRPHOS=l 1 point if TPORTHOS=l
Gynecology Services 1 point if BROOMHOS=l 1 point if OBLEV=2 or 3 and OBHOS=] 1 point if REPROHOS=l
l ~
1 point if WOMHCHOS=l r ~
Service Mix ] point if ALCHHOS=l ] point if COUTRHOS=l 1 point if HOMEHHOS=l ] point if HOSPCHOS=l ] point if PSYEDHOS=] 1 point if PSYLSHOS=] 1 point if REPROHOS=l ] point if SOCWKHOS=] ] point if WOMHCHOS=]
l
i
1
[ l
AppendixC
Diagnosis-Related Group (DRG) Groupings l by Specialty
r 1
DRG10 DRGll DRG64 DRG82 DRGl72 DRG173 DRG199 DRG203 DRG239
DRG257 DRG258 DRG259 DRG260 DRG274
r 1 DRG275 DRG338 DRG344 DRG346 DRG347 DRG354 DRG355 DRG357 DRG366 DRG367 DRG400 DRG401 DRG402 DRG403 DRG404 DRG405 DRG409 DRG410 DRG411 DRG412 DRG413 DRG414
r 1 DRG473 DRG492
1
U
I 1
LJ
Cancer
NERVOUS SYSTEM NEOPLASMS W CC NERVOUS SYSTEM NEOPLASMS WIO CC EAR NOSE MOUTH amp TIIROAT MALIGNANCY RESPIRATORY NEOPLASMS DIGESTIVE MALIGNANCY W CC DIGESTIVE MALIGNANCY WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS PAlHOLOGICAL FRACTURES amp MUSCULOSKELETAL amp CONN TISS MALIGNANCY TOTAL MASTECTOMY FOR MALIGNANCY W CC TOTAL MASTECTOMY FOR MALIGNANCY WIO CC SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC SUBTOTAL MASTECTOMY FOR MALIGNANCY WIO CC MALIGNANT BREAST DISORDERS W CC MALIGNANT BREAST DISORDERS WIO CC TESTES PROCEDURES FOR MALIGNANCY OTHER MALE REPRODUCTIVE SYSTEM OR PROCEDURES FOR MALIGNANCY MALIGNANCY MALE REPRODUCTIVE SYSTEM W CC MALIGNANCY MALE REPRODUCTIVE SYSTEM WIO CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG W CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG WIO CC UTERINE amp ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY MALIGNANCY FEMALE REPRODUCTIVE SYSTEM W CC_ MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WIO CC LYMPHOMA amp LEUKEMIA W MAJOR OR PROCEDURE LYMPHOMA amp NONmiddotACUTE LEUKEMIA W OTHER OR PROC W CC LYMPHOMA amp NON-ACUTE LEUKEMIA W OTHER OR PROC WIO CC LYMPHOMA amp NON-ACUTE LEUKEMIA W CC LYMPHOMA amp NON-ACUTE LEUKEMIA WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGE 0-17 RADIOlHERAPY CHEMOTHERAPY WIO ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS HISTORY OF MALIGNANCY WIO ENDOSCOPY HISTORY OF MALIGNANCY W ENDOSCOPY OlHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGEgt17 CHEMOTHERAPY W ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS
DRG146 DRG147 DRG148 DRG149 DRG150 DRG151 DRG152 DRG153 DRG154 DRG155 DRG156 DRG170
l i DRG171 DRG174 DRG175
L DRG176 DRG177 DRG178 DRG179 DRG180 DRG181 DRG182 DRG183 DRG184 DRG188
l DRG189 DRG190 DRG191
i J DRG192 DRG193 DRG194 DRG195 DRG196 DRG197
t
LeJ DRG198 DRG200 DRG201 DRG202 DRG204 DRG205 DRG206 DRG207 DRG208 DRG493 DRG494
Digestive Disorders
RECTAL RESECTION W CC RECTAL RESECTION WIO CC MAJOR SMALL amp LARGE BOWEL PROCEDURES W CC MAJOR SMALL amp LARGE BOWEL PROCEDURES WIO CC PERITONEAL ADHESIOLYSIS W CC PERITONEAL ADHESIOLYSIS WIO CC MINOR SMALL amp LARGE BOWEL PROCEDURES W CC MINOR SMALL amp LARGE BOWEL PROCEDURES WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE gt17 W CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGEgt17 WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE 0-17 OTHER DIGESTIVE SYSTEM OR PROCEDURES W CC OTHER DIGESTIVE SYSTEM OR PROCEDURES WO CC G HEMORRHAGE W CC GJ HEMORRHAGE WIO CC COMPLICATED PEPTIC ULCER UNCOMPLICATED PEPTIC ULCER W CC UNCOMPLICATED PEPTIC ULCER WIO CC INFLAMMATORY BOWEL DISEASE GI OBSTRUCTION W CC GI OBSTRUCTIONWO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 W CC ESOPHAGmS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 WIO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGE 0-17 OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 W CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 WIO CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0-17 PANCREAS LIVER amp SHUNT PROCEDURES W CC PANCREAS LIVER amp SHUNT PROCEDURES W 10 CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE W CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE WIO CC CHOLECYSTECTOMY W CDE W CC CHOLECYSTECTOMY W CDE WIO CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE W CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY OTHER HEPATOBILIARY OR PANCREAS OR PROCEDURES CIRRHOSIS amp ALCOHOLIC HEPATITIS DISORDERS OF PANCREAS EXCEPT MALIGNANCY DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEP A W CC DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEPA WIO CC DISORDERS OF THE BILIARY TRACT W CC DISORDERS OF THE BILIARY TRACT WO CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE W CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE WO CC
DRG49 DRG50 DRG51 DRG55 DRG57 DRG58 DRG61 DRG62 DRG63 DRG65 DRG66 DRG67
DRG68
DRG69 DRG70 DRG71 DRG72 DRG73 DRG74
DRG353 DRG356 DRG358 DRG359 DRG360 DRG361 DRG362 DRG363 DRG364 DRG365 DRG368 DRG369
Ear Nose and Throat
MAJOR HEAD amp NECK PROCEDURES SIALOADENECTOMY SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY MISCELLANEOUS EAR NOSE MOUTH amp TIiROAT PROCEDURES TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGEgt17 TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGE 0-17 MYRINGOTOMY W TUBE INSERTION AGE gt17 MYRINGOTOMY W TUBE INSERTION AGE 0-17 OTHER EAR NOSE MOUTH amp TIiROAT OR PROCEDURES DYSEQUILIBRIUM EPISTAXIS EPIGLOTTITIS
OTITIS MEDIA amp URI AGEgt17 W CC OTITIS MEDIA amp URI AGEgt17 WIO CC OTITIS MEDIA amp URI AGE 0-17 LARYNGOTRACHEITIS NASAL TRAUMA amp DEFORMITY OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE gt17 OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE 0-17
Geriatrics ALL CASES
Gynecology
PELVIC EVISCERATION RADICAL HYSTERECTOMY amp RADICAL VULVECTOMY FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY W CC UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY WIO CC VAGINA CERVIX amp VULVA PROCEDURES LAP AROSCOPY amp INCISIONAL TUBAL INTERRUPTION ENDOSCOPIC TUBAL INTERRUPTION DampC CONIZATION amp RADIO-IMPLANT FOR MALIGNANCY DampC CONIZATION EXCEPT FOR MALIGNANCY OrnER FEMALE REPRODUCTIVE SYSTEM OR PROCEDURES INFECTIONS FEMALE REPRODUCTIVE SYSTEM MENSTRUAL amp OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
DRG103 DRGl04 DRG105 DRG106 DRG107 DRG108 DRG109
DRG1l0 DRG1l1 DRG112 DRG115 DRG1l6 DRG117 DRG118 DRG121 DRG122 DRG123 DRG124 DRG125 DRG126 DRG127 DRG128 DRG129 DRG130 DRG131 DRG132 DRG133 DRG135 DRG136 DRG137 DRG138 DRG139 DRG140 DRG141middot DRG142 DRG 144 DRG145
r i
f ~
Heart
HEART TRANSPLANT CARDIAC VALVE PROCEDURES W CARDIAC CATH CARDIAC VALVE PROCEDURES WIO CARDIAC CATH CORONARY BYPASS W CARDIAC CATH CORONARY BYPASS WIO CARDIAC CATH OTHER CARDIOTHORACIC PROCEDURES CORONARY BYPASS WIO CARDIAC CATH
MAJOR CARDIOVASCULAR PROCEDURES W CC MAJOR CARDIOVASCULAR PROCEDURES WIO CC PERCUTANEOUS CARDIOVASCULAR PROCEDURES PERM CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK OTH PERM CARDIAC PACEMAKER IMPLANT OR AICD LEAD OR GENERATOR PRO
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT CARDIAC PACEMAKER DEVICE REPLACEMENT CIRCULATORY DISORDERS W AMI amp CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI WIO CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI EXPIRED CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH AND CMPLX DIAG CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH WIO CMPLX DIAG ACUTE amp SUBACUTE ENDOCARDmS HEART FAILURE amp SHOCK DEEP VEIN THROMBOPHLEBITIS CARDIAC ARREST UNEXPLAINED PERIPHERAL VASCULAR DISORDERS W CC PERIPHERAL VASCULAR DISORDERS WIO CC ATHEROSCLEROSIS W CC ATHEROSCLEROSIS WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 W CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGE 0-17 CARDIAC ARRHYTIIMIA amp CONDUCTION DISORDERS W CC CARDIAC ARRHYTHMIA amp CONDUCTION DISORDERS WIO CC ANGINA PECTORIS SYNCOPE amp COLLAPSE W CC SYNCOPE amp COLLAPSE WIO CC OTHER CIRCULATORY SYSTEM DIAGNOSES W CC OTHER CIRCULATORY SYSTEM DIAGNOSES WIO CC
1
DRG286 DRG287 DRG288 DRG289 DRG290 DRG292 DRG293 DRG294 DRG295 DRG296 DRG297
t DRG298 DRG299
DRG300 DRG301
~- --j
DRG316 DRG317 DRG320 DRG321 DRG322 DRG325 DRG326 DRG327 DRG 331 DRG332 DRG333
f
Hormonal Disorders
ADRENAL amp PITUITARY PROCEDURES SKIN GRAFTS amp WOUND DEBRID FOR ENDOC NUTRlT amp METAB DISORDERS OR PROCEDURES FOR OBESITY P ARA1HYROID PROCEDURES 1HYROIDPROCEDURES OrnER ENDOCRINE NUTRIT amp METAB OR PROC W CC 01HER ENDOCRINE NUTRIT amp METAB OR PROC WIO CC DIABETES AGE gt35 DIABETES AGE 0-35 NUTRlTIONAL amp MISC METABOLIC DISORDERS AGEgt17 W CC NUTRITIONAL amp MISC METABOLIC DISORDERS AGE gt17 WIO CC NUTRlTIONAL amp MISC METABOLIC DISORDERS AGE 0-17 INBORN ERRORS OF METABOLISM ENDOCRINE DISORDERS W CC ENDOCRINE DISORDERS WIO CC
Kidney Disease
RENAL FAILURE ADMIT FOR RENAL DISEASE KIDNEY amp URINARY TRACT INFECTIONS AGE gt17 W CC KIDNEY amp URINARY TRACT INFECTIONS AGEgt17 WIO CC KIDNEY amp URINARY TRACT INFECTIONS AGE 0-17 KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 W CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 WIO CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMS AGE 0-17 01HERKIDNEY amp URINARY TRACT DIAGNOSES AGE gt17 W CC 01HER KIDNEY amp URINARY TRACT DIAGNOSESgt 17 WIO CC 01HER KIDNEY amp URINARY TRACT DIAGNOSES AGE 0-17
Neurology and Neurosurgery
DRGl CRANIOTOMY AGE gt17 EXCEPT FOR TRAUMA DRG2 CRANIOTOMY FOR TRAUMA AGEgt17 DRG3 CRANIOTOMY AGE 0-17 DRG4 SPINAL PROCEDURES DRG5 EXTRACRANIAL VASCULAR PROCEDURES DRG6 CARPAL TUNNEL RELEASE DRG7 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC W CC DRG8 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC WIO CC DRG9 SPINAL DISORDERS amp INJURIES DRG12 DEGENERATIVE NERVOUS SYSTEM DISORDERS
j DRG13 MULTIPLE SCLEROSIS amp CEREBELLAR ATAXIA DRG14 SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA DRG15 TRANSIENT ISCHEMIC ArrACK amp PRECEREBRAL OCCLUSIONS DRG16 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC DRG17 NONSPECIFIC CEREBROVASCULAR DISORDERS WIO CC DRG18 CRANIAL amp PERIPHERAL NERVE DISORDERS W CC DRG19 CRANIAL amp PERIPHERAL NERVE DISORDERS WIO CC DRG20 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGmS DRG21 VIRAL MENlNGITIS DRG22 HYPERTENSIVE ENCEPHALOPATHY DRG23 NONTRAUMATICSTUPORampCOMA DRG24 SEIZURE amp HEADACHE AGEgt17 W CC DRG25 SEIZURE amp HEADACHE AGEgt17 WIO CC DRG26 SEIZURE amp HEADACHE AGE 0-17 DRG27 TRAUMATIC STUPOR amp COMA COMA gt1 HR DRG28 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGEgt17 W CC DRG29 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE gt17 WIO CC
imiddot DRG30 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE 0-17 DRG31 CONCUSSION AGEgt17 W CC DRG32 CONCUSSION AGEgt17 WIO CC DRG33 CONCUSSION AGE 0-17 DRG34 OTHER DISORDERS OF NERVOUS SYSTEM W CC DRG35 OTHER DISORDERS OF NERVOUS SYSTEM WIO CC
(
DRG209 DRG210 DRG211 DRG212 DRG213 DRG216 DRG217 DRG218 DRG219 DRG220 DRG221 DRG222 DRG223 DRG224 DRG225 DRG226 DRG227 DRG228 DRG229 DRG230 DRG231 DRG232 DRG233 DRG234 DRG235
j DRG236 DRG237 DRG238 DRG240 DRG241 DRG471 DRG485
DRG491 DRG496 DRG497 DRG498
f DRG501 DRG502 DRG503
Orthopedics
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 W CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 WIO CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0-17 AMPUTATION FOR MUSCULOSKELETAL SYSTEM amp CONN TISSUE DISORDERS BIOPSIES OF MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE WND DEBRID amp SKN GRFT EXCEPT HANDFOR MUSCSKELET amp CONN TISS DIS LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 W CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 WIO CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGE 0-17 KNEE PROCEDURES W CC KNEE PROCEDURES WO CC MAJOR SHOULDERIELBOW PROC OR OTHER UPPER EXTREMITY PROC W CC SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC WIO CC FOOT PROCEDURES SOFT TISSUE PROCEDURES W CC SOFT TISSUE PROCEDURES WIO CC MAJOR THUMB OR JOINT PROCOR OTH HAND OR WRIST PROC W CC HAND OR WRIST PROC EXCEPT MAJOR JOINT PROC WIO CC LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES OF HIP amp FEMUR LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES EXCEPT HIP amp FEMUR ARTHROSCOPY OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC W CC OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC WIO CC FRACTURES OF FEMUR FRACTURES OF HIP amp PELVIS SPRAINS STRAINS amp DISLOCATIONS OF HIP PELVIS amp THIGH OSTEOMYELmS CONNECTIVE TISSUE DISORDERS W CC CONNECTIVE TISSUE DISORDERS WIO CC BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY LIMB REATTACHMENT HIP AND FEMUR PROC FOR MULT SIGNIFICANT
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY COMBINED ANTERIORIPOSTERIOR SPINAL FUSION SPINAL FUSION WI CC SPINAL FUSION WIO CC KNEE PROC WI PDX OF INFECTION WI CC KNEE PROC WI PDX OF INFECTION WOCC KNEE PROC WOPDX OF INFECTION WI CC
~ t L ~
l
DRG76 DRG77 DRG78 DRG79 DRG80 DRG81 DRG85 DRG86 DRG87 DRG88 DRG89 DRG90 DRG91 DRG92 DRG93 DRG94 DRG95 DRG96 DRG97 DRG98 DRG99 DRG100 DRG101 DRG102 DRG475
DRG242 DRG244 DRG245 DRG246 DRG247 DRG256
i_J
Respiratory Disorders
OTHER RESP SYSTEM OR PROCEDURES W CC OTHER RESP SYSTEM OR PROCEDURES WO CC PULMONARYEMBOUSM RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 W CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 WO CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGE 0-17 PLEURAL EFFUSION W CC PLEURAL EFFUSION WO CC PULMONARY EDEMA amp RESPIRATORY F AlLURE CHRONIC OBSTRUCTIVE PULMONARY DISEASE SIMPLE PNEUMONIA amp PLEURISY AGEgt17 W CC SIMPLE PNEUMONIA amp PLEURISY AGEgt17 WO CC SIMPLE PNEUMONIA amp PLEURISY AGE 0-17 INTERSTITIAL LUNG DISEASE W CC INTERSTITIAL LUNG DISEASE W 10 CC PNEUMOTIIORAX W CC PNEUMOTIIORAX WO CC BRONCHmS amp ASTIIMA AGEgt17 W CC BRONCHmS amp ASTIIMA AGEgt17 WO CC BRONCIDTIS amp ASTIIMA AGE 0-17 RESPIRATORY SIGNS amp SYMPTOMS W CC RESPIRATORY SIGNS amp SYMPTOMS WO CC OTHER RESPIRATORY SYSTEM DIAGNOSES W CC OTHER RESPIRATORY SYSTEM DIAGNOSES WO CC RESPIRATORY SYSTEM DIAGNOSIS WITII VENTILATOR SUPPORT
Rheumatology
SEPTIC ARTHRITIS BONE DISEASES amp SPECIFIC ARTHROPATIIIES W CC BONE DISEASES amp SPECIFIC ARTHROPATIDES WO CC NON-SPECIFIC ARTHROPATHIES SIGNS amp SYMPTOMS OF MUSCULOSKELETAL SYSTEM amp CONN TISSUE OTIIER MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE DIAGNOSES
DRG302 DRG303 DRG304 DRG305 DRG306 DRG307 DRG308 DRG309 DRG31O DRG311 DRG312 DRG313 DRG314
DRG315 DRG323 DRG324 DRG328 DRG329 DRG330 DRG334 DRG335 DRG336 DRG337 DRG339 DRG340 DRG341 DRG342 DRG343 DRG348 DRG349 DRG350 DRG351 DRG352
Urology
KIDNEY TRANSPLANT KIDNEYURETER amp MAJOR BLADDER PROCEDURES FOR NEOPLASM KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL W CC KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL WIO CC PROSTATECTOMY W CC PROSTATECTOMY WIO CC MINOR BLADDER PROCEDURES W CC MINOR BLADDER PROCEDURES WIO CC TRANSURETHRAL PROCEDURES W CC TRANSURETHRAL PROCEDURES WIO CC URETHRAL PROCEDURES AGE gt17 W CC URETHRAL PROCEDURES AGEgt17 WIO CC URETHRAL PROCEDURES AGE 0-17 OTHER KIDNEY amp URINARY TRACT OR PROCEDURES URINARY STONES W CC amplOR ESW LTIHOTRIPSY URINARY STONES WIO CC URETHRAL STRICTURE AGEgt17 W CC URETHRAL STRICTURE AGE gt17 WIO CC URETHRAL STRICTURE AGE 0-17 MAJOR MALE PELVIC PROCEDURES W CC MAJOR MALE PELVIC PROCEDURES WIO CC TRANSURETHRAL PROSTATECTOMY W CC TRANSURETHRAL PROSTATECTOMY WIO CC TESTES PROCEDURES NON-MALIGNANCY AGEgt17 TESTES PROCEDURES NON-MALIGNANCY AGE 0-17 PENIS PROCEDURES CIRCUMCISION AGEgt17 CIRCUMCISION AGE 0-17 BENIGN PROSTATIC HYPERTROPHY W CC BENIGN PROSTATIC HYPERTROPHY WIO CC INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM STERILIZATION MALE OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES
AppendixD
f 2001 Sample Physician Questionnaire
( Americas Best Hospitals)
This survey of physicians judgments provides the
basis for the reputation component of the annual
ranking of hospitals for U S News amp World Report
c
Conducted by the National Opinion Research Center at the University of Ctlicago 1155 East 60th Street Chicago IL 60637
( THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with rehabilitation regardless of location or expense (weve provided space for both hospital andlor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
l L Answers to these questions will help Have your patients been helped ormiddot
us to understand the impact of the hindered by the information they have Internet on medica practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions
D Neith~imiddoto Yes
D BothONo D Does notapply
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
D Helped
D Hindered
D Neither
D Both
D I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D A day or two a week
l D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical L company web sites
DYes D No
D Does not apply
Do you ever access medical association web sites
DYes D No
ri D Does not apply L
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet isbullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes D No
Do you allow your patients to communicate with you via electronic mail
DYes o No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes D No
D Does not apply
Thank you again for your participation
r I
l~
National Opinion Research Center at the University of Chicago 1155 East 60th Street Chicago IL 60637
Jbullbullbull
(12th Annual Survey of PhysiciansJ Direct input from physicians is
crucial in evaluating hospital quality_ f
Conducted by the National Opinion Research Center at the University of Chicago 1155 East 60th Street Chica9o IL 60637
l J
(THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with cancer regardless of location or expense (weve provided space for both hospital andor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
Answers to these questions will help Have your patients been helped or us to understand the Impact of the hindered by the information they have Internet on medical practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions o NeitherOmiddotYes o BothD No o Does not apply
-Continued
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
HelpedD HinderedD NeitherD BothD
0 I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D Aday or two a week
D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical company web sites
DYes
D No
D Does not apply
Do you ever access medical association web sites
DYes
D No
D Does not apply
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet is bullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes
D No
Do you allow your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Thank you again for your participation
r
r
1 National Opinion Research Center at th~ University of Chicagobull 0 __ bull bull
1155 East 60th Street Chicago IL 60637
AppendixE
Predicted Mortality APR-DRG Methodology
r
shyi
Introduction to DRGs
The All Patient Refined Diagnosis Related Groups (APR-DRGs) were developed by 3M Health
Information Systems (3M-HIS) in conjunction with the National Association of Childrens Hospitals and
Related Institutions (NACHRI) APR-DRGs expand the basic diagnosis-related group (DRG) structure to
address patient severity of illness risk ofmorta1ity and resource intensity The APR-DRG Version 140
uses the Health Care Financing Administration (HCFA) Version 140 DRG methodology Because APRshy
DRGs are based on DRGs and All Patient DRGs (AP-DRGs) a brief explanation of both structures will
be useful
Current HCFA DRG Structure
Created from Adjacent Diagnosis Related Groups (ADGs) which combine patients into groups
with common characteristics DRGs were developed by Yale University in the 1970s to relate a
hospitals case mix index to the resource demands and associated costs experienced by the hospital
ADGs were created by subdividing an MDC1 into two groups based on the presence or absence of
an operating room procedure Surgical patients identified as those having an operating room procedure
were then classified by type ofprocedure to form surgical ADGs Patients with multiple procedures were
assigned to the highest surgical class Medical patients were divided into smaller groups based on their
principal diagnosis to form medical ADGs
DRGs use ADGs as a base and then further classify patients into selected disease and procedure
categories based on whether or not they have substantial comorbidities or complications (CC)
Approximately 3000 diagnosis codes have been designated by HCFA as substantial CCs (defined by a
list of additional diagnosis codes that a panel of physicians felt would increase the length of stay by at
least one day for 75 percent of the patients) This list covers a broad range of disease conditions and no
differentiation in severity or complexity level was made among the additional diagnoses The patients
age and discharge status were sometimes used in the definition ofDRGs
r
1 Major Diagnostic Categories (MDCs) are broad medical and surgical categories one step hierarchically higher than DRGs (several DRGs roll-up into an MDC) MDCs are divided by body systems such as nervous ear nose and throat and respiratory
Current AP-DRG Structure
In 1987 the New York State Department of Health entered into an agreement with 3M-HIS to
evaluate the applicability of DRGs to a non-Medicare population with a specific focus on neonates and
patients with Human Immunodeficiency Virus (HIV) infections The DRG definitions developed by this
relationship are referred to as the AP-DRGs
The AP-DRGs are modeled after the HCF A DRGs and attempt to improve the DRGs in an effort
to more accurately predict a hospitals resource demands and associated costs for all acute care patients
In the creation ofAP-DRGs the modifications made to the DRG structure can be summarized as follows
bull Except for neonates who die or are transferred within the first few days of life AP-DRGs define six ranges ofbirth weight that represent distinct demands on hospital resources Within each birth weight range neonates are then subdivided based on the presence of a significant operating room procedure and then further subdivided based on presence ofmultiple major minor or other problems
bull Assignment to neonatal MDC is based on age Specifically the AP-DRGs assign a patient to the neonatal MDC when the age of the patient is less than 29 days at admission regardless of the principal diagnosis
bull MDC 25 was created to account for the highly specialized treatment of multiple trauma patients Patients assigned to MDC 25 have at least two significant trauma diagnoses from different body sites
bull MDC 20 for alcohol and substance abuse was restructured to differentiate patients based on the substance being abused
bull Across all MDCs patient with a tracheostomy were put into either of two tracheostomy AP-DRGs tracheostomy performed for therapeutic reasons and tracheostomy representing long-term ventilation
bull All liver bone marrow heart kidney and lung transplant patients were assigned to an AP-DRG independent of the MDC ofthe principal diagnosis
bull For several MDCs a single major comorbidity and complication (CC) AP-DRG was formed across all surgical patients within an MDC and a single major CC AP-DRG was formed across all medical patients within an MDC
I I The AP-DRGs introduced changes to the HCF A DRGs in an attempt tomiddot depart from using the
LJ principal diagnosis as the initial variable for assignment The AP-DRGs were designed to more
accurately group patients into like groups that provide an operational means of defining and measuring a
hospitals case mix complexity
r
All Patient Refined DRGs
APR-DRG Objectives
The primary objective of the RCF A DRG and AP-DRG patient classification systems was to
relate the type ofpatients treated to the hospital resources they consumed This limited focus on resource
intensity does not allow providers to classify patients into other groups for meaningful analysis The
APR-DRG patient classification system goes beyond traditional resource intensity measures and was
designed with the ability to address the following needs
bull Compare hospitals across a wide range ofresource and outcome measures
bull Evaluate differences in inpatient mortality rates
bull Implement and support critical pathways
bull Identify continuous quality improvement initiatives
bull Support internal management and planning systems
bull Manage capitated payment arrangements
To meet these needs the APR-DRG system classifies patients according to severity of illness risk
of mortality and resource intensity Therefore in the APR-DRG classification system a patient is
assigned three distinct descriptors base APR-DRG severity of illness subclass and risk of mortality
subclass
Severity of illness can be defined as the extent of physiologic decompensation or organ system
loss of function experienced by the patient In contrast risk of mortality is defined as the patients
likelihood ofdying
For analyses such as evaluating resource intensity or patient care outcomes the base APR-DRGs
in conjunction with the severity of illness subclass is used For evaluating patient mortality the base
APR-DRGs in conjunction with the risk ofmortality subclass is used
Development of the APR-DRGs
The AP-DRGs were used as the base DRGs in the development of the APR-DRGs because they
were representative of the entire inpatient population and accounted for populations not included in DRGs
at the time of development Several consolidations additions and modifications were made to the APshy
DRGs to form the list of APR-DRGs used in the severity of illness and risk of mortality subclass
assignments
The following list summarizes the revisions made to the AP-DRGs in the creation ofthe APR-DRGs
bull All age CC and major CC splits were consolidated
bull Splits based on discharge status or death were consolidated
bull Definitions based on the presence or absence ofa complicated principal diagnosis were consolidated
bull Additional APR-DRGs were created for pediatric patients
bull APR-DRGs for newborns were completely restructured to create medical and surgical hierarchies within each birth weight range
bull Low volume APR-DRGs were consolidated into other related APR-DRGs
bull APR-DRGs that could be explained by the severity of illness subclasses were consolidated into one APR-DRG
bull Due to risk ofmortality subclasses several APR-DRGs were split to account for significant differences in mortality between patient groups
APR-DRG Severity oflllness Subclass Assignment
With the exception of neonatal patients after a patient has been given an APR-DRG code a
Severity of Illness Subclass is assigned based on the level of the secondary diagnoses presence of certain
non-OR procedures and the interaction among secondary diagnoses age APR-DRG and principal
diagnosis Neonatal patients have their own hierarchical method for determining severity of illness and
will be discussed later The four severity ofillness subclasses are
t l
~~~~~i~~ 1 Minor (Includes non CC)
2 Moderate
3 Major
i L 4 Extreme
The severity of illness subclass is used in conjunction with the patients base APR-DRG for
analysis such as evaluating resource intensity or patient care outcomes A patients severity of illness
subclass should not be used with their DRG because several DRGs may form one APR-DRG Therefore
since severity of illness subclasses correspond to the APR-DRG number and not the DRG it is important
to use the APR-DRG number to accurately interpret data
The process for assigning a patient a severity of illness subclass is a three phase process and is
summarized as follows
Phase
bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further analysis
bull Remaining secondary diagnoses are assigned one of four distinct Standard Severity of lllness Levels Figure 1 presents examples of secondary diagnoses in each severity ofillness leveL
Figure 1 Examples of Secondary Diagnoses by Severity of Illness Level
Minor Benign hypertension acute bronchitis lumbago
Moderate Chronic renal failure viral pneumonia diverticulitis
Major Diabetic ketoacidosis chronic heart failure acute cholecystitis
Extreme Septicemia acute myocardial infarction cerebral vascular accident
bull The Standard Severity of Illness Level is modified for some secondary diagnoses based on age APRshyDRG and presence of non-OR procedures Figure 2 displays an example of modifications to the standard severity ofillness level based on the APR-DRG
Bronchitis and asthma Minor
Chronic renal failure Moderate Diabetes Major LJ
Cardiomegaly Moderate Chronic heart failure Minor
Uncomplicated Minor Vaginal delivery Moderate LJ diabetes
f
f
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Severity of Illness Level is retained This prevents double counting clinically similar diagnoses
bull The Base Severity of Illness Subclass of the patient is set to the highest Standard Severity of lllness Level ofany of the secondary diagnoses
bull Patients with a Base Severity of Illness Subclass of major (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Standard Severity of Illness Level Figure 3 displays the requirements for keeping a severity of illness subclass ofmajor or extreme
Major
Extreme Two or more secondary diagnoses that are extreme or one secondary diagnosis that is extreme and at least two second dia oses that are maor
Phase III bull A minimum Severity of Illness Subclass is established based on the patients principal diagnosis This
accounts for patients assigned to codes that contain both the underlying disease and an associated manifestation of the disease (ie diabetes with hyperosmolar coma) but is only assigned to the APRshyDRG that accounts for the underlying disease
bull A minimum Severity of Illness Subclass is established based on combinations of principal diagnosis and age for specific APR-DRGs
bull A minimum Severity of Illness Subclass is established for some APR-DRGs with certain APR-DRG and non-OR procedure combinations as well as principal diagnosis and non-OR procedure combinations
bull A minimum Severity of Illness Subclass is established based on the presence of certain combinations ofsecondary diagnoses Figure 4 shows the combination of secondary diagnoses necessary to increase the severity of illness subclass to a minimum severity of illness level For example a type 1 combination would be a major bacterial infection with pleural effusion If a diagnosis from both of these categories is present plus at least one other secondary diagnosis that is at least a major severity of illness level then the minimum patient severity of illness subclass will be extreme
Figure 4 Minimum Severity of Illness Requirements
maor second dia osis 2 At least one additional Major
moderate secondary dia osis
3 Specified combinations of At least one additional Major a moderate and a minor moderate secondary cate 0 dia osis
4 Specified combinations of At least two additional Moderate r--1 Two minor cate ories minor second i Ii 5 Specified combinations of
Two moderate cate ories None Major
bull The final patient Severity of Illness Subclass is selected based on the maximum of the Phase II Base Patient Severity of Illness Subclass and the Phase III minimum Severity of Illness Subclass
Both medical and surgical patients are assigned a severity of illness level of 1-4 based on the
assignment process outlined previously
f
r-
I
l
r f
~
l
r 1
APR-DRG Risk of Mortality Subclass Assignment
Similar to the Severity ofIllness Subclass assignment the Risk ofMortality Subclass assignment
is based on the level ofthe secondary diagnoses and the interaction among secondary diagnoses age
APR-DRG and principal diagnosis In general the patients Risk ofMortality Level and Subclass will be
lower than the Severity ofIllness Level and Subclass respectively Neonatal patients have their own
hierarchical method for determining risk ofmortality and will be discussed later The four severity of
illness subclasses are
~~~~~~~G~~pound~) bull~~~~~~~~S~rs~~2bullbullmiddott~ 1 Minor (includes non CC)
2 Moderate
3 Major
4 Extreme
The risk ofmortality subclass is used in conjunction with the patients base APR-DRG for
evaluating patient mortality Like the severity of illness subclass a patients risk ofmortality subclass
should not be used with their DRG because several DRGs may form one APR-DRG Therefore since
risk ofmortality subclasses correspond to the APR-DRG number and not the DRG it is important to use
the APR-DRG number to accurately interpret data
The process for assigning a patient a risk ofmortality subclass is a three phase process and is
summarized as follows
Phase I bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further
analysis
bull Remaining secondary diagnoses are assigned one of four distinct Risk ofMortality Levels
bull The Risk ofMortality Level is modified for some secondary diagnosis based on the patients age and APR-DRG
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Risk ofMortality Level is retained This prevents double counting clinically-similar diagnoses
bull The Base Risk ofMortality Subclass of the patient is set to the highest Risk ofMortality Level ofany of the secondary diagnoses
bull Patients with a Base Risk ofMortality Subclass ofmajor (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Risk ofMortality Level
Phase III
bull A minimum Risk ofMortality Subclass is established based on the patients principal diagnosis This accounts for specific APR-DRGs that have a principal diagnosis indicative of a higher risk ofmortality relative to the other principal diagnoses in the APR-DRG r
i
l ~ bull A minimum Risk ofMortality Subclass is established based on the presence ofcertain combinations of secondary diagnoses
bull The final patient Risk ofMortality Subclass is selected based on the maximum ofthe Phase II Base l
Risk ofMortality Subclass and the Phase III minimum Risk ofMortality Subclass
J
r
AppendixF
f Index of Hospital Quality (lHQ) Scores by Specialty
i
i L
F-~
f laquo
2001
C
ance
r B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
con
sc
ore
R
N s
R
ank
Ho
spit
al
10
0
sco
re
rate
M
embe
r (o
f 7
) D
isch
arg
es
to b
eds
Mem
oria
l S
loan
-Ket
teri
ng
can
cer
Cen
ter
N
ew Y
ork
10
00
7
18
0
93
Y
es
60
51
67
21
2
2 U
niv
ersi
ty 0
1 T
exas
M
D
A
nder
son
Cen
cer
Cen
ter
H
oust
on
98
2
68
5
07
7
Yes
5
0
5103
2
68
3
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
78
3
59
0
69
Y
es
70
15
78
14
2
4 D
ana-
farb
er C
ance
r In
stit
ute
B
osto
n 6
37
3
88
0
81
No
60
21
8 2
27
5
May
o C
lin
ic
Ro
ches
ter
M
inn
5
81
2
50
0
60
Y
es
70
37
11
13
1
(+3
SO)
6 UC
LA M
edic
al C
ente
r
los
Ang
eles
41
0
79
0
56
Y
es
70
12
19
10
8 7
Un
iver
sity
01
Chi
cago
Ho
spit
als
40
6
65
0
66
Y
es
70
14
69
19
4
8 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
401
7
1
07
5
Yes
7
0
3494
1
81
9
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
40
0
91
0
82
Y
es
60
18
44
16
1
10
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
38
5
10
7
09
2
Yes
4
0
1105
1
61
11
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r
Ann
Arb
or
38
4
31
0
42
Y
es
70
16
56
17
9
12
Un
iver
sity
01
was
hing
ton
Med
ical
Cen
ter
S
eatt
le
38
3
79
0
66
Y
es
60
92
6 1
10
13
M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 3
80
8
8
09
5
Yes
7
0
2022
1
38
14
C
lari
an H
ealt
h P
art
ners
In
dia
nap
oli
s 3
78
5
2
07
5
Yes
7
0
2149
1
67
15
U
niv
ersi
ty o
f P
ittS
bu
rgh
Med
ical
Cen
ter
37
4
26
0
56
Y
es
65
23
10
16
7
(+2
SO)
16
Cle
vel
and
Cli
nic
3
62
3
1
07
4
Yes
7
0
2018
1
94
17
R
osw
ell
Par
k C
ance
r In
stit
ute
B
uff
alo
36
1
55
0
85
Y
es
50
16
76
28
7
18
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
35
5
37
0
73
Y
es
60
14
15
14
3
19
Un
iver
sity
of
Ken
tuck
y H
osp
ital
le
xin
gto
n
351
0
5
05
6
Yes
7
0
1047
2
20
20
fo
x C
hase
can
cer
Cen
ter
P
hil
adel
ph
ia
35
0
56
0
83
Y
es
50
10
46
15
8
21
H
lee M
off
itt
can
oer
Cen
ter
T
ampa
F
la
35
0
15
0
65
Y
es
60
16
44
16
8lt
22
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
Cen
ter
Ch
arl
ott
esv
ille
3
49
0
5
061
Y
es
60
13
48
22
7
23
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
34
8
17
0
67
Y
es
70
99
9 2
40
24
S
hand
s H
osp
ital
at
the
Un
iver
sity
of
flo
rid
a
Gei
nes
vil
le
34
7
14
0
46
Y
es
60
10
23
15
7
25
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
34
6
00
0
57
Y
es
60
12
22
191
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
34
4
17
0
67
Y
es
80
16
15
151
27
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
34
3
15
0
66
Y
es
55
14
14
15
8
28
Un
iver
sity
Ho
spit
al o
f A
rkan
sas
li
ttle
Roc
k 3
43
0
5
06
3
Yes
5
5
1287
2
54
29
U
niv
ersi
ty H
osp
ital
D
enve
r 3
42
2
7
05
7
Yes
5
0
431
24
0
30
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
34
2
23
0
49
Y
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60
44
8 1
72
lt
31
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
34
2
00
0
61
Y
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70
15
55
15
3
32
Art
hu
r G
Ja
mes
Can
cer
Ho
spit
al
Col
umbu
s
Ohi
o 3
41
0
0
04
8
Yes
5
5
2147
1
56
33
U
niv
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ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
34
0
19
0
69
Y
es
70
11
42
13
6
34
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
33
9
00
0
50
Y
es
55
14
81
14
9
35
New
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k P
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yte
rian
HO
spit
al
33
7
34
0
86
Y
es
70
31
03
13
2
36
Un
iver
sity
of
cali
forn
ia
San
Fra
nci
soo
Med
ical
Cen
ter
33
5
30
0
71
Yes
6
0
573
17
5
37
fG
M
cGaw
Ho
spit
al a
t lo
yo
la U
niv
ersi
ty
May
woo
d
Ill
3
33
1
6
07
0
Yes
6
0
1023
1
62
38
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
33
3
00
0
62
Y
es
60
12
79
15
2
39
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
-Sal
em
33
3
19
0
84
Y
es
70
20
21
181
40
fa
irv
iew
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iver
sity
Med
ical
Cen
ter
M
inn
eap
oli
s 3
32
0
4
06
2
Yes
5
0
1248
1
56
41
G
reat
er B
alti
mo
re M
edic
al C
ente
r B
alti
mo
re
33
2
00
0
58
Y
es
35
12
39
20
0
42
Un
iver
sity
Ho
spit
als
of
Cle
vel
and
3
30
0
0
06
4
YampS
70
19
71
12
1
43
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
lo
we
Cit
y
32
9
04
0
70
Y
es
70
13
05
13
4
44
St
Jo
hn
S H
osp
ital
S
pri
ng
fiel
d
Ill
3
29
0
0
05
5
Yes
6
0
996
13
3
45
Hen
ry F
ord
Ho
spit
al
Detr
oit
3
27
0
0
07
6
Yes
6
5
1473
1
92
46
B
arn
es-J
ewis
h H
osp
ital
S
t
lou
is
32
6
05
0
74
Y
es
85
27
56
14
9
47
luth
era
n G
ener
al H
ealt
hSys
tem
P
ark
Rid
ge
Ill
3
26
0
0
06
2
Ves
6
0
1420
1
14
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
3
24
0
5
05
0
Yes
7
0
776
10
9
49
Coo
k C
ount
y H
osp
ital
C
hica
go
32
3
04
0
49
Y
es
50
49
1 2
10
50
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
32
2
09
0
90
Y
es
50
13
24
19
2
1
2001
D
iges
tiv
e D
iso
rder
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N
s
Tra
uma
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
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) D
isch
arg
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to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
59
8
05
9
Yes
8
0
7660
1
31
Yes
2
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
82
3
50
0
63
Y
es
75
31
28
14
2
Yes
3
Cle
vel
and
Cli
nic
6
27
3
05
0
57
Y
es
80
44
75
19
4 N
o 4
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
58
9
29
9
08
7
Yes
8
0
4403
1
38
Y
es
5 M
ount
Sin
ai
Med
ical
Cen
ter
N
ew Y
ork
49
5
23
2
09
8
Yes
8
0
5220
1
57
Y
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6 UC
LA M
edic
al C
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r
Los
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ngel
es
44
5
18
5
081
Y
es
80
25
40
10
8
Yes
7
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
39
7
14
3
09
0
Yes
8
0
3787
1
81
Yes
8
un
ivers
ity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
37
9
13
2
07
0
Yes
7
0
1596
1
75
N
o 9
Un
iver
sity
of
Chi
oago
Ho
spit
als
37
0
131
0
93
Y
es
80
19
84
19
4
Yes
(+
3 SO
) 10
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
30
6
57
0
61
Y
es
80
91
3 1
98
Y
es
11
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 2
99
5
2
07
5
Yes
8
0
4048
1
67
Y
es
12
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
2
95
7
7
09
9
Yes
8
0
2348
1
61
Yes
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
29
2
47
0
72
Y
es
80
56
89
14
9
Yes
14
U
niv
ersi
ty o
f M
iohi
gan
Med
ical
Cen
ter
Ann
Arb
or
291
3
8
06
8
Yes
8_
0 28
16
17
9
Yes
15
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 2
90
4
9
07
4
Yes
8
0
2636
1
43
Y
es
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
28
0
50
0
74
Y
es
50
20
34
161
Y
es
17
Cla
rian
Hea
lth
part
ners
In
dia
nap
oli
s 2
78
5
2
09
2
Yes
8
0
5286
1
67
Y
es
18
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
27
6
45
0
84
Y
es
80
28
28
15
3
Yes
19
B
eth
Isra
el
Dea
cone
ss M
edio
al C
ente
r
Bos
ton
21
4
34
0
73
Y
es
70
45
27
15
8
Yes
20
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
27
1
30
0
45
Y
es
80
99
2 1
09
Y
es
21
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
N
ew Y
ork
26
5
16
0
49
Y
es
70
26
18
21
2
No
22
New
Yor
k P
resb
yte
rian
Ho
spit
al
26
2
52
1
01
Yes
8
0
4884
1
32
Yes
23
U
niv
ers
ttv o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
26
0
20
0
65
Y
es
80
21
84
13
6 Y
es
(+2
SOI
24
Med
ical
Un
iver
sity
of
Sou
th C
aro
lin
a C
har
lest
on
2
58
6
9
12
0
Yes
7
0
2202
2
09
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
25
1 2
2
07
5
Yes
6
5
2472
1
57
Y
es
26
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
oak
M
ich
2
50
0
8
07
0
Yes
8
0
5809
1
88
Y
es
27
8ay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
49
2
6
07
8
Yes
6
0
4673
1
22
y
es
28
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
24
8
00
0
60
Y
es
70
26
48
191
Y
es
29
St
L
ou
is U
niv
ersi
ty H
osp
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2
42
1
4
06
9
Yes
7
5
1677
1
47
Y
es
30
Los
A
ngel
es C
ount
y-U
Sc
Med
ical
Cen
ter
24
2
08
0
37
Y
es
60
39
5 1
67
Y
es
31
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
24
0
18
0
79
Y
es
70
18
25
24
0
Yes
32
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
24
0
39
0
78
y
es
80
11
34
11
0
No
33
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Il
l
23
8
00
0
59
Y
es
60
31
21
11
4
Yes
34
U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
oer
Cen
ter
H
oust
on
23
7
33
0
80
Y
es
60
13
61
26
8
No
35
Lah
ey H
itch
coo
k C
lin
io
Bu
rlin
gto
n
Mas
s
23
6
00
0
67
Y
es
70
26
77
15
2
Yes
36
C
edar
s-S
inai
Med
ical
Cen
ter
L
os A
ngel
es
23
4
27
0
94
Y
es
80
47
95
10
6
Yes
37
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
Sit
y
May
woo
d
Ill
2
34
0
0
06
6
Yes
7
0
2180
1
62
Y
es
38
Mar
y H
itch
coo
k M
emor
ial
Ho
sp
ital
le
ban
on
N
H
23
4
04
0
68
Y
es
70
15
58
19
4
Yes
39
U
niv
ersi
ty o
f C
ali
forn
ie
Dav
is M
edio
al C
ente
r
Sac
ram
ento
2
33
0
0
06
8
Yes
8
0
1751
2
79
Y
es
40
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
iCS
Io
wa
Cit
y
23
3
13
0
77
Y
es
80
19
31
13
4
Yes
41
N
ew E
ngla
nd M
edic
al C
ente
r
Bos
ton
23
3
20
0
82
Y
es
10
11
88
24
2
Yes
42
F
roed
tert
Mem
oria
l L
uth
eran
Ho
spit
al
Mil
wau
kee
23
2
00
0
63
Y
es
70
19
29
14
6
Yes
43
T
hom
as J
eff
ers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
32
0
8
07
6
Yes
1
0
3206
1
23
Y
es
44
Tem
ple
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
30
1
7
01
0
Yes
7
5
1450
1
46
N
o 45
G
reat
er B
alti
mo
re M
edic
al C
ente
r
Bal
tim
ore
2
30
1
2
071
Y
es
SO
24
95
20
0
No
46
Hen
ry F
ord
Ho
spit
al
Detr
oit
2
29
0
8
08
6
Yes
7
5
3475
1
82
Y
es
47
Un
iver
sity
Of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pal
Hil
l 2
29
1
0
081
Y
es
60
29
86
15
2
Yes
48
O
chsn
er F
ou
nd
atio
n H
osp
1ta
l
New
Orl
ean
s 2
28
1
5
07
4
Yes
6
5
2465
1
40
N
o 49
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
F
la
22
S
00
0
62
14
0 7
0
5778
1
67
Y
es
SO
Un
iVer
sity
Ho
spit
al
Den
ver
22
7
11
0
81
Yes
6
0
1151
2
40
Y
es
L r
middotmiddot
2001
E
ar
Nos
e
and
Thr
oat
Bes
t H
osp
ital
Lis
t
Hos
pita
lwid
e T
echn
olog
y R
eput
atio
nal
mo
rtal
ity
C
OTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
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sc
ore
rate
M
embe
r (o
f 5)
D
isch
arge
s to
bed
s C
ente
r
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s H
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osp
ital
B
alti
mor
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00
0
40
2
08
2
Ves
5
0
26
4
14
2
Yes
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
8S
4
32
4
08
6
Yes
5
0
219
13
4
Ves
3
Mas
saoh
uset
ts E
ye
and
Ear
In
firm
ary
B
osto
n 7
66
2
71
0
11
No
3
0
26
8
18
7
Ves
4
May
o C
lin
io
Roo
hest
er
Min
n
68
2
21
0
07
2
Ves
5
0
502
13
1
Ves
5
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
6
39
1
90
0
82
Y
es
50
28
3 1
79
Y
es
6 U
niv
ersi
ty o
f P
itts
bUrg
h M
edic
al C
ente
r 6
23
1
85
0
84
V
es
50
36
3 1
67
Y
es
7 UC
LA M
edic
al C
ente
r
los
Ang
eles
6
21
1
89
0
83
Y
es
50
2
88
1
08
Y
es
8 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
cano
er C
ente
r H
oust
on
51
6
14
7
08
9
Ves
4
0
124
26
8
No
9 H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
5
05
1
36
1
02
Y
es
50
26
7 1
61
Y
es
10
Cle
vela
nd C
lin
ic
49
5
10
6
06
7
Yes
5
0
23
6
19
4
No
11
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nio
N
ashv
ille
4
64
9
3
09
4
Yes
5
0
28
4
24
0
Yes
12
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
caU
f
46
1
10
8
08
6
Yes
3
0
13
4
16
1
Yes
1
3
Bar
nesmiddot
Jew
ish
Ho
spit
al
St
lo
uis
4
68
9
0
08
2
Yes
5
0
39B
1
49
Y
es
14
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
42
6
10
1
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7 Y
es
50
8
6
11
0
No
15
M
etho
dist
Ho
spit
al
Hou
ston
4
09
1
02
1
07
Y
es
40
2
30
1
33
No
(+
3 SO
l 16
M
emor
ial
Slo
anmiddotK
ette
rin
g e
ence
r C
ente
r
New
Vor
k 3
91
5
4
07
9
Yes
5
0
24
9
21
2
No
17
Mou
nt S
lnai
Med
ioal
Cen
ter
New
Vor
k 3
86
7
8
11
1
Yes
5
0
31
2
15
7
Yes
18
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
37
9
45
0
79
Y
es
50
16
6 1
57
Y
es
19
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
oo M
edio
al C
ente
r 3
78
6
3
08
5
Ves
4
0
131
17
5
No
20
Duk
e U
niv
ersi
ty M
edio
al C
ente
r D
urha
m
NC
3
50
4
3
09
3
Yes
5
0
15
3
18
1
Ves
21
U
niv
ersi
ty o
f W
isoo
nsin
Ho
spit
al a
nd C
lin
ios
Med
ison
3
40
1
9
07
7
Yes
5
0
23
2
13
6
Yes
22
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
enoe
s C
ente
r C
har
lott
esv
ille
3
39
3
0
08
1
Ves
4
0
195
22
7
No
23
un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 3
37
2
2
07
9
Ves
4
0
18
9
15
2
Yes
(+
2 SO
l 2
4
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
33
4
26
0
77
V
es
50
4
4
19
8
Ves
2
5
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty O
f F
lori
da
Gai
nes
vil
le
33
3
18
0
76
V
es
40
16
7 1
57
Y
es
26
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middot Sal
em
33
1
26
0
92
Y
es
50
2
43
1
61
Y
es
27
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
33
0
29
0
76
Y
es
35
11
2 1
01
V
es
28
H
enry
For
d H
osp
ital
D
etro
it
32
9
05
0
73
Y
es
45
2
14
1
82
V
es
29
st
lo
uis
Un
iver
sity
Ho
spit
al
32
5
12
0
71
Y
es
50
1
13
1
47
Y
es
30
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
w
ashi
ngto
n
DC
3
24
1
7
05
3
Ves
5
0
89
1
0
9middot
Yes
31
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hioa
go
32
3
26
0
92
V
es
40
18
4 1
70
ve
s 32
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
C
hica
go
32
3
20
0
70
V
es
50
14
5 1
14
No
3
3
Fai
rvie
w-U
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
32
3
23
0
79
Y
es
30
3
57
1
56
No
3
4
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
25
0
90
Y
es
50
1
00
1
94
Y
es
35
Un
iver
sity
Ho
spit
al
Den
ver
31
7
15
0
74
Y
es
40
52
2
40
Y
es
36
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
3
17
1
9
08
5
Yes
4
0
19
9
12
3
Yes
3
7
Sum
ma
Hea
lth
syst
em
Akr
on
Ohi
o 3
16
0
0
06
9
Ves
4
0
28
7
14
9
Yes
3
8
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
sa
cram
ento
3
15
0
5
07
6
Ves
5
0
14
3
27
9
Ves
3
9
lOS
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
31
2
13
0
20
Y
es
35
42
1
67
Y
es
40
Val
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
31
2
16
0
92
Y
es
50
2
43
1
53
V
es
41
Un
iver
sity
of
Tex
as M
edio
al B
rano
h H
osp
ital
s
Gal
vest
on
31
1
27
0
91
Yes
4
0
118
15
3
Yes
4
2
Lut
hera
n G
ener
al H
ealt
hsys
tem
P
ark
Rid
ge
Ill
3
09
0
0
07
0
Yes
4
0
212
11
4
Yes
4
3
Un
iver
sity
of
Illi
no
is
Ho
spit
al a
nd C
lin
iCs
Chi
cago
3
06
1
2
06
6
Yes
2
5
87
1
29
Y
es
44
lah
ey H
itoh
oook
Cli
nic
B
url
ing
ton
M
ass
3
05
0
5
07
6
Yes
4
0
138
15
2
Yes
4
5
Art
hur
G
Jam
es C
anoe
I H
osp
ital
C
olum
bus
O
hio
30
4
00
0
57
V
es
40
13
1 1
56
Y
es
46
w
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
30
3
05
0
86
Y
es
40
2
16
1
92
V
es
47
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 3
02
0
4
08
7
Yes
5
0
35
5
16
7
Ves
4
8
wil
liam
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
3
02
0
0
08
5
Yes
5
0
29
6
18
8
Yes
4
9
New
Vor
k Ey
e an
d E
ar
Infi
rmar
y
New
Yor
k 3
02
1
7
00
0
No
35
50
2
63
Y
es
50
F
G
McG
aw H
osp
ital
at
lOll
ola
Un
iver
sity
M
ayw
ood
Il
l
30
0
10
0
87
Y
es
40
16
6 1
62
Y
es
L L
2001
G
eria
tric
s B
est
Ho
spit
al L
ist
Hos
ptta
lwid
e T
echn
olog
y D
isch
arge
S
erv
ice
Ger
iatr
ic
Rep
utat
iona
l m
ort
alit
y
COTH
sc
ore
R
N
s
plan
ning
m
ix
serv
ices
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 8
) to
bed
s (o
f 3
) (o
f 1
0)
(of
7)
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
10
00
3
97
0
83
Y
es
80
1
08
3
6 5
2 JO
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
89
5
33
6
08
2
Yes
8
0
14
2
3 9
4 3
Mou
nt
Sin
ai M
edic
al C
ente
r N
ew Y
ork
73
3
27
6
11
1
Yes
8
0
15
7
3 8
4 4
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
6
11
1
98
0
93
Y
es
80
1
81
3
7 3
5 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
59
4
18
5
09
3
Yes
8
0
13
8
3 8
4 6
May
o C
11ni
c
Roo
hest
er
Min
n
51
1
11
2
07
2
Yes
8
0
13
1
3 1
0
8 7
St
L
ouis
Un
iver
sity
Ho
spit
al
45
2
95
0
71
Y
es
80
1
47
3
4 3
8 Y
alemiddot
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
4
33
1
00
0
92
Y
es
80
1
53
3
1 3
9 C
leve
land
lt1
1nio
4
28
7
0
06
7
Yes
8
0
19
4
3 8
4 10
U
niv
ersi
ty o
f M
ichI
gan
Med
ical
Cen
ter
Ann
Arb
or
42
2
79
0
82
Y
es
80
1
79
3
9 4
11
Bet
h Is
rael
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
11
7
7
08
4
Yes
7
0
15
8
3 9
4 (+
3 SO
) 12
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
68
7
3
08
7
Yes
7
0
11
0
2 6
2 1
3
Un
iver
sity
01
Chi
cago
Ho
spit
als
35
4
50
0
90
Y
es
80
1
94
3
8 4
14
B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
33
6
32
0
82
Y
es
80
1
49
3
9 4
15
U
niv
ersi
ty H
osp
ital
D
enve
r 3
34
2
5
07
4
Yes
7
0
24
0
3 8
5 16
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
28
3
0
08
1
Yes
8
0
14
3
3 7
4 17
R
ush
middotPre
sby
teri
anmiddotS
t L
uke
s M
edic
al C
ente
r C
hica
go
32
5
14
0
70
Y
es
80
1
14
3
9 5
19
u
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co l
led
ical
Cen
ter
32
5
36
0
85
Y
es
70
1
75
3
6 4
(+2
SO)
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
0
34
0
86
Y
es
60
1
61
3
9 3
20
Ho
spit
al o
f th
e U
niv
ersi
ty o
f pe
nnsy
lvan
ia
Ph
ilad
elp
hia
3
16
4
4
10
2
Yes
8
0
16
1
I 8
3 21
U
niv
ersi
ty H
osp
ital
s o
f C
leve
land
3
13
2
5
07
9
Yes
8
0
12
1
2 8
4 2
2
Par
klan
d ll
emor
ial
Ho
spit
al
Dal
las
31
3
1S
0
77
Y
es
80
1
98
3
7 4
23
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middotSai
em
31
1
20
0
92
Y
es
80
1
61
3
10
6
24
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
30
8
05
0
53
Y
es
70
1
09
3
8 4
25
U
niv
ersi
ty o
f Il
lin
Ois
Ho
spit
al a
nd C
lin
ios
C
hioa
go
30
7
11
0
66
Y
es
55
1
29
3
7 4
26
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 3
04
4
1
10
5
Yes
8
0
11
8
3 1
4 2
7
Fai
rvie
wmiddotu
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
30
4
14
0
19
Y
es
60
1
56
3
9 5
28
Sos
ton
Med
ioal
Cen
ter
30
4
16
0
75
Y
es
60
2
10
3
7 4
29
Fra
nci
s S
cott
Key
Med
ical
Cen
ter
Bal
tim
ore
30
4
18
0
80
Y
es
70
0
79
3
8 5
30
S
parr
ow H
osp
ital
and
Hea
lth
Sys
tem
L
anS
ing
M
ich
3
04
0
0
06
5
No
70
1
13
3
10
6
31
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
02
0
8
08
4
Yes
8
0
16
7
3 9
7 3
2
Los
Ang
eles
cou
ntymiddot
uSC
lle
dica
l C
ente
r 3
01
0
3
02
0
Yes
6
5
16
7
3 8
3 3
3
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
98
2
3
09
2
Yes
7
0
17
0
3 9
4 3
4
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
29
7
03
0
68
Y
es
70
1
49
3 9
3 3
5
Coo
k C
ount
y H
osp
ital
C
hica
go
28
6
00
0
55
Y
es
60
2
10
3
7 4
36
U
niv
ersi
ty o
f C
onne
ctic
ut H
ealt
h C
ente
r
Far
min
gton
2
94
4
6
10
0
Yes
6
0
26
0
3 3
2 3
7
Ho
spit
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 2
91
0
0
01
0
Yes
6
0
15
1
3 5
4 3
8
Un
iver
sity
Med
ioal
Cen
ter
Tuc
son
A
riz
2
90
0
0
06
6
Yes
7
0
17
2
3 7
3 3
9
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
28
9
07
0
79
Y
es
70
1
52
3
10
3
40
Thom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
28
9
13
0
85
Y
es
70
1
23
3
9 4
41
Hen
nepi
n C
ount
y M
edic
al C
ente
r
Min
neap
olis
2
89
0
0
06
1
Yes
6
5
10
5
3 7
3 4
2
St
L
uk
es
Ho
spit
al
Ch
este
rfie
ld
Mo
2
88
0
0
06
7
No
70
1
06
3
8 8
43
Aug
usta
Hea
lth
Car
e
Fis
her
svil
le
Va
2
87
0
0
06
5
No
50
1
35
3
8 5
44
John
D
Arc
hbol
d M
emor
ial
Ho
spit
al
Tho
maS
Vil
le
Ga
2
86
0
0
06
3
No
70
0
93
3
7 4
45
F
G
McG
aw H
osp
ital
at
Loy
ola
un
iver
sity
M
ayw
ood
Il
l
28
5
14
0
87
Y
es
70
1
62
3
9 3
46
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
Sac
ralll
ampnt
o 2
84
0
4
07
6
Yes
8
0
27
9
3 6
4 4
7
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
28
4
00
0
70
Y
es
70
1
14
3
7 4
49
Hen
ry F
ord
Ho
spit
al
Det
roit
2
83
0
4
07
3
Yes
7
5
18
2
3 4
4 4
9
Un
iver
sity
of
Vir
gin
ia H
ealt
h Sc
ienc
amps
Cen
ter
Ch
arlo
ttes
vil
le
282
0
3
08
1
Yes
7
0
22
7
3 9
4 50
S
t
Jose
ph H
osp
ital
D
enve
r 2
80
0
0
06
3
No
70
1
03
3
6 3
2001
G
ynec
olog
y B
est
Ho
spit
al L
ist
Hos
p1ta
lwid
e T
echn
olog
y G
ynec
olog
y R
eput
atio
nal
mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
serv
ices
R
ank
Ho
spit
al
IHQ
sc
ore
ra
te
Mem
ber
(of
8)
Dis
char
ges
to b
eds
Cen
ter
(of
4)
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
32
5
0B
2
Yes
8
0
24
0
14
2
Yes
4
2 M
ayo
Cli
nic
R
oche
ster
M
inn
7
53
2
10
0
72
Y
es
80
13
40
13
1
Yes
3
3 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 6
70
1
77
0
81
Y
es
80
4
83
1
43
Y
es
4 4
UCLA
Med
ical
Cen
ter
L
os A
ngel
es
58
3
14
2
08
3
Yes
8
0
310
10
8
Yes
4
5 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
cer
Cen
ter
Hou
ston
5
72
1
59
0
89
Y
es
60
2
34
2
68
No
0
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
49
9
10
9
09
3
Yes
8
0
512
18
1
Yes
4
7 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
49
8
11
0
09
3
Yes
8
0
418
13
8
Yes
4
8 P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 4
89
1
01
0
77
Y
es
80
9
4
19
8
Yes
3
11 Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
4
37
1
00
1
15
Y
es
80
56
0 1
32
Y
es
4 1
0
Un
iver
sity
of
Nor
th C
arol
ina
Ho
spit
als
Cha
pel
Hil
l 4
06
6
1
07
9
Yes
7
0
34
3
15
2
Yes
4
11
Mem
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loan
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Can
cer
Cen
ter
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k 4
03
7
4
07
9
Yes
7
0
179
21
2
No
1 1
2
Sta
nfo
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niv
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ty H
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S
tan
ford
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alif
3
87
6
7
08
6
Yes
5
0
274
16
1
Yes
2
13
M
agee
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spit
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Pit
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urg
h
38
4
50
0
67
Y
es
65
55
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53
No
3
14
U
niv
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ichi
gan
Med
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Cen
ter
Ann
Arb
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38
3
52
0
82
Y
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80
3
90
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79
Y
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N
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tern
Mem
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l H
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hica
go
36
5
52
0
92
Y
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29
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3 SD
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6
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aven
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spit
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36
3
50
0
92
Y
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80
34
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53
Y
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4 17
C
leve
land
Cli
nic
3
59
3
7
06
7
Yes
7
0
711
19
4
No
3 18
H
osp
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of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
3
54
5
5
10
2
Yes
8
0
222
16
1
Yes
4
19
Un
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sity
of
Chi
cago
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spit
als
35
1
43
0
90
Y
es
80
2
33
1
94
Y
es
4 2
0
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
34
3
50
0
85
Y
es
70
51
1
75
No
3
21
Van
der
bil
t U
niv
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ty H
osp
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and
Cli
niC
N
ash
vil
le
33
B
35
0
84
Y
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30
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40
Y
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2
Geo
rget
own
Un
iver
sity
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spit
al
Was
hing
ton
D
C
32
2
12
0
S3
Y
es
80
16
9 1
09
Y
es
4 2
3
Los
Ang
eles
Cou
nty-
uSC
Med
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Cen
ter
31
7
12
0
20
Y
es
65
4
0
16
7
Yes
4
24
Bar
nes-
Jew
ish
Ho
spit
al
St
L
ouis
3
16
2
3
08
2
Yes
7
5
62
3
14
9
Yes
4
25
R
ush
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sby
teri
an-S
t
Luk
es
Med
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Cen
ter
Chi
oago
3
15
2
2
07
0
Yes
8
0
30
3
114
No
3
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irmin
gham
3
14
3
1
09
6
Yes
8
0
411
15
1
Yes
4
(+2
SO)
27
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
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elp
hia
2
97
1
9
08
5
Yes
7
0
33
7
12
3
Yes
4
28
U
niv
ersi
ty M
edic
al C
ente
r T
uoso
n A
riz
2
95
0
8
06
6
Yes
7
0
150
17
2
Yes
3
29
U
niv
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ty H
osp
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enve
r 2
92
1
3
07
4
Ves
6
0
90
2
40
Y
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0
Mou
nt S
inai
Med
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ter
New
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k 2
92
3
2
11
1
Yes
8
0
317
15
7
Yes
4
31
Art
hur
G
Jam
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ance
r H
osp
ital
C
olum
bus
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hio
29
1
00
0
57
Y
es
70
1
73
1
56
Y
es
3 32
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
90
0
0
05
5
Yes
6
0
69
21
0
Yes
4
33
U
niv
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ty o
f C
alif
orn
ia
Irv
ine
Med
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Cen
ter
Ora
nge
2B
9
30
0
82
Y
es
60
69
1
05
Y
es
1 3
4
Un
iver
sity
of
Was
hing
ton
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ical
Cen
ter
S
eatt
le
28
8
24
0
87
Y
es
80
2
07
1
10
No
4
35
S
tbull
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ph H
osp
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D
enve
r 2
88
0
8
05
3
No
70
2
89
1
03
No
4
36
C
edar
smiddotS
inai
Med
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Cen
ter
Lo
s A
ngel
es
29
4
29
1
07
Y
es
BO
S
02
10
6
Yes
4
37
Su
mm
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ealt
h S
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m
Akr
on
Ohi
o 2
83
0
0
06
8
Yes
6
5
37
6
14
9
Yes
4
38
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r D
alla
s 2
8S
1
6
08
8
Yes
6
5
559
12
2
Yes
4
39
M
ary
Hit
chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
28
2
12
0
86
V
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70
2
34
1
94
Y
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4 4
0
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y U
niv
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ty H
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ital
A
tlan
ta
28
1
38
0
90
Y
es
80
2
09
0
93
No
0
41
Wom
en a
nd
Infa
nts
Ho
spit
al O
f R
hode
Is
lan
d
Pro
vide
nce
28
1
04
0
29
Y
es
50
5
19
0
63
No
4
42
B
eth
Isra
el
Oea
cone
ss M
edic
al C
ente
r B
osto
n 2
80
1
2
08
4
Yes
7
0
286
15
8
Yes
3
43
C
lari
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ealt
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artn
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In
dia
nap
oli
s 2
79
1
1
08
7
Yes
8
0
55
8
16
7
Yes
3
44
Ohi
o S
tate
un
iver
sity
Med
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Cen
ter
Col
umbu
s 2
77
1
0
07
6
Yes
6
5
157
10
1
Yes
4
45
W
illi
am
Bea
umon
t H
osp
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oyal
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ich
2
75
0
4
08
5
Yes
9
0
59
5
18
9
Yes
4
46
L
uthe
ran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
27
4
00
0
70
Y
es
70
2
60
1
14
Y
es
4 4
7
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nic
s
Mad
ison
2
12
1
2
07
7
Yes
7
0
20
7
13
6
Yes
1
48
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
27
1
05
0
76
Y
es
70
2
62
1
57
Y
es
2 4
9
Gre
ater
Bal
tim
ore
Med
ical
Cen
ter
Bal
tim
ore
27
0
00
0
69
Y
es
55
46
0 2
00
No
4
50
FG
M
oGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
70
1
0
08
7
Yes
7
0
186
16
2
Yes
4
rmiddot--
I
i L
L
2001
H
eart
Bes
t H
osp
ital
Lis
t
Ran
k H
osp
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1 C
leve
land
Cli
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2
May
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11ni
o
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hest
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Min
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3 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
4 Jo
hns
Hop
kins
Ho
spit
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Bal
tim
ore
5 B
righ
am a
nd W
omen
s H
osp
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B
osto
n 8
Duk
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niv
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ty M
edic
al C
ente
r D
urha
m
NC
7
Tex
as H
eart
In
stit
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Luk
es
Epi
scop
al H
osp
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H
oust
on
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nfo
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niv
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osp
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S
tan
ford
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ali
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9 Em
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sity
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Bet
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rael
Dea
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ton
11
B
arne
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osp
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12
W
illi
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spit
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h
13
Un
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gham
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4
Un
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5
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ass
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6
Par
klan
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spit
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7
Orl
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Reg
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18
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ord
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9
Thom
as
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niv
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hil
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ph
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20
Sum
ma
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lth
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tem
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kron
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21
U
niv
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rgh
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2
2
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2
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niv
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9
UCLA
Med
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Cen
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Ang
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Un
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L
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idge
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43
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niv
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44
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Geo
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47
M
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48
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es
80
2
44
50
00
0
19
4
YeS
2
86
0
0
06
0
Yes
8
0
79
90
00
0
10
9
Yes
2
85
0
0
08
7
Yes
8
0
40
88
00
00
1
15
Y
es
28
4
00
0
70
N
o 8
5
45
27
00
00
1
59
N
o 2
83
0
6
07
6
No
80
8
15
10
00
0
19
9
No
28
3
00
0
71
No
8
0
31
45
00
00
1
10
N
o
2001
H
oroo
nal
Dis
ord
ers
Bes
t H
osp
ital
lis
t
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
RN
s
T
raum
a R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (O
f 7
) D
isch
arge
s to
bed
s C
ente
r
May
o C
lin
ic
Roc
hest
er
Min
n
10
00
6
12
0
66
Y
es
70
14
59
13
1
Yes
2
Mas
sach
uset
ts G
ener
al H
OSp
tal
B
osto
n 9
89
5
27
0
91
Y
es
70
l1
B3
13
B
Yes
3
John
s H
opki
ns H
osp
ital
B
alti
mor
e 5
96
2
52
0
64
Y
es
70
B
07
14
2
Yes
4
Bri
gham
and
Wom
en s
H
osp
ital
B
osto
n 5
36
2
05
0
72
Y
es
70
6
17
1
43
Y
es
I
Bet
h Is
rael
Dee
cone
ss M
edic
al C
ente
r B
osto
n 4
55
1
13
0
62
Y
es
60
11
46
15
8
Ves
6
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
45
4
11
5
04
9
Yes
6
0
1029
2
27
No
7
Un
iver
sity
of
Cal
ifo
rnia
Se
n F
ranc
isco
Med
ical
Cen
ter
45
3
14
5
07
2
Yes
6
0
416
17
5
No
9 B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
45
3
11
6
09
5
Yes
7
0
1968
1
49
Y
es
9 C
leve
land
Cli
nic
4
37
9
3
04
6
Ves
7
0
1133
1
94
No
(+
3 11
m
10
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
41
6
82
0
66
Y
es
10
8
13
1
19
Y
es
11
Un
iver
sity
of
Chi
cago
Ho
spit
als
41
1
89
0
B2
Y
es
70
00
1 1
94
Y
es
12
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
41
0
10
4
00
4
Yes
7
0
752
10
8
Yes
13
u
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
B8
0
4
05
6
Yes
1
0
31
9
11
0
No
14
Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
3
83
1
11
1
54
Y
es
70
15
52
13
2
Yes
15
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
78
3
9
05
5
Ves
7
0
757
24
0
Yes
16
N
orth
Wes
tern
Mem
oria
l H
osp
ital
C
hica
go
37
5
51
0
73
Y
es
60
97
5 1
70
Y
es
17
Hen
ry F
ord
Ho
spit
al
Det
roit
3
75
1
2
05
6
Yes
6
5
19
45
1
82
Y
es
(+2
SD)
18
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
st
anfo
rd
Ca1
1f
36
1
68
0
83
Y
es
50
47
2 1
61
Y
es
19
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 3
64
3
6
05
6
Yes
7
0
328
19
8
Yes
2
0
Duk
e U
nive
rSit
y M
edic
al C
ente
r D
urha
m
NC
3
59
2
7
06
8
Yes
7
0
91
6
18
1
Yes
21
U
niv
ersi
ty H
osp
ital
D
enve
r 3
58
2
5
04
5
Yes
8
0
320
24
0
Yes
2
2
was
hing
ton
Ho
spit
al C
ente
r W
ashi
ngto
n
DC
3
57
2
0
07
6
Yas
6
0
1658
1
92
Y
es
23
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
35
4
16
0
65
Y
es
70
12
59
16
7
Yes
2
4
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 3
47
2
7
05
1
Yes
5
5
719
10
1
Yes
2
5
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
34
5
23
0
13
Y
es
70
86
6 1
61
Y
es
26
S
t
lou
is U
niv
ersi
ty H
osp
ital
3
43
0
7
04
0
Yes
1
0
637
14
1
Yes
2
7
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
3
43
1
1
06
4
Yes
1
0
1080
1
51
Y
es
28
U
niv
ersi
ty H
osp
ital
P
ort
lan
d
ore
3
42
2
8
048
Y
es
60
32
8 0
111
Yes
2
9
Un
iver
sity
of
Tex
as M
edic
al B
ranc
h H
osp
ital
s
Gal
vest
on
33
9
05
0
4B
Y
es
60
81
8 1
53
Y
es
30
G
ood
Sam
arit
an R
egio
nal
Med
ioal
Cen
ter
Pho
enix
3
38
1
0
01
7
Yes
7
0
58
0
10
7
Yes
31
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
Cha
pel
Hil
l 3
37
0
6
05
2
Yes
6
0
791
15
2
Yes
32
U
niv
ersi
ty o
f W
isco
nsin
Hos
pita
l an
d C
Hn
ics
Mad
ison
3
37
0
5
03
3
Yes
7
0
519
13
6
Yes
33
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al O
ak
Mio
h
33
7
06
0
80
Y
es
70
14
14
18
8
Yes
3
4
Flo
rid
a H
osp
ital
Med
ical
Cen
ter
Orl
ando
F
la
33
7
00
0
51
No
6
0
1698
1
67
Y
es
35
U
niv
ersi
ty o
f M
aryl
and
Med
ical
sys
tem
B
alti
mor
e 3
36
0
6
05
1
Ves
7
0
55
3
111
4 Y
es
36
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edic
al C
ente
r S
acra
men
to
33
4
06
0
59
Y
es
70
55
7 2
19
Y
es
37
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
33
3
05
0
50
Y
es
60
56
0 1
57
Y
es
38
Yal
emiddotN
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
33
2
38
1
03
Y
es
10
8
10
1
53
Y
es
39
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
9
00
0
38
Y
es
60
76
8 1
14
Y
es
40
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
3
29
0
0
04
9
Yes
5
5
656
13
5
Yes
41
A
lleg
heny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
32
8
00
0
66
Y
es
60
6
10
1
91
Y
es
42
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 3
27
6
4
16
7
Yes
7
0
1555
1
57
Y
es
43
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
6
05
0
20
Y
es
70
32
9 1
09
Y
es
44
M
emor
ial
Med
ical
Cen
ter
Sav
anna
h G
a
32
6
00
0
48
Y
es
60
5
52
1
42
V
es
45
Med
ical
Col
lege
of
Geo
rgia
Ho
spit
al a
nd C
lin
iC
Aug
usta
3
23
0
0
03
1
Yes
5
0
381
15
0
Yes
46
S
t L
uk
es
Med
ioal
Cen
ter
Milw
auke
e W
is
32
3
00
0
62
Y
es
60
13
70
08
6
Yes
4
1
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
trd
ty
May
woo
d
Ill
3
23
1
0
07
1
Yes
6
0
64
3
16
2
Yes
4
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
32
3
07
0
68
Y
es
70
6
85
1
34
Y
es
49
M
edic
al C
ente
r o
f D
elaw
are
Wil
min
gton
3
21
0
0
08
1
ves
60
12
35
17
5
Ves
50
u
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
32
1
00
0
68
Y
es
70
77
3 1
51
Y
es
- L
2001
K
idne
y D
isea
se B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Dis
char
ge
Med
ical
l R
epu
tati
on
al
Mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
pla
nn
ing
S
urg
ical
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 5
) D
isch
arg
es
to
beds
C
ente
r (o
f 3
) B
eds
Mas
sach
use
tts
Gen
eral
Ho
spit
al
B
osto
n 1
00
0
27
6
09
5
Yes
5
0
1091
1
36
Y
es
3 83
2
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
95
6
25
6
061
Y
es
50
74
2 1
43
Y
es
3 30
3
May
o C
lin
iC
Ro
ches
ter
M
inn
82
B
18
5
06
3
Yes
5
0
1217
1
31
Y
es
3 94
4
Cle
vel
and
Cli
nic
8
28
1
94
0
53
Y
es
50
11
24
19
4
No
3 44
5
New
Yor
k P
resb
yte
rian
Ho
spit
al
80
6
19
6
12
2
Yes
5
0
1617
1
32
Y
es
3 11
1
6 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
77
3
17
4
05
4
Yes
4
5
811
14
2
Yes
3
41
7 UC
LA M
edic
al C
ente
r
Los
Ang
eles
7
26
1
53
0
60
Y
es
50
97
5 1
08
Y
es
3 54
8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
69
6
14
3
07
8
Yes
5
0
1108
1
81
Y
es
3 57
9
Bar
nes
-Jew
ish
Ho
spit
al
S
t
Lou
is
88
7
12
0
05
9
Yes
5
0
1863
1
49
Y
es
3 76
10
U
niv
ersi
ty H
osp
ital
D
enve
r 6
58
1
41
0
61
Yes
4
0
408
24
0
Yes
3
0 11
U
niv
ersi
ty O
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbor
5
89
8
8
05
4
Yes
5
0
922
17
9
Yes
3
60
12
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
iC
Nas
hv
ille
5
78
9
1
04
9
Yes
4
0
850
24
0
Yes
3
28
13
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
56
6
89
0
63
Y
es
40
52
8 1
61
Y
es
3 67
14
P
ark
lan
d M
emor
ial
Ho
spit
al
D
alla
s 56
1
73
0
31
Yes
5
0
660
19
8
Yes
3
39
15
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
41
6
6
06
2
Yes
5
0
1128
1
67
Y
es
3 80
16
U
niv
ersi
ty o
f C
ali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
53
4
74
0
45
Y
es
50
63
1 1
75
N
o 3
35
17
Ho
spit
al o
f th
e U
niv
ersi
ty O
f P
enn
sylv
ania
P
hil
adel
ph
ia
52
8
75
0
73
Y
es
50
96
2 1
61
Yes
3
44
18
Em
ory
Un
iver
sity
Ho
spit
al
A
tlan
ta
52
1
77
0
58
Y
es
45
78
4 0
93
N
o 3
48
19
un
ivers
ity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
51
6
78
0
55
Y
es
50
42
1 1
10
N
o 2
46
(+3
SO)
20
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
47
3
56
0
93
Y
es
40
12
02
15
1
Yes
2
86
21
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
45
3
47
0
61
Yes
5
0
1013
1
58
Y
es
3 0
22
Hen
ry F
ord
Ho
spit
al
Detr
oit
4
47
2
1
05
8
Yes
5
0
1459
1
82
Y
es
3 76
2
3
Un
iver
sity
of
No
rth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
44
5
37
0
48
Y
es
40
10
33
15
2
Yes
3
16
24
F
airv
ieW
-Un
iver
sity
Med
ical
Cen
ter
Min
neap
Oli
s 4
44
5
2
07
2
Yamp
s 5
0
690
15
6
No
3 24
2
5
Un
iver
sity
of
Chi
cago
Ho
spit
als
44
2
31
0
47
Y
es
50
75
8 1
94
Y
es
3 3
0
26
H
erm
ann
Ho
spit
al
Hou
ston
4
24
1
7
03
0
Yes
4
5
668
11
4
Yes
3
54
27
Ru
sh-P
resb
yte
rian
-St
L
uke
s
Med
ical
Cen
ter
C
hica
go
41
8
16
0
37
Y
es
50
12
73
11
4
No
3 49
2
8
New
Eng
land
Med
ical
Cen
ter
8
0st
on
4
16
4
2
07
9
Yes
5
0
330
24
2
Yes
2
30
2
9
Un
iver
sity
of
Cali
forn
ia
Dav
iS M
edic
al C
ente
r
Sac
ram
ento
4
16
2
2
05
5
Yes
5
0
681
27
9
Yes
3
40
30
Yal
e-N
ew H
aven
H
osp
ital
N
ew H
aven
C
onn
4
12
3
8
09
9
Yes
5
0
943
15
3
Yes
3
52
(+2
SO)
31
Los
An
gel
es C
ount
y-U
SC
Med
ical
Cen
ter
40
9
04
0
08
Y
es
45
21
3 1
67
Y
es
3 43
32
S
hand
s H
osp
ital
et
the U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
40
6
34
0
74
Y
es
45
69
9 1
57
Y
es
2 3
0
33
St
L
ou
is U
niv
ersi
ty H
osp
ital
3
99
1
2
041
Y
es
45
58
7 1
47
Y
es
3 43
3
4
Bos
ton
Med
ical
Cen
ter
39
4
15
0
44
Y
es
40
40
5 2
10
Y
es
3 36
35
U
niv
ersi
ty o
f T
exes
Med
ical
Bra
nch
Ho
spit
als
G
alv
esto
n
39
0
05
0
41
Yes
5
0
890
15
3
Yes
3
38
36
Un
iver
sity
Ho
spit
al
Po
rtla
nd
are
3
90
3
4
07
2
Yes
4
5
356
091
Y
es
3 18
37
M
eth
od
ist
Ho
spit
al
Hou
ston
3
89
3
3
10
0
Yes
4
6
796
13
3
No
3 69
38
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
88
0
6
06
0
Yes
5
0
935
17
0 Y
es
3 6
3
39
Fro
edte
rt M
emor
ial
Lu
ther
an H
osp
ital
M
ilw
auke
e 3
87
1
2
05
5
Yes
5
0
784
14
6
Yes
3
35
40
Un
iver
sity
Ho
spit
els
and
Cli
niC
S
Col
umbi
a
Mo
3
87
2
6
06
6
Yes
4
5
374
15
1
Yes
2
30
41
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
niC
S
Chi
cago
3
85
0
0
01
9
Yes
4
5
382
12
9
Yes
3
42
42
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
Ari
z
38
3
00
0
29
Y
es
45
37
6 1
72
Y
es
3 46
43
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
38
3
12
0
41
Y
es
00
81
4 1
68
N
o 91
44
W
illi
am B
eaum
ont
Ho
spit
el
Roy
al O
ak
Mic
h
38
3
03
0
74
Y
es
50
16
88
18
8
Yes
3
60
45
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
3
81
0
5
06
1
Yes
4
5
941
19
4
Yes
3
63
46
Un
iver
sity
01
Wis
con
sin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
7
22
0
82
Y
es
50
82
0 1
36
Y
es
3 32
4
7
Sax
ar C
ount
y H
osp
ital
Dis
tric
t
San
An
ton
io
37
7
16
0
64
Y
es
45
36
8 1
21
Y
es
3 51
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
WaS
hing
ton
D
C
37
7
05
0
43
Y
es
50
39
5 1
09
Y
es
3 53
49
U
niv
ersi
ty 0
1 V
irg
inie
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
3
77
1
4
06
4
Yes
5
0
930
22
7
No
3 34
50
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r
Dal
las
31
5
05
0
72
Y
es
45
97
6 1
22
Y
es
3 86
j r
l
~
2001
N
euro
logy
and
Neu
rosu
rger
y B
est
Ho
spit
al L
ist
Tec
hnol
ogy
Re p
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
so
ore
rate
M
embe
r (o
f 7)
D
isoh
arge
s to
bed
s C
ente
r
1 M
ayo
Cli
nic
R
oche
ster
M
inn
1
00
0
57
5
09
1
Yes
7
0
4763
1
31
Y
es
2 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
83
7
46
0
09
5
Yes
7
0
3705
1
38
Y
es
3 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
74
6
37
2
07
0
Yes
7
0
2641
1
42
Y
es
4 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
7
27
3
73
0
95
Y
as
70
40
78
13
2
Yes
5
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
51
6
24
1
10
0
Yes
6
0
1503
1
75
No
6 C
leve
land
Cli
nic
5
12
1
88
0
65
Y
es
70
33
38
19
4
No
7 B
arne
smiddotJe
wis
h H
osp
ital
S
t l
ou
is
38
9
92
0
81
Y
es
70
46
67
14
9
Yes
8
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
37
4
10
5
09
1
Yes
7
0
22
86
1
61
Y
es
(+3
SD)
9 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
32
4
70
1
02
Y
es
70
29
21
18
1
Yes
1
0
UCLA
Med
ioal
Cen
ter
lo
s A
ngel
es
32
2
64
0
80
Y
es
70
19
67
10
8
Yes
11
M
ount
S
inai
Med
ical
Cen
ter
Ne
w Y
ork
31
7
55
0
85
Y
es
70
23
83
15
7
Yes
12
M
etho
dist
Ho
spit
al
Hou
ston
3
15
6
2
08
6
Yes
6
0
3768
1
33
No
13
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
15
6
6
09
3
Yes
7
0
1925
1
43
Y
es
14
Un
iver
sity
of
Mic
higa
n M
edic
al C
arot
er
Ann
Arb
or
30
4
68
1
06
Y
es
70
17
02
17
9 Y
es
15
S
t J
ose
ph
s H
osp
ital
and
Med
ical
Cen
ter
Pho
enix
3
04
5
2
09
2
Yes
6
0
3336
1
27
Y
es
16
Los
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
29
9
04
0
29
Y
es
55
39
9 1
67
Y
es
17
H
enry
F
ord
Ho
spit
al
Det
roit
2
99
1
3
06
4
Yes
6
5
3299
1
82
Y
es
18
Den
ver
Hea
lth
and
Ho
spit
als
29
5
04
0
16
No
5
5
353
17
0
Yes
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
29
4
49
0
89
Y
es
50
19
06
16
1
Yes
2
0
Dan
amiddotF
arbe
r C
ence
r In
stit
ute
B
osto
n 2
94
0
3
00
0
No
85
6
22
7
No
21
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
29
3
15
0
46
Y
es
70
11
51
10
9
Yes
2
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
29
1
37
0
82
Y
es
70
21
86
13
4
Yes
(+
2 SD
) 2
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
28
8
13
0
36
V
es
60
33
6 2
68
No
2
4
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 2
88
1
8
07
0
Yes
7
0
3234
1
18
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
28
8
27
0
70
Y
es
60
15
98
15
7
Yes
2
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
87
2
1
07
0
Yes
6
0
1970
1
70
Y
es
27
u
niv
ersi
ty H
osp
ital
D
enve
r 2
87
3
3
07
3
Yes
6
0
613
24
0
Yes
2
8
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
28
6
08
0
19
Y
es
70
44
69
16
7
Yes
2
9
Un
iver
sity
of
Vir
gIn
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
28
5
34
0
83
Y
es
60
32
29
22
7
No
30
D
ooto
rs C
Onm
luni
ty H
osp
ital
la
nham
M
d
28
0
00
0
05
No
5
5
901
09
7
No
31
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
2
78
0
0
00
0
Yes
3
0
870
03
4
Ho
32
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 2
77
1
8
07
0
Yes
7
0
896
19
8
Yes
3
3
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
O
ak
Mic
h
27
6
00
0
82
V
es
70
48
44
18
8
Yes
3
4
St
L
uke
s H
osp
ital
N
ewbu
rgh
N
Y
27
5
00
0
02
No
5
0
82
6
08
0
No
35
B
osto
n M
edio
al C
ente
r 2
74
2
5
07
7
Ves
5
0
1255
2
10
Y
es
36
F
airv
ieW
-Uni
vers
ity
Med
ical
Cen
ter
Min
neap
olis
2
74
2
0
06
1
Ves
5
0
1685
1
56
No
37
U
nIv
ersi
ty M
edic
al C
ente
r T
ucso
n
Ari
z
27
4
00
0
50
Y
es
60
86
5 1
72
Y
es
38
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
73
0
0
06
6
Yes
6
0
3299
1
49
Y
es
39
Sc
hwab
Reh
abil
itat
ion
Ho
spit
al
Chi
cago
2
70
0
0
02
3
Yes
2
5
769
04
1 Y
es
40
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
68
0
0
04
9
Yes
5
0
498
21
0
Yes
41
S
t V
ince
nt H
ospI
tal
and
Hea
lth
Cen
ter
In
dia
nap
olb
2
66
0
0
07
0
Yes
6
0
32
89
1
37
Y
es
42
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
Chi
cago
2
65
0
6
05
4
Yes
7
0
1848
1
14
No
4
3
Bet
h Is
rael
Dea
oone
ss M
edio
al C
ente
r B
osto
n 2
65
1
4
08
5
Yes
6
0
2838
1
58
Y
es
44
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
2
64
0
0
00
6
No
35
12
64
03
8
No
45
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
2
63
1
8
08
8
Yes
7
0
1659
2
40
Y
es
46
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
nic
s C
hioa
go
26
2
13
0
62
Y
es
45
83
0 1
29
Y
es
47
H
arpe
r H
osp
ital
D
etro
it
26
1
04
0
55
Y
es
60
20
72
12
6
No
48
E
vans
ton
Nor
thw
este
rn H
ealt
h C
are
E
vans
ton
Il
l
28
1
09
0
75
Y
es
60
29
33
10
2
Yes
4
9
was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
2
59
0
4
07
7
Yes
6
0
2269
1
92
Y
es
50
Car
din
al H
ill
Reh
abil
itat
ion
Ho
spit
al
lex
ing
ton
K
y
25
8
00
0
02
No
0
5
1313
0
55
No
t
2001
O
rth
op
edio
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
GOTH
so
ore
R
N
$
Tra
uma
Ran
k H
osp
ital
IH
O
sco
re
rate
M
embe
r (o
f 5)
D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
49
2
05B
Y
es
50
77
52
13
1
Yes
2
Ho
spit
al f
or
Sp
ecia
l S
urg
ery
N
ew Y
ork
88
3
40
6
01
3
Yes
4
5
6837
1
57
Y
es
3 M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 7
13
3
20
1
01
Y
es
50
34
89
13
8
Yes
4
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
43
1
90
0
73
Y
es
50
16
28
14
2
Yes
5
Cle
vel
and
Cli
nic
5
19
1
73
0
63
Y
es
50
36
20
19
4
No
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
40
1
34
1
07
Y
es
50
28
63
18
1
Yes
7
Har
borv
iew
Med
ical
Cen
ter
S
eatt
le
37
2
101
1
05
Yes
3
5
820
23
3
Yes
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
37
0
75
0
74
Y
es
50
15
09
13
4
Yes
9
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
36
0
84
0
99
Y
es
50
17
57
10
8
Yes
(+
3 SO
) 10
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
2
68
0
56
Y
es
50
97
3 1
10
No
11
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
A
rbor
3
29
3
9
06
8
Yes
5
0
1586
1
79
Y
es
12
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
32
7
43
0
80
Y
es
50
26
80
14
3
Yes
13
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
32
6
48
0
92
Y
es
50
28
72
16
7
Yes
14
B
exar
Cou
nty
Ho
spit
al D
istr
ict
San
Ant
onio
3
24
3
9
04
8
Yes
4
0
645
12
1
Yes
15
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
3
49
0
87
Y
es
30
21
43
161
Y
es
16
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
35
0
67
Y
es
50
11
56
19
4
Yes
17
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
31
8
71
1
23
Y
es
50
58
7 1
98
Y
es
18
Un
iver
sity
Ho
spit
al
Den
ver
31
7
31
0
44
Y
es
40
63
3 2
40
Y
es
19
Bar
nes
middotJew
ish
Ho
spit
al
St
lo
uis
3
11
3
6
08
9
Yes
5
0
2911
1
49
Y
es
20
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f fl
ori
da
Gai
nes
vil
le
30
7
21
05
9
Yes
4
0
1781
1
57
Y
es
21
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
30
5
62
1
04
Y
es
40
92
7 1
75
No
(+
2 SO
) 22
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
03
1
6
05
9
Yes
5
0
1608
2
40
Y
es
23
Ho
spit
al o
f th
e U
niv
ersi
ty o
f p
enn
sylv
ania
P
hil
adel
ph
ia
30
1
45
1
04
Y
es
50
10
76
161
Y
es
24
U
niv
ersi
ty o
f A
labe
ma
Ho
spit
al a
t B
irm
ingh
am
29
9
22
0
73
Y
es
50
15
94
151
Y
es
25
Ho
spit
al f
or
Join
t D
isea
sesmiddot
Ort
ho
ped
ic I
nst
itu
te
New
Yor
k 2
97
4
0
02
5
No
30
21
10
09
3
No
26
SUl1
l1la
Hea
lth
sy
stem
A
kron
O
hio
29
5
05
0
49
Y
es
40
38
99
14
9
Yes
27
Y
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
Onn
2
93
1
2
061
Y
es
50
14
62
15
3
Yes
28
N
ew Y
ork
Pre
sby
teri
an H
osp
ital
2
92
4
5
12
2
Yes
5
0
2394
1
32
Y
es
29
Un
iver
sity
of
Ten
ness
ee M
edic
al C
ente
r
Mem
phis
2
92
4
2
05
4
No
46
90
1
50
No
30
U
niv
ersi
ty o
f W
isco
nsi
n H
osp
ital
and
Cli
nic
s
Mad
ison
2
89
1
1
061
Y
es
50
14
42
13
6
Yes
31
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
sacr
amen
to
28
6
24
0
87
Y
es
50
11
56
27
9
Yes
32
S
t
lou
is U
niv
ersi
ty H
osp
ital
2
83
0
4
04
8
Yes
5
0
819
14
7
Yes
33
R
ushmiddot
Pre
sby
teri
an
-St
lu
kes
Med
ical
Cen
ter
Chi
cago
28
1
25
0
79
Y
es
50
21
23
11
4
No
34
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Ill
28
0
00
0
46
Y
es
40
25
63
11
4
Yes
35
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
2
80
0
6
04
7
Yes
5
0
952
10
9
Yes
36
C
aro
lin
as M
edic
al C
ente
r
Ch
arlo
tte
N
C
28
0
23
1
03
Y
es
50
29
00
18
4
Yes
37
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
27
9
06
0
71
Yes
4
0
2274
1
58
Y
es
38
Coo
k C
ount
y H
osp
ital
C
hica
go
27 _
7 1
2
05
5
Yes
3
0
184
21
0
Yes
39
U
niv
ersi
ty o
f lo
uis
vil
le H
osp
ital
lo
uis
vil
le
Ky
2
76
0
5
04
2
Yes
4
0
317
19
0
Yes
40
A
lleg
hen
y G
ener
al H
osp
ital
P
itts
bu
rgh
2
76
0
0
06
4
Yes
4
0
2161
1
91
Yes
41
H
enry
For
d H
osp
ital
D
etro
it
27
6
00
0_
63
Yes
4
5
1834
1
82
Y
es
42
Un
iver
sity
of
Mia
mi
Jack
son
Mem
oria
l H
osp
ital
2
78
3
0
06
2
Yes
0
0
748
16
8
No
43
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 2
75
0
5
06
6
Yes
4
0
1518
1
52
Y
es
44
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
27
5
00
0
32
Y
es
40
87
1 1
72
Y
es
45
Mar
y H
itch
cock
Mem
oria
l H
osp
ital
le
ban
on
N
H
27
4
00
0
57
Y
es
40
14
30
19
4
Yes
46
B
apti
st M
emor
ial
Ho
spit
al
Mem
phis
2
74
4
5
11
2
No
50
29
14
09
3
Yes
47
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
2
73
1
2
08
6
Yes
4
0
2025
1
70
Yes
48
L
os A
ngel
es C
ou
nty
USC
Med
ical
Cen
ter
27
3
05
0
00
Y
es
35
23
6 1
Il7
Yes
49
M
edic
al C
ente
r o
f C
entr
al M
assa
chu
sett
s W
orc
este
r 2
73
0
0
06
0
Yes
4
5
1285
1
89
Y
es
60
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
middotSal
em
27
3
11
0
92
Y
es
50
21
20
1I
II
Yes
r-
-
2001
R
esp
irat
ory
Dis
ord
ers
Bes
t H
osp
ital
Lis
t Tec
hnol
ogy
Dis
char
ge
Rep
uta
tio
nal
M
ort
ali
ty
COTH
sc
ore
R
N
s T
raum
a p
lan
nin
g
Ran
k H
osp
Ital
IH
Q
sco
re
rate
M
embe
r (o
f 4
) D
isch
arg
es
to b
eds
Cen
ter
(of
3)
1 N
atio
nal
Jew
ish
Cen
ter
D
enve
r 1
00
0
501
0
22
N
o 3
0
121
37
5
No
3 2
May
o C
lin
ic
Ro
ches
ter
M
inn
8
S2
41
1
08
1
Yes
4
0
4391
1
31
Yes
3
3 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
63
3
2B0
0
95
Y
es
40
14
61
14
2
Yes
3
4 B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
54
6
21
2
08
9
Yes
4
0
5329
1
49
Y
es
3 5
Un
iver
sity
Ho
spit
al
Den
ver
45
7
151
0
83
Y
es
40
9
80
2
40
Y
es
3 6
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
43
2
15
0
09
0
Yes
4
0
1015
1
75
N
o 3
7 M
assa
chu
sett
s G
ener
al H
osp
Ital
B
osto
n 43
1
16
4
11
4
Yes
4
0
3306
1
38
V
es
3 8
Cle
vel
and
Cli
nic
4
20
1
24
0
77
Y
es
40
27
32
19
4
No
3 9
Bri
gham
and
WO
men
s H
osp
ital
B
osto
n 3
69
9
0
08
2
Yes
4
0
2526
1
43
V
es
3 10
U
CSIl
Med
ical
Cen
ter
S
an D
iego
3
68
9
1
08
0
Yes
4
0
1130
1
48
Y
es
3 11
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
4
12
0
09
8
Yes
4
0
720
11
0
110
2 12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbo
r 3
48
8
1
08
7
Yes
4
0
1927
1
79
Ves
3
(+3
SO)
13
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
II
C
33
7
96
1
12
Y
es
40
29
49
18
1
Yes
3
14
Bo
sto
n M
edic
al C
ente
r 3
25
3
8
05
7
Yes
4
0
1105
2
10
Y
es
3 15
H
osp
ital
of
the U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
32
3
96
1
15
Y
es
40
15
07
16
1
Ves
3
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
32
2
74
0
95
Y
es
40
16
20
161
Y
es
3 1
7
Un
ivers
ity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
05
6
0
09
7
Yes
4
0
2957
1
67
Y
es
3 18
UC
LA M
edic
al C
ente
r
Los
Ang
eles
2
97
4
1
07
5
Yes
4
0
1910
1
08
Y
es
3 19
V
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
onn
2
95
5
3
09
3
Ves
4
0
2355
1
53
Y
es
3 20
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
85
5
5
10
0
Yes
4
0
1432
1
94
Y
es
3 21
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
28
5
25
0
74
V
es
40
27
79
15
2
Yes
3
(+2
SO)
22
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
27
9
35
0
87
V
es
40
20
51
24
0
Yes
3
23
Los
A
ng
eles
Cou
nty-
USC
Med
ical
Cen
ter
27
5
04
0
18
Y
es
40
46
9 1
67
Y
es
3 24
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
Sac
ram
ento
2
73
1
2
06
7
Yes
4
0
1820
2
79
V
es
3 2
5
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
73
1
0
06
2
Yes
4
0
1475
1
47
Y
es
3 26
C
ook
Cou
nty
Ho
spit
al
C
hica
go
27
3
00
0
49
Y
es
40
11
45
21
0
Yes
3
27
San
Fra
nci
sco
Gen
eral
Ho
spit
al M
edio
al C
ente
r 2
70
5
6
08
7
Yes
2
0
899
11
0
No
3 28
H
enne
pin
Cou
nty
Med
ical
Cen
ter
M
inn
eap
oli
s 2
67
0
0
05
2
Yes
4
0
1959
1
05
Y
es
3 29
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
26
4
07
0
66
Y
es
40
17
63
15
7
Yes
3
30
Geo
r-ge
tow
n U
niv
ersi
ty H
osp
ital
w
ash
ing
ton
D
C
26
2
04
0
59
Y
es
40
99
3 1
09
Y
es
3 31
C
lar-
ian
Hea
lth
Part
ners
In
dia
nap
Oli
S
26
0
12
0
79
Y
es
40
42
95
16
7
Yes
3
32
Ru
sh-P
resb
yte
rian
-St
L
uk
es
Med
ical
Cen
ter
C
hica
go
25
4
28
0
82
Y
es
40
18
56
11
4
No
3 33
H
enry
Fo
rd H
osp
ital
D
etr
oit
2
54
1
4
08
5
Yes
4
0
3875
1
82
Y
es
3 34
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
2
53
2
2
08
3
Yes
4
0
2302
2
27
No
3
35
W
est
Jeff
ers
on
Med
ical
Cen
ter
M
arre
ro
La
2
52
0
0
05
3
No
40
14
94
11
3
Ves
3
36
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
251
0
0
07
1
Yes
4
0
6185
1
49
Y
es
3 37
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
iCS
M
adis
on
25
0
05
0
70
Y
es
40
14
28
13
6
Yes
3
38
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
50
0
4
07
2
Yes
4
0
1071
1
72
Y
es
3 39
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
sity
M
ayw
ood
Ill
2
49
1
8
08
6
Yes
4
0
1415
1
62
V
es
3 40
U
niv
ersi
ty o
f Il
lin
ois
Ho
spit
al a
nd C
11
nic
s
Chi
cago
2
49
0
5
06
6
Yes
3
5
779
12
9
Yes
3
41
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
46
0
0
06
3
Yes
3
5
1677
1
01
Yes
3
42
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
2
45
3
7
10
3
Yes
4
0
2116
1
51
Ves
2
43
Har
bo
rvie
w M
edic
al C
ente
r
Seett
le
24
4
24
0
89
Y
es
30
80
5 2
33
Y
es
3 44
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
2
44
2
3
09
2
Ves
4
0
1334
1
34
Y
es
3 45
T
rum
an M
adic
al C
ente
r-W
est
K
ansa
s C
ity
M
o
24
4
00
0
64
Y
es
35
99
1 1
14
Y
es
3 46
M
emor
ial
Med
ical
Cen
ter
S
avan
nah
G
a
24
2
00
0
71
Y
es
40
14
03
14
2
Yes
3
47
Tou
ro
Infi
rmar
y
lew
Orl
ean
s 24
1
00
0
65
V
es
40
14
07
06
5
Ves
3
48
St
Jo
sep
h H
osp
ital
D
enve
r 2
41
0
0
05
5
No
40
25
11
10
3
No
3 49
L
os A
ng
eles
Cou
nty-
Har
bor-
UC
LA
Med
ical
Cen
ter
24
0
13
0
10
No
4
0
420
16
5
Yes
2
50
Bay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
40
1
2
08
7
Ves
4
0
3026
1
22
V
es
3
-
J 1
2001
R
heum
atol
ogy
Bes
t H
osp
ital
lis
t
Hos
pita
lwid
e T
echn
olog
y D
isch
arge
R
epu
tati
on
al
mo
rtal
ity
CO
TH
sco
re
RN
s
plan
ning
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 5
) to
bed
s (o
f 3
)
May
o C
lin
ic
Roo
hest
er
Min
n
10
00
4
96
0
72
Y
es
50
1
31
3
2 Jo
hns
Hop
kins
Has
p ta
l 8
alti
mo
rs
85
9
38
0
08
2
Yes
5
0
14
2
3 3
Ho
spt
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 8
09
2
70
0
10
Y
es
45
1
57
3
4 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 7
17
2
54
0
81
Y
es
50
1
43
3
5 C
leve
land
Cli
nic
6
76
2
03
0
67
Y
es
50
1
94
3
6 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
66
4
22
1
09
3
Yes
5
0
1 3
8
3 7
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
66
2
21
2
08
3
Yes
5
0
10
8
3 B
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
64
1
20
8
09
6
Yes
5
0
15
1
2 9
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
5
68
1
34
0
93
Y
es
50
1
81
3
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co M
edic
al C
ente
r 5
58
1
23
0
85
Y
es
40
1
75
3
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
5
37
1
12
0
86
Y
es
30
1
61
3
12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
52
1
82
0
82
Y
es
50
1
79
3
(+3
SD)
13
B
arne
s-Je
wis
h H
osp
ital
S
t
lou
is
49
2
57
0
82
Y
es
50
1
49
3
14
H
osp
ital
fo
r Jo
int
Dis
ease
s-O
rtho
pedi
c In
stit
ute
N
ew Y
ork
48
9
59
0
55
No
3
0
09
3
3 1
5
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 4
86
7
8
10
5
Yes
5
0
11
8
3 1
6
los
Ang
eles
Cou
nty-
USC
Med
ical
can
ter
48
4
00
0
20
Y
es
35
1
S7
3
17
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
47
7
46
0
84
Y
es
50
1
67
3
la
St
lu
kes
Ho
spit
al
New
burg
h
NY
4
74
0
0
00
1
No
35
0
80
3
19
U
niv
ersi
ty H
osp
ital
D
enve
r 4
70
3
6
07
4
Yes
-4
0
24
0
3 2
0
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
46
9
32
0
77
Y
es
50
1
98
3
21
Doc
tors
Com
mun
ity H
osp
ital
L
anha
m
Md
4
69
0
0
00
7
No
35
0
97
2
(+2
SO)
22
Den
ver
Hea
lth
and
Ho
spit
als
48
1
00
0
21
No
4
0
17
0
2 2
3
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
46
6
53
1
02
Y
es
50
1
61
3
24
R
ehab
ilit
atio
n I
nst
itu
te o
f C
hica
go
46
3
00
0
03
Y
es
25
0
34
2
25
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
DC
4
62
0
9
05
3
Yes
5
0
10
9
3 2
6
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
4
58
0
0
00
9
No
25
0
38
3
27
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
45
4
39
0
92
Y
es
40
1
70
3
28
T
he
Inst
itu
te f
or
Reh
abil
itat
ion
and
Res
earc
h H
oust
on
45
3
00
0
13
No
1
5
06
9
3 2
9
Un
iver
sity
of
Chi
cago
Ho
spit
als
45
2
29
0
90
Y
es
50
1
94
3
30
C
ard
inal
Hil
l R
ehab
ilit
atio
n H
osp
ital
L
exin
gton
K
y
44
9
00
0
01
No
0
5
05
5
3 31
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
47
2
6
08
4
Yes
4
0
15
8
3 3
2
Reh
abil
itat
ion
In
stit
ute
of
Mic
higa
n
Det
roit
4
47
0
0
01
2
No
25
0
39
2
33
S
t
lou
is U
niv
ersi
ty H
osp
ital
4
44
0
4
07
1
Yes
5
0
14
7
3 3
4
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
44
4
05
0
66
Y
es
40
1
72
3
35
Coo
k C
ount
y H
osp
ital
C
hica
go
44
3
00
0
55
Y
es
30
2
10
)
36
Su
nnyv
iew
Ho
spit
al a
nd R
ehab
ilit
atio
n C
ente
r S
chen
ecta
dy
NY
4
42
0
0
00
7
No
10
0
43
2
37
B
osto
n M
edic
al C
ente
r 4
39
1
6
07
5
Yes
3
0
21
0
3 3
8
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
niC
S
Mad
ison
4
39
0
8
07
7
Yes
5
0
13
6
3 3
9
Hil
lsid
e R
ehab
ilit
atio
n H
osp
ital
W
arre
n
Ohi
o 4
38
0
0
01
2
No
15
0
30
2
40
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
4
36
1
4
08
6
Yes
5
0
13
4
3 41
U
niv
ersi
ty o
f M
aryl
and
Med
ical
Sys
tem
B
alti
mor
e 4
35
1
6
09
2
Yes
5
0
19
4
3 4
2
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hiO
4
35
0
0
06
8
Yes
4
0
14
9
3 4
3
UCSD
Med
ical
Cen
ter
San
Die
go
43
5
26
0
90
Y
es
30
1
48
3
44
R
ush
-pre
sby
teri
an-S
t
luk
es
Med
ical
can
ter
Chi
cago
4
34
0
0
07
0
Yes
5
0
11
4
3 4
5
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
43
4
15
0
92
Y
es
50
1
53
3 4
6
Hen
ry F
ord
Ho
spit
al
Det
roit
4
34
0
0
07
3
Yes
4
5
18
2
3 4
7
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
can
ter
S
acra
men
to
43
4
00
0
76
Y
es
50
2
19
3
48
H
enne
pin
coun
ty M
edic
al c
ante
r M
inne
apol
is
43
2
00
0
61
Y
es
35
1
05
3
49
W
est
Jeff
erso
n M
edic
al C
ente
r M
arre
ro
lao
43
2
00
0
55
No
4
0
11
3
3 5
0
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
43
2
09
0
87
Y
es
50
1
67
3
~
-
2001
U
rolo
gy B
est
Has
pi ta
l li
st
Tec
hnol
ogy
Rep
uta
tio
nal
M
Ort
alit
y CO
TH
sco
re
RN
s
Tra
uma
Ran
k H
osp
ital
IH
O so
ore
rate
M
embe
r (o
f 8
) D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
70
7
07
8
Yes
7
5
1231
1
42
Y
es
2 C
leve
land
Cli
nio
6
94
4
14
0
50
Y
es
80
1
61
8
19
4
No
3 M
ayo
Cli
nic
R
oche
ster
M
inn
6
80
3
92
0
50
Y
es
80
3
81
8
13
1
Yes
4
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
50
0
25
7
12
3
Yes
8
0
14
50
1
08
Y
es
5 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
4
41
1
79
0
79
Y
es
80
30
61
13
2
Yes
6
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
35
1
73
0
56
Y
es
70
11
61
21
2
No
1 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
13
1
49
0
81
Y
es
80
1
75
8
18
1
Yes
8 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
40
7
15
3
09
6
Yes
8
0
1401
1
38
Y
es
9 B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
iS
39
0
12
9
08
2
Yes
8
0
1778
1
49
Y
es
10
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
38
5
15
2
12
9
Yes
5
0
973
16
1
Yes
11
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
co M
edic
al C
ente
r 3
57
1
07
0
62
Y
es
70
78
3 1
75
No
(+
3 SO
) 1
2
Met
hodi
st H
osp
ital
H
oust
on
33
8
10
9
11
0
Yes
6
5
1381
1
33
No
1
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
33
0
10
8
11
1
Yes
6
0
69
0
26
8
No
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
32
0
60
0
78
Y
es
80
1
28
5
17
9
Yes
1
5
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
31
0
54
0
86
Y
es
80
14
97
16
7
Yes
1
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
07
3
7
04
8
Yas
7
0
95
9
17
0
Yes
1
7
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
30
0
31
0
55
Y
es
80
12
74
16
1
Yes
(+
2 SD
) 1
6
Van
der
bil
t U
niv
ersi
ty H
osp
ital
an
d C
11ni
c
Nas
hv
ille
2
92
5
6
11
5
Yes
7
0
83
3
24
0
Yes
1
9
Lah
ey H
itch
cock
Cli
nic
B
url
ing
ton
M
ass
2
91
2
7
05
4
Yes
7
0
886
15
2
Yes
2
0
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
28
7
51
1
09
Y
es
80
69
7 1
43
Y
as
21
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
28
8
41
0
65
Y
es
80
2
83
1
98
Y
es
22
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
seatt
le
27
9
27
0
24
Y
es
80
5
32
1
10
No
2
3
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
cen
ter
Ch
arlo
ttes
vil
le
27
7
28
0
51
Y
es
70
73
2 2
27
No
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddot S
alem
2
77
1
8
07
7
Yes
8
0
957
16
1
Yes
2
5
Shan
ds H
osp
ital
at
the
Un
iver
sity
of
Flo
rid
a
Gai
nes
vil
le
27
7
15
0
57
Y
es
65
90
5 1
57
Y
es
26
Car
oli
nas
Med
ical
Cen
ter
C
har
lott
e
N C
2
78
0
0
03
3
Yes
8
0
908
18
4
Yes
27
U
niv
ersl
ty o
f W
isco
nsin
Hos
pita
l an
d C
lin
ios
Mad
ison
2
74
0
5
04
5
Yes
8
0
1151
1
36
Y
es
28
Ne
w Y
ork
Un
iver
sity
Med
ioal
Cen
ter
27
3
16
0
66
Y
es
80
16
70
11
8
Yes
2
9
Hen
ry F
ord
Ho
spit
al
Det
roit
2
72
0
0
04
3
Yes
7
5
1079
1
82
Y
es
30
U
niv
ersi
ty H
osp
ital
D
enve
r 2
70
1
0
00
0
Yes
6
0
371
24
0
Y9$
31
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
67
1
4
06
9
Yes
7
0
1011
1
23
Y
es
32
Y
ale-
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
2
67
0
5
06
8
Yes
8
0
98
4
15
3
Yes
33
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
26
7
00
0
42
Y
es
60
9
17
1
92
Y
es
34
A
lban
y M
adic
al C
ente
r A
lban
y
NY
2
66
0
5
04
7
Yes
6
0
77
3
16
7
Yes
3
5
36
Lo
s A
ngel
es C
ount
ymiddotU
SC M
edic
al C
ente
r W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
26
5
26
4
14
0
0
00
0
06
2
Yes
Y
es
60
8
0
65
1
73
0
16
7
18
8
Yes
Y
es
37
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edio
al C
ente
r
Sao
ram
ento
2
64
1
0
05
1
Yes
8
0
412
27
9
Yes
3
8
Nor
th S
hore
Un
iver
sity
Ho
spit
al
Man
hass
et
NY
2
63
0
0
05
5
Yes
8
0
35
4
12
7
Yes
3
9
Sum
ma
Ilea
lth
Sys
tem
A
kron
O
hio
26
2
00
0
04
5
Yes
6
5
775
14
9
Yes
4
0
St
L
ouis
Un
iver
sity
Ho
spit
al
26
1
18
0
72
Y
es
75
4
25
1
47
Y
es
41
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
26
0
21
0
66
Y
es
70
1
12
9
09
3
No
42
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
25
9
00
0
26
Y
es
65
3
56
1
72
Y
es
43
U
niv
ersi
ty o
f L
ou
isv
ille
Ho
spit
al
Lo
uis
vil
le
Ky
2
58
0
8
00
0
Yes
6
0
28
1
90
Y
es
44
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
2
57
0
0
05
9
Yes
6
0
96
5
13
5
Yes
4
5
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
57
1
4
09
9
Yes
7
0
84B
1
62
Y
es
46
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
25
6
04
0
77
Y
es
75
83
3 1
94
Y
es
47
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
25
6
09
0
78
Y
es
60
80
1 1
52
Y
es
48
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
56
2
0
10
9
Yes
8
0
701
19
4
Yes
4
9
Bex
ar C
ount
y H
osp
ital
Dis
trio
t
San
Ant
onio
2
56
0
5
00
0
Yes
8
5
229
12
1
Yes
5
0
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
25
5
13
0
57
Y
es
80
34
9 1
09
Yes
~
l
i i
f
AppendixG
r bull Reputational Rankings for Special-Service Hospitals
i
I
I L
1~
r-
2001
E
yes
Rep
uta
tio
nal
Sco
re
Rep
uta
tio
nal
R
ank
Ho
spit
al
soo
re
Joh
ns
Hop
kins
Ho
spit
al
(Wilm
er
Eye
In
stit
ute
)
Bal
tim
ore
71
2
2 U
niv
ersi
ty o
f M
iam
i (B
asC
om
Pal
mer
Ey
e In
stit
ute
) 6
46
3
Wil
ls E
VQ
Hos
pita
l--
h
ilad
llip
hia
57
0
(+3
l
4 M
assa
chu
sett
s E
ye
and
Ear
In
firm
ary
B
osto
n 4
00
5
UCLA
Med
ioal
Cen
ter
(JII
IIIS
Ste
in E
ye
Inst
itu
te)
lo
s A
ngeJ
es
30
3
(+2
SO)
6 U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nio
s
Iow
a C
ity
1
93
7
USC
Un
iver
sity
Ho
spit
al
(Doh
eny
Eye
In
stit
ute
)
los
Ang
eles
1
03
8
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
B3
9
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
BO
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
66
11
M
ayo
Cli
nic
R
och
este
r
Min
n
63
12
N
ew Y
ork
Eye
an
d E
ar I
nfi
rmar
y
61
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
58
14
C
lev
elan
d C
lin
ic
54
16
M
eth
od
ist
Ho
spit
al
(Cul
len
Eye
Inst
itu
te)
H
oust
on
39
16
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
17
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
6
I
-~
r
middot
2001
P
edia
trio
s R
epu
tati
on
al S
core
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L
AppendixH
The 2001 Honor Roll
Lj
l
r
t
The Honor Roll
To lend additional perspective we have constructed a measure called the Honor Roll to
indicate excellence across a broad range ofspecialties
To be listed on the Honor Roll a hospital has to rank at least 2 standard deviations
(SD s) above the mean in at least 6 ofthe 16 specialties A hospitals ranking in the Honor
Roll is based on points assigned as follows
bull For ranking between 2 and 3 standard deviations above the mean in a specialty a
hospital receives one point
bull For ranking at least 3 standard deviations above the mean a hospital receives two
points
We chose to use a standard deviation based criteria rather than simply adding up a
hospitals rankings in individual specialties for three reasons (1) the number ofoutstanding
hospitals varies from specialty to specialty (2) setting a threshhold is more informative because
it establishes a level ofalmost excellent and (3) it gives some measure ofthe distance
between hospitals which rankings do not
f
middot1
THE 2001 HONOR ROLL
16
Mayo Clinic Rochester Minn 27 13 1
Massachusetts General Hospital Boston 26 12 2
4 Cleveland Clinic 23 11 1
5 UCLA Medical Center Los Angeles 22 8 6
6 Duke University Medical Center Durham NC 20 8 4
7 Barnes-Jewish Hospital St Louis 18 6 6
7 University of Michigan Medical Center Ann Arbor 18 6 6
7 University of California San Francisco Medical Center 18 7 4
10 Stanford University Hospital Stanford Calif 17 6 5
11 Brigham and Womens Hospital Boston 16 6 4
12 University of Washington Medical Center Seattle 12 4 4
13 New York Presbyterian Hospital 12 5 2
14 Hospital of the University of Pennsylvania Philadelphia 11 3 5
15 University of Chicago Hospitals 9 1 7
16 University QfPittsburgh Medical Center 9 2 5 1 1
l
i
(
L
We regularly examine the impact of hospital mergers on our rankings For this release
three mergers among hospitals previously ranked as independent entities appear on the lists
Albany Medical Center NY Evanston Northwestern Medical Center Evanston Ill and
Harper Hospital Detroit These hospitals responded as new corporate entities for the first time
in the 1999 AHA database The following sections define the universe of tertiary-care
hospitals for the purpose of this project describe and define the standardized mortality ratios
and the structural components and explain how process-related data is collected As a guide
the materials on which each of the components of the index is based are outlined below
I Reputation bull The reputational score is based on cumulative infonnation from three NORC
surveys of physicians carried out in 1999 2000 and 2001 the sample design is consistent across the three years
bull The sample for the 2001 survey consists of 2550 board-certified physicians selected from the American Medical Associations (AMA) Physician Masterfile of 811000 physicians
bull StratifYing by region and by specialty within region we selected a sample of 150 physicians from each of 17 specialty areas for a total of2550 physicians
bull The final sample includes both non-federal and federal medical and osteopathic physicians residing in the 50 states and the District ofColumbia
II Structure bull The structural score is based on data related to the structural characteristics of
each specialty within each hospital bull These elements represent volume of work technology and other elements of the
hospital environment bull Most of the data comes from the 1999 AHA Annual Survey bull The volume data comes from the Health Care Financing Administrations
(HeFA) MEDP ARS database which contains information on all Medicare discharges (primarily aged over 65) in each specialty
III ()utco~e
bull The outcome measure is based on HCFAs MEDP ARS database
bull An adjusted mortality rate is computed based on predicted mortality rates bull The data and the model were provided by Solucient Inc of Evanston Ill using
the All Patient Refined Diagnosis Related Group (APR-DRG) method designed by 3M Health Infonnation Systems
bull The APR-DRG adjusts expected deaths for severity of illness by means of principal diagnosis and categories of secondary diagnoses
bull This method is applied to the pooled 1997 1998 and 1999 data set of Medicare reimbursement claims made to HCF A by hospitals
4
In the final section we outline new directions anticipated for the index For a more
exhaustive review of the foundation as well as the development and use of the individual
measures and the composite index see ItBest Hospitals A Description of the Methodology for
the Index ofHospital Quality3
shy
J
r
5
IL The Index ofHospital Quality
A Universe Defmition
We have implemented a two-stage approach to defining eligible hospitals for each of the
IHQ specialty lists
First eligible hospitals must be considered tertiary-care centers To be identified as a
tertiary-care hospital a hospital must meet at least one of the following criteria
bull COTH membership or
bull medical school affiliation or
bull a score of9 or higher on our hospital-wide high-technology index
(Appendix A)
Using these criteria we identified 1878 tertiary-care hospitals that were eligible for any of the
thirteen IHQ-based rankings Once the eligible hospitals were identified data for these hospitals
were drawn from the 1999 AHA Annual Survey As with any data collection effort the AHA
Annual Survey database is incomplete due to nonresponding hospitals Although it did not affect
the analysis this year we have a procedure to allow eligible hospitals that are nonresponders to
the current AHA Annual Survey to remain in our database First for all previously ranked
hospitals that are nonresponders to the current survey we average the two prior years ofdata and
substitute the result for the missing data Two-year non-responders that lack data both from the
current survey and from the previous two surveys are ranked without any structure data
Although nonresponding hospitals need to be treated separately for the IHQ analysis it is
unnecessary to do so for the four reputation-only lists
We then created separate analytic universes for each of the 13 IHQ-driven specialties
using criteria such as specialty-specific technology or facilities and a minimum number of
discharges across appropriate DRGs (Figure 1) However hospitals with a non-zero reputational
score were deemed eligible for ranking even if they had insufficient volume (discharges) in a
specialty
The flow chart in Figure 2 illustrates the eligibility process
6
Figure 1 1999 Universe Definition by Specialty
~pec~~ltyi bull Number ()fllospit~ Imiddotimiddotf~~ifji~t~~f~frl~~~~~~~~~fmiddot ~~ bull~~ bullbull ~ f~middot~~~~ ~ ~~)~~~~ ~~~ Imiddotmiddot~ lt IA~~~~~ri1j~(~~tl = ~-~ ~~~~~f~~-~)~~lt-)-_~- ~~ ~ ~ v~_~ ~_~~ ~~
Cancer minimum of 380 discharges for relevant DRGs or 935 non-zero reputation score
Digestive disorders minimum of734 discharges for relevant DRGs or non- 1394 zero reputation score
Ear nose and minimum of37 discharges for relevant DRGs or non- 1371 throat zero reputation score
Geriatrics score of 1 or more on the geriatrics service index and 1412 minimum of 5947 discharges for all DRGs or nonshy
zero reputation score
Gynecology minimum of 52 discharges for relevant DRGs or non- 1356 zero reputation score
have a cardiac catheterization lab or Heart offer open heart surgery or 853
offer angioplasty and minimum of 245 surgical discharges for relevant
DRGs or non-zero reputation score
Hormonal Minimum of3615 discharges for relev 944 disorders non-zero reputation score
Kidney disease Minimum of 185 discharges for relev 1389 non-zero reputation score
Neurology and Minimum of464 discharges for rete 1408 Neurosurgery non-zero reputation score Orthopedics Minimum of392 discharges for relevant DRGs or 1406
non-zero reputation score Respiratory Minimum of881 discharges for relevant DRGs or 1409
disorders non-zero reputation score Rheumatology Minimum of22 discharges for relevant DRGs or non- 1376
zero reputation score Urology Minimum of 133 discharges for relevant DRGs or 1370
non-zero reputation score
7
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B Composite Measure of Structure
The structural dimension defines the tools and environment available to care providers in
treating patients It represents the possibilities of care for a patient and physician Healthcare
research overwhelmingly supports the use of a measure of structure in assessing quality of care
However no prior research has revealed a single indicator of quality that summarizes all others
or that adequately represents the structure construct on its own Thus the structural component
must be represented by a composite variable comprising different measures that are specialtyshy
specific and are weighted relative to each other
For the 2001 index all structural elements other than volume are derived from the 1999
AHA Annual Survey of Hospitals database and are described below For specific mapping of
variables to the AHA data elements see Appendix B
COTH membership This dichotomous variable indicates membership in the Council of
Teaching Hospitals
Technology indices In 2001 we added medical and surgical intensive care beds to
the list of nephrology elements All other technology elements for all other specialties are
unchanged A complete list of the technologies considered for each specialty can be found in
AppendixA
Since the 1996 version of the index we have allowed our technology indices to reflect
the real cost of high-technology services While providing a service inside the hospital is
convenient for patients the cost may be unacceptable to some hospitals Many hospitals
provide access to technology services through the hospitals health system a local community
network or a contractual arrangement or joint venture with another provider in the
community We have taken this into account by giving hospitals that provide a service such as
ultrasound on-site one full point for that element hospitals that provide the service locally
through a formal arrangement receive a half-point A hospital receives no more than one point
for each element of the index
Volume The volume measure reflects the total number of medical or surgical (or both
when appropriate) discharges in the appropriate specialty-specific ORO groupings submitted for
HCF A reimbursement In the heart specialty surgical discharges indicates volume Data from
the three most recent years is pooled The ORO groupings are shown in Appendix C
9
RNs to beds The number of beds is defined by the AHA as beds set up and staffed at
the end of the reporting period Only nurses who have graduated with RN degrees from
approved schools of nursing and who are currently registered by their state are considered
Nurses must be full-time (35 hoursweek or more) and on staff Private-duty nurses nursing
staff whose salary is financed entirely by outside sources (eg an agency or a research grant)
and LPNs are not counted Registered nurses more appropriately classified in other
occupational categories (eg supervisory nurses facility administrators) also are not counted
Trauma In 1992 the annual US News survey of board-certified physicians ranked the
presence of an emergency room and a hospitals trauma provider level high on a list of hospital
quality indicators Physicians in nine specialties ranked trauma as one of the top five indicators
of quality The indications of these specialists and resultant high factor loadings supported the
inclusion of this data for heart hormonal disorders digestive disorders gynecology kidney
disease neurology and neurosurgery orthopedics ear nose and throat respiratory disorders and
urology
The trauma indicator is dichotomous and reflects two variables from the AHA database
whether the hospital has a certified trauma center in the hospital and the level of the trauma
center To receive credit for trauma services hospitals must provide either Level 1 or Level 2
trauma services in-hospital (as opposed to providing trauma services only as part of a health
system network or joint venture) Levell trauma service is defined as a regional resource
trauma center which is capable of providing total care for every aspect of injury and plays a
leadership role in trauma research and education4 Level 2 is defined by the AHA as a
community trauma center which is capable ofproviding trauma care to all but the most severely
injured patients who require highly specialized care4
Discharge planning The three elements of discharge planning are patient-education
services case management services and patient representative services TA service must be
provided in-hospital to receive credit
Service mix This indicator ranges from 0 to 10 points and comprises alcoholdrug abuse
or dependency inpatient care hospice home health services social work services reproductive
health services psychiatric education services womens health centerservices and psychiatric
consultationlliaison services Services must be provided within the hospital We do not award a
half-point for items in this measure
10
L
Geriatric services This indicator ranges from 0 to 7 points and comprises arthritis
treatment centers adult day care programs patient representative services geriatric services
meals on wheels assisted living and transportation to health facilities Again to receive credit
for a service it must be provided in-hospital
Gynecology services This indicator was introduced in 19975 It provides a means to
better rate the quality of services a hospital provides for its gynecological and obstetric patients
High factor loadings provide support to this variables inclusion With a range of 0 to 4 the
services included are obstetric care reproductive health care birthing rooms and womens
health center The half-point scheme used for the technology indices was not employed for this
indicator
Medicalsurgical intensive care beds This indicator is new in 2001 it surfaced as an
important factor for the nephrology specialty The AHA database provides the number of
medical and surgical intensive care beds per facility To be counted beds must be physically
located within the hospital and set up and staffed at the end of the reporting period
To combine these structural variables we weight the elements to create a flnal
composite measure Using factor analysis we force a one-factor solution and use the resultant
loadings as weight values for each variable in the composite structural measure The
relative weight assigned to each element varies from specialty to specialty and from one release
to the next within specialty Figure 3 provides the factor weights assigned to each element for
the 2001 release
11
F
Fig
ure
3 F
acto
r Lo
adin
g by
Spe
cial
ty
CO
TH
Imiddot
Tec
hnic
al
V
olum
e R
Ns
lBed
s D
is-
Goomiddot
Inde
xes
chan
ze
Can
cer
73
59
70
70
Dig
esti
ve d
isor
ders
69
52
60
63
Ear
nos
e a
nd th
roat
72
54
64
63
Ger
iatr
ics
35
81
Gyn
ecol
ogy
61
71
I H
eart
72
62
65
61
I
56
Hor
mon
al d
isor
ders
71
53
56
65
I
63
Kid
ney
dise
ase
63
66
62
57
I 54
Neu
rolo
gy a
nd n
euro
surg
ery
68
54
62
66
62
Ort
hope
dics
69
46
54
66
63
Res
pira
tory
dis
orde
rs
50
73
31
51
58
Rhe
umat
olog
y 45
82
Uro
logy
73
49
C Process
The process dimension of the quality equation is the sum or net effect of physicians
clinical decision-making Physicians clinical choices about the use of medication or diagnostic
tests admission to the hospital or one ofits units and length ofstay account for a large fraction
of the outcomes experienced by patients However measurements ofprocess on a national scale
are extremely difficult to obtain In order to measure process we rely on an alternative measure
to act as a proxy for process We contend that when a qualified expert identifies a hospital as
one of the best he or she is in essence endorsing the process choices made at that hospital
Thus we use the nomination of a hospital by a board-certified specialist as a measure off process In order to collect these nominations we conduct an annual survey of board-certified
f - physicians As in past releases we have pooled nominations for the past three years [1999-2001] I to arrive at the process measure i
Survey sample The sample for the 2001 survey consists of 2550 board-certified
physicians selected from the American Medical Associations (AMA) Physician Masterfile of
811000 physicians From within the Masterfile we selected a target population of 194916
board-certified physicians who met the eligibility requirements listed in Figure 4 Stratifying by
region and by specialty within region we selected a probability (random) sample of 150
t l physicians from each of 17 specialty areas for a total of 2550 physicians The final sample
r includes both non-federal and federal medical and osteopathic physicians residing in the 50
states and the District ofColumbia Figure 4 displays the list of specialties surveyed in 2001
f Eligibility requirements We defined a probability sample of physicians who could
properly represent the 17 specialty groupings delineated by us News amp World Report We
used two rules of eligibility one related to a mapping between the 17 specialties and the AMAs
list of 85 self-designated specialties and the second related to a mapping between these 85
specialties and the 23 member boards of the American Boards ofMedical Specialties (ABMS)
Under the first rule we linked each of the 17 specialties to one or more relevant AMA
specialties from the list of AMA self-designated practice specialty codes Physicians who
designated a primary specialty in one of the 17 specialties were preliminarily eligible for the
survey Under the second rule the physicians must also be certified by the corresponding
member board of the ABMS Figure 4 displays the correspondence between the specialty [ specified for US News amp World Report AMA self-designated specialty and the corresponding
member board
13
Figure 4 Physician Sample Mapping
us NEWS SPECIALTY
Cancer
r Digestive disorders
Ear nose and throat
Eyes
Geriatrics
i
Gynecology L
Heart
Hormonal disorders
Kidney disease
Neurology and Neurosurgery
-l ~
Orthopedics
Pediatrics
Psychiatry
Rehabilitation
Respiratory disorders
Rheumatology
Urology
I AMAKEY CODE
HEMl22 ON24
GEl
OTO48
OPW46
FPG38 IMG38
GYN21 OBG42
CD08 CDS08
END14 DW12
NEP
N36 NS
ORS85
PO55 ADUOI
P63
PW62
PUD
RHU174
Ul91
AMASELF-middot DESIGNATED
Hematology Oncology
Gastroenterology
Otolaryngology
Ophthalmology
Geriatrics
Gynecology Obstetrics amp gynecology
Cardiovascular diseases Cardiovascular surgery
Endocrinology Diabetes
Nephrology
Neurology Neurological surgery
Orthopedic surgery
Pediatrics Adolescent medicine
Psychiatry
Physical medicine amp rehabilitation
Pulmonary diseases
Rheumatology
Urological surgery
14
AMERICAN BOARD OF
Internal medicine Internal medicine
almedicine
Otolaryngology
Ophthalmology
Internal medicine
Obstetrics amp gynecology Obstetrics amp gynecology
Internal medicine Surgery
Internal medicine Internal medicine
Internal Medicine
Psychiatry amp neurology
Orthopedic surgery
Pediatrics Pediatrics
Psychiatry amp neurology
Physical medicine amp rehabilitation
Internal medicine
I Internal medicine
Urology
r -
l
r
to
f -
1 bull
Stratification To compensate for the widely varying number of eligible physicians
across the targeted specialties we used different probabilities of selection for each grouping and
used proportionate stratification across the four United States Census regions (West Northeast
South and North Central) Within each of the 17 strata we achieved a sample that was also
geographically representative of the spread ofphysicians across the country
2001 physician survey Sampled physicians were mailed a three-page questionnaire (see
Appendix D) a cover letter and a prepaid return envelope We also included a token incentive
in the form of a two-dollar bilL One week after the initial survey mailing a reminder postcard
was sent to the sampled physicians Two weeks following the reminder mailing we sent a
second mailing to nonrespondents including the questionnaire a cover letter and a business reply
envelope Three weeks after the second mailing we re-sent the questionnaire to nonrespondents
This third mailing was sent by Federal Express and included the questionnaire a cover letter and
a business reply envelope
2001 questionnaire redesign In consultation with Dr Donald Dillman of Washington
State University a noted questionnaire designer we revised the physical layout of the project
questionnaire (Appendix D) so that respondents could read and complete it more easily We
believe that the redesign had appreciable impact on this years response rate (below and Figure
5)
Response rate Of the 2550 physicians surveyed for this years report 1377 physicians
returned a useable questionnaire a response rate of 547 percent (Response rate is calculated as
the ratio of completed questionnaires to the total eligible in accordance with standard practice
any member of the sample found to be ineligible was removed from the denominator of the
equation for calculation purposes) Figure 5 shows response rates by specialty for the three years
used for the 2001 index
2001 experiments NORC conducted two experiments as part of the physician survey
for 2001 Briefly the experiments were 1) a Web version of the survey permitting direct onshy
line response for physicians and 2) a comparison of explicit citations of the Americas Best
Hospitals project for US News amp World Report and implicit references to the 12th Annual
15
Survey of Physicians conducted for US News amp World Report Citations appeared on both the
cover letters and questionnaire cover As with last years experimental launching of the Web
version this years version was used successfully by a small number of respondents We plan to
evaluate the cost-effectiveness ofthis strategy before using it again next year With regard to the
project citation experiment half of the physicians in each specialty were told explicitly that their
responses would be used to rank hospitals in Americas Best Hospitals issue of US News amp
World Report and the other half were told that they were participating in an annual survey of
physicians for US News amp World Report Our comparison of the explicit and implicit project
citations indicated no difference in response rates The difference in the number of survey
questionnaires returned by each group within each specialty ranged from 1 to 8 Figure 5 [
details the total number of surveys returned for each specialty
16
r
~
r-
lt
ance
r ig
esti
ve d
isor
ders
orm
onal
dis
orde
rs
idne
y di
seas
e
euro
logy
and
esp
irat
ory
diso
rder
s gy
Fig
ure
5 R
espo
nse
Rat
e b
y Y
ear
(150
sam
pled
phy
sici
ans
per
spe
cial
ty p
erye
ar)
n 70
71
82
75
84
70
62
68
62
78
r
Weighting Weighting was carried out in two steps First weights were assigned to
physicians that reflected the probabilities of selection within specialty groups and the overall
rates ofresponse within these groups Second the weights from the first step were poststratified
using the two-dimensional contingency table of specialty (17 categories) by census region
(Northeast Midwest South and West) To check the weights we ~nfinned that the sum across
the sample of the weights in each cell of the classifications (specialty x region) equaled the
population size
D Outcome
Many healthcare professionals have decried the use of mortality rates because of
limitations in the methods used to adjust for risk Nonetheless research strongly suggests a
positive correlation between a risk-adjusted mortality rate that is better than average and overall
quality8-17 Based on these findings we used adjusted mortality rate as the outcome measure for
our quality of care model All predicted mortality rates were provided by Solucient Inc of
Evanston Ill using the All Patient Refined Diagnosis Related Group (APR-DRG) method
designed by 3M Health Information Systems The APR-DRG adjusts expected deaths for
severity of illness by means of principle diagnosis and categories of secondary diagnoses A
detailed description of the full APR-DRG methodology is provided in Appendix E Solucient
applied this method to the pooled 1997 1998 and 1999 data set of reimbursement claims made to
HCF A by hospitals These complete data sets were the most current available
2001 DRG refmements We annually review the DRG-groupings for every specialty In 2001
we chose to conduct a thorough examination of the DRG groupings in heart and orthopedics
Because we anticipated likely changes as a result we conducted two independent reviews
Solucient conducted a review of each specialty and an independent consultant shy
a cardiologist and an orthopedic surgeon--conducted a review in his specialty Where the two
reviews agreed as they did in each of the two specialties we implemented the recommended
changes Revisions for each specialty are detailed below
18
Heart DRGs Three DRGs were added
109 = Coronary bypass wlo cardiac cath
124 =Circulatory disorders except AMI w cardiac cath and complex diag
125 =Circulatory disorders except AMI w cardiac cath and wlo complex diag
Orthopedic DRGs Two DRGs were deleted and six were added
DeletedDRGs
214 =Back amp neck procedures wI CC
215 =Back amp neck procedures wlo CC
AddedDRGs
496 =Combined anteriorlposterior spinal fusion
497 = Spinal fusion wI CC r 498 = Spinal fusion wlo CC 501 =Knee proc wI pdx ofinfection wi CC
502 =Knee proc wI pdx ofinfection wlo CC
503 =Knee proc wlo pdx ofinfection
As in previous years we used an all-cases mortality rate for four specialties (geriatrics
gynecology ear nose and throat and rheumatology) rather than a specialty-specific rate either
because the number of hospitals with sufficient discharges in the particular DRG-grouping was
too low or because the DRG groupings proved to be less robust than was desired Appendix C r -
lists the DRGs for each specialty
In 2000 we modified the construction of the outcome measure The IRQ is the final
score for each hospital in the specialty rankings It gives equal weight to process (represented by
reputation) outcome (mortality) and structure (volume technology and other elements of the
hospital environment) The numbers produced for each of these three measures however differ
greatly in magnitude and in range or variability Without correcting for that the final score
even when the three measures are weighted equally would be distorted
19
Pre-2000 solution For each specialty prior to 2000 the calculated mortality ratio for each
hospital was inverted--the ratio of actual to expected deaths was divided into 1 so that as with
other measures higher meant better For example a better-than-expected mortality ratio of 08
would produce an inverted result of 125 a worse-than-expected ratio of 12 would produce an
inverted result of 083 (The published rankings continued to display the ratio of actual to
expected deaths) Then the scores for reputation mortality and structure were standardized or
adjusted so that the degree ofvariability in each measure was the same
A difficulty with this approach was that inverting caused very low mortality ratios to
distort the outcome (Inverted a mortality ratio of 025 produces a score of 4 a ratio of 005
produces a score of 20 and a ratio of 001 produces a score of 100) If instead of being divided
into 1 the mortality ratio is subtracted from I-this could be called reverse scoring-such extremes r
are eliminated Using reverse scoring a mortality ratio of 025 produces a score of 075 a ratio
of 005 produces a score of 095 and a ratio of 001 produces a mortality score of 99 This
maintains the magnitudes of the differences and avoids extreme values Accordingly the new
rankingsreflect reverse scoring in mortality To dampen the effect of year-to-year fluctuations
mortality scores will be averaged over three years
Finally scores at the extremes in mortality and in certain structural measures were
trimmed to eliminate the influence ofvery wide variation Figure 6 gives the percentile at which
each of the mortality distributions was trimmed
Lj Figure 6 Percentile at Which Each Mortality Distribution Was Trimmed
Specialty
Cancer
Digestive disorders
Ear nose and throat
Geriatrics
Gynecology
Heart
Hormonal disorders l ~
Percentile
95
99
95
99
99
95
95
Specialty Percentile
Kidney disease 99
Neurology and neurosurgery 99
Orthopedics 95
Respiratory disorders 99
Rheumatology 99
Urology 90
20
l
A second round of standardizing also was added in 2000 after trimming extremes
Previously this second standardization was not perfonned resulting in trimmed measures having
less influence on the final score than other measures did Restandardizing restores the balance so
that trimmed and untrimmed measures have the same influence
Phase-in The changes described affect the final scores so they are phased in over two
years For 2000 each hospitalts final score averaged pre-2000 and current methodologies As
before the top hospital in each specialty received a score of 100 with other hospitals scaled
down from that figure
In 2001 the phase-in is complete with the 2001 mortality ratios fully reflecting the
revised methodology
J
--
21
E Calculation of the Index
i
The calculation of the IRQ for each hospital (other than in specialties ranked solely on
reputation) considers equally the three dimensions of quality of care structure process and
outcome Although all three measures represent a specific aspect of quality a single score not
only provides an easier-to-use result but yields a more accurate portrayal of overall quality than
would the three aspects individually
Therefore in computing the final scores for a particular specialty the reputational score
mortality scores and the collective set of structural indicators receive arithmetically equivalent
importance
The total fonnula for calculation of the specialty-specific IHQs is
where
IHQi = Index for Hospital Quality for specialty i
Sl-n = Structural indicators (STRUCTURE)
F = Factor loading
P = Nomination score (PROCESS)
M = Standardized mortality ratio (OUTCOME)
The general fonnula for deriving the index scores for tertiary-level hospitals is the same
as it began in 1993 Each of the three components--structure process and outcomes--is
considered equally in determining the final overall score For presentation purposes we
standardized raw scores then equated the raw IRQ scores as computed above to a 100-point
scale where the top hospital in each specialty received a score of 100
The mean and standard deviation of each of the 17 specialties are listed in Figure 7
Note that for the four reputation-only rankings mean and standard deviation of the reputational
score are presented This data further illustrates that the spread of IRQ scores produces a very
small number of hospitals two and three standard deviations above the mean Horizontal lines
in each of the 17 specialty lists in Appendices F and G indicate the cutoff points of two and
three standard deviations above the mean
22
We could not calculate scores for hospitals that provide care in eyes pediatrics
psychiatry or rehabilitation because data for robust and meaningful structural and outcomes
measures are not available for these specialties Thus as shown in Appendix G we rank
hospitals in these specialties solely by reputation Although the four reputation-only specialties
are ranked without the Index of Hospital Quality standard deviations of the reputational scores
are still useful in identifying truly superior hospitals (in terms of statistically relevant nomination
scores)
Figure 7 Mean and Standard Deviations ofIHQ and Reputational Scores
Mean Standard deviation 1 SD above Z SDs above 3 SDs above the mean the mean the mean
~- IHQScore
Cancer 2390 652 3042 3694 4346
Digestive disorders 1514 538 2052 2590 3128
Ear nose and throat 2064 647 2711 3358 4005
Geriatrics 2049 588 2637 3225 3813 Gynecology 1857 598 2455 3053 3651
Heart 2079 674 2753 3427 4101 Hormonal disorders 2545 574 3119 3693 4267 Kidney disease 2600 758 3358 4116 4874
Neurology and 1781 562 2343 2905 3467 neurosurgery Orthopedicsmiddot 1960 539 2499 3038 3577I Respiratory disorders 1665 569 I 2234 2805 3372 Rheumatology 3768 454 4222 4676 5130 Urology 1930 502 2432 2934 3436
Reputational Score
lEyes 455 1272 1727 2999 4271 [pediatrics 299 659 958 1617 2276 psychiatry 252 524 776 1300 1824 Rehabilitation 287 777 1064 1841 2618
23
III Directions for Future Releases
The US News Index has since its inception used the most rigorous methodology
available to define measure and combine the components of quality incorporated in its
construction Over the next few years we plan to subject each of the components (process
outcome and structure) to a searching re-examination We are aware that the skewed
distribution of the reputation scores can appear to give an inappropriate advantage to hospitals
that obtain a high percentage ofnominations and we will continue to examine the way in which
the reputation scores are used to define the process score We intend to test and evaluate
different transformations of the raw scores to see whether a transformation would produce a
bull i superior measure With regard to outcome the refinement of definitions of non-fatal outcomesshy
particularly in some specialties-suggests incorporating some of these measures into outcome
scores We will continue to refine and develop our measures of technology for the structural
component Finally we will re-examine the way in which the three components are combined
into the IHQ There may be ways to maintain the principle of equal weight for the three
components while improving the method ofcombining them
We will also examine the possibility of extending the evaluation of the four specialties
that are currently ranked only on reputation to incorporate appropriate structure and outcome
measures
As in years past we welcome input from users of the index in charting new directions
Readers and users are encouraged to contact the authors with suggestions and questions
j bull
24
l
lmiddot
References 1 Donabedian A Evaluating the quality of medical care The Milbank Memorial Fund Quarterly
1966 44166-203
2 Donabedian A Promoting quality through evaluating the process of patient care Med Care 1968 6181
3 Hill CA Winfrey KL Rudolph BA Best Hospitals A description of the methodology for the index ofhospital quality Inquiry 1997 34(1)80-90
4 American Hospital Association 1996 Annual Survey of Hospitals Data Base Documentation Manual
5 Ehrlich RH Hill CA Winfrey KL 1997 Survey oBest Hospitals Chicago NORC 1997
6 Hill CA Winfrey KL1995 Survey on Best Hospitals Chicago NORC 1995
7 Palella FJ Jr Delaney KM Moorman AC Loveless MO Fuhrer J Satten GA Aschman DJ Holmberg SD Declining Morbidity and Mortality Among Patients With Advanced Human Immunodeficiency Virus Infection N Engl J Med 1998 338853-860
8 United States Department of Health and Human Services Medicare hospital mortality information HCFA publication 01-002 Report prepared by Otis R Bowen and William L Roper Washington DCUSGPO 1987
9 Blumberg MS Comments on HCFA hospital death rate statistical outliers HSR Health Services Research 1987 21715-40
10 Dubois RW Brook RH Rogers WH Adjusted hospital death rates a potential screen or the quality ofmedical care MPH 1987 771162-6
11 Gillis KD Hixson JS Efficacy of statistical outlier analysis for monitoring quality of care Journal oBusiness and Economic Statistics 1991 9241-52
12 Green J Wintfield N Sharkey P Passman LJ The importance of severity of illness in assessing hospital mortality JAMA 1990 263241-6
13 Green J Passman LJ Wintfield N Analyzing hospital mortality the consequences ofdiversity in patient mix JAMA 1991 2651849-53
14 Greenfield S Aronow HU ElashoffRM Watanabe D Flaws in mortality data the hazards of ignoring comorbid disease JAMA 1988 2602253-7
15 Rosen HM Green BA The HCFA excess mortality lists a methodological critique Hospital and Health Services Administration 1987 2119-24
16 Flood AB Scott WR Conceptual and methodological issues in measuring the quality of care in hospitals In Hospital structure and performance Baltimore Johns Hopkins University Press 1987
17 Iezzoni LI Ash AS Coffinan GA Moskowitz MA Predicting in-hospital mortality a comparison of severity measurement approaches Med Care 1992 30347-59
25
Appendix A
Technology Indices by Specialty t
1
All Hospital Index
17 elements (used to define eligible hospitals)
r
Cancer
7 Elements
AnRioplasty Cardiac Catheterization Lab
Cardiac Intensive Care Beds
Computed Tomography Scanner
Diagnostic Radioisotope Facility
Diagnostic Mammography Services
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
MedicaVSurgical Intensive Care
Neonatal Intensive Care Beds
Open Heart Surgery
Pediatric Intensive Care Beds
Positron Emission Tomography Scanner
ReprQductive Health
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraphy Scanner Magnetic Resonance Imaging
Oncology Services
Pediatric Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
I Digestive disorders
8 Elements Computed Tomography Scanner Diagnostic Radioisotope Facility
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound i
X-ray Radiation Therapy
Ear Nose and Throat
5 Elements Comouted Tomorrraohv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
Heart
9 Elements Angioplasty Cardiac Catheterization Lab
Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Open Heart Surgery
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
j
Hormonal disorders
7 Elements
Geriatrics
8 Elements
Gynecology
8 Elements
Computed TomoRraphv Scanner Diagnostic Radioisotope Facility
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Cardiac Catheterization Lab Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraDhv Scanner Diagnostic Mammography Services
Magnetic Resonance Imaging
Neonatal Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Kidney disease
5 Elements
Neurology and f Neurosurgery t j
7 Elements
t
l
Orthopedics
5 Elements I t
Respiratory disorders 4 Elements
Extracorporeal Shock Wave Lithiotripter Ultrasound
Computed Tomography Scanner
Diagnostic Radioisotope FacUity
Transplant Services
Computed Tomography Scanner Diagnostic Radioisotope FacUity
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed Tomolraphv Scanner Magnetic Resonance Imaging
Positron Emissions Tomography Scanner
Single Photon Emissions Computed Tomography
Ultrasound
Computed Tomographv Scanner Diagnostic Radioisotope FacUity
Radiation Therapy
Ultrasound
Rheumatology
5 Elements Computed TomoJraphv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
Urology
8 Elements Extracorporeal Shock Wave Lithiotripter X-ray Radiation Therapy
Computed Tomography Scanner
Diagnostic Radioisotope Facility
i Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
(
i
AppendixB
Structural Variable Map
f
L
r
t bull
r
tJ
L
The following variables used to construct structural elements of the 2001 IHQ were taken from the 1999 Annual Survey of Hospitals Data Base published by the American Hospital Association
ALL HOSP~TAL ~NDBX - used to define hospital eligibility 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ~GIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICBDHOS=l half point if CICBDSYS CICBDNET or CICBDVEN=l 1 point if CTS CNHOS=1 half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if MSICHOS=l half point if MSICSYS MSICNET or MSICVEN=l 1 point if NICBDHOS=l half point if NICBDSYS NICBDNET or NICBDVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PEDBDHOS=l half point if PEDBDSYS PEDBDNET or PEDBDVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if REPROHOS=l half point if REPROSYS REPRONET or REPROVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Cancer Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if ONCOLHOS=l half point if ONCOLSYS ONCOLNET or ONCOLVEN=l 1 point if PEDICHOS=l half point if PEDICSYS PEDICNET or PEDICVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
Digestive Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Ear I Nose and Throat Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRIVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
1
Heart Technology Index 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ANGIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNETor CICVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Hormonal Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRlHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Geriatrics Technology Index 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNET or ClCVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETROS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Gynecology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if NICHOS=l half point if NICSYS NICNET or NlCVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Kidney Disease Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=lhalf point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if TPLNTHOS=l half point if TPLNTSYS TPLNTNET or TPLNTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Neurology and Neurosurgery Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Orthopedics TeChn610gy ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Respiratory Disorders Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Rheumatology Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Urology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
r
I
Discharge Planning COTH ] point if CMNGTHOS=] Yes if MAPP8=1 ] point if PATEDHOS=] 1 point if PATRPHOS=l RN I s to Beds
Full-time Registered Nurses Geriatric Services (FTRNTF) divided by Total Hospital 1 point if ADULTHOS=l Beds (HOSPBD) ] point if ARTHCHOS=l 1 point if ASSTLHOS=l Trauma ] point if GERSVHOS=l Yes if TRAUML90=] or 2 and 1 point if MEALSHOS=l TRAUMHOS=l 1 point if PATRPHOS=l 1 point if TPORTHOS=l
Gynecology Services 1 point if BROOMHOS=l 1 point if OBLEV=2 or 3 and OBHOS=] 1 point if REPROHOS=l
l ~
1 point if WOMHCHOS=l r ~
Service Mix ] point if ALCHHOS=l ] point if COUTRHOS=l 1 point if HOMEHHOS=l ] point if HOSPCHOS=l ] point if PSYEDHOS=] 1 point if PSYLSHOS=] 1 point if REPROHOS=l ] point if SOCWKHOS=] ] point if WOMHCHOS=]
l
i
1
[ l
AppendixC
Diagnosis-Related Group (DRG) Groupings l by Specialty
r 1
DRG10 DRGll DRG64 DRG82 DRGl72 DRG173 DRG199 DRG203 DRG239
DRG257 DRG258 DRG259 DRG260 DRG274
r 1 DRG275 DRG338 DRG344 DRG346 DRG347 DRG354 DRG355 DRG357 DRG366 DRG367 DRG400 DRG401 DRG402 DRG403 DRG404 DRG405 DRG409 DRG410 DRG411 DRG412 DRG413 DRG414
r 1 DRG473 DRG492
1
U
I 1
LJ
Cancer
NERVOUS SYSTEM NEOPLASMS W CC NERVOUS SYSTEM NEOPLASMS WIO CC EAR NOSE MOUTH amp TIIROAT MALIGNANCY RESPIRATORY NEOPLASMS DIGESTIVE MALIGNANCY W CC DIGESTIVE MALIGNANCY WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS PAlHOLOGICAL FRACTURES amp MUSCULOSKELETAL amp CONN TISS MALIGNANCY TOTAL MASTECTOMY FOR MALIGNANCY W CC TOTAL MASTECTOMY FOR MALIGNANCY WIO CC SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC SUBTOTAL MASTECTOMY FOR MALIGNANCY WIO CC MALIGNANT BREAST DISORDERS W CC MALIGNANT BREAST DISORDERS WIO CC TESTES PROCEDURES FOR MALIGNANCY OTHER MALE REPRODUCTIVE SYSTEM OR PROCEDURES FOR MALIGNANCY MALIGNANCY MALE REPRODUCTIVE SYSTEM W CC MALIGNANCY MALE REPRODUCTIVE SYSTEM WIO CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG W CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG WIO CC UTERINE amp ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY MALIGNANCY FEMALE REPRODUCTIVE SYSTEM W CC_ MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WIO CC LYMPHOMA amp LEUKEMIA W MAJOR OR PROCEDURE LYMPHOMA amp NONmiddotACUTE LEUKEMIA W OTHER OR PROC W CC LYMPHOMA amp NON-ACUTE LEUKEMIA W OTHER OR PROC WIO CC LYMPHOMA amp NON-ACUTE LEUKEMIA W CC LYMPHOMA amp NON-ACUTE LEUKEMIA WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGE 0-17 RADIOlHERAPY CHEMOTHERAPY WIO ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS HISTORY OF MALIGNANCY WIO ENDOSCOPY HISTORY OF MALIGNANCY W ENDOSCOPY OlHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGEgt17 CHEMOTHERAPY W ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS
DRG146 DRG147 DRG148 DRG149 DRG150 DRG151 DRG152 DRG153 DRG154 DRG155 DRG156 DRG170
l i DRG171 DRG174 DRG175
L DRG176 DRG177 DRG178 DRG179 DRG180 DRG181 DRG182 DRG183 DRG184 DRG188
l DRG189 DRG190 DRG191
i J DRG192 DRG193 DRG194 DRG195 DRG196 DRG197
t
LeJ DRG198 DRG200 DRG201 DRG202 DRG204 DRG205 DRG206 DRG207 DRG208 DRG493 DRG494
Digestive Disorders
RECTAL RESECTION W CC RECTAL RESECTION WIO CC MAJOR SMALL amp LARGE BOWEL PROCEDURES W CC MAJOR SMALL amp LARGE BOWEL PROCEDURES WIO CC PERITONEAL ADHESIOLYSIS W CC PERITONEAL ADHESIOLYSIS WIO CC MINOR SMALL amp LARGE BOWEL PROCEDURES W CC MINOR SMALL amp LARGE BOWEL PROCEDURES WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE gt17 W CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGEgt17 WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE 0-17 OTHER DIGESTIVE SYSTEM OR PROCEDURES W CC OTHER DIGESTIVE SYSTEM OR PROCEDURES WO CC G HEMORRHAGE W CC GJ HEMORRHAGE WIO CC COMPLICATED PEPTIC ULCER UNCOMPLICATED PEPTIC ULCER W CC UNCOMPLICATED PEPTIC ULCER WIO CC INFLAMMATORY BOWEL DISEASE GI OBSTRUCTION W CC GI OBSTRUCTIONWO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 W CC ESOPHAGmS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 WIO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGE 0-17 OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 W CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 WIO CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0-17 PANCREAS LIVER amp SHUNT PROCEDURES W CC PANCREAS LIVER amp SHUNT PROCEDURES W 10 CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE W CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE WIO CC CHOLECYSTECTOMY W CDE W CC CHOLECYSTECTOMY W CDE WIO CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE W CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY OTHER HEPATOBILIARY OR PANCREAS OR PROCEDURES CIRRHOSIS amp ALCOHOLIC HEPATITIS DISORDERS OF PANCREAS EXCEPT MALIGNANCY DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEP A W CC DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEPA WIO CC DISORDERS OF THE BILIARY TRACT W CC DISORDERS OF THE BILIARY TRACT WO CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE W CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE WO CC
DRG49 DRG50 DRG51 DRG55 DRG57 DRG58 DRG61 DRG62 DRG63 DRG65 DRG66 DRG67
DRG68
DRG69 DRG70 DRG71 DRG72 DRG73 DRG74
DRG353 DRG356 DRG358 DRG359 DRG360 DRG361 DRG362 DRG363 DRG364 DRG365 DRG368 DRG369
Ear Nose and Throat
MAJOR HEAD amp NECK PROCEDURES SIALOADENECTOMY SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY MISCELLANEOUS EAR NOSE MOUTH amp TIiROAT PROCEDURES TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGEgt17 TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGE 0-17 MYRINGOTOMY W TUBE INSERTION AGE gt17 MYRINGOTOMY W TUBE INSERTION AGE 0-17 OTHER EAR NOSE MOUTH amp TIiROAT OR PROCEDURES DYSEQUILIBRIUM EPISTAXIS EPIGLOTTITIS
OTITIS MEDIA amp URI AGEgt17 W CC OTITIS MEDIA amp URI AGEgt17 WIO CC OTITIS MEDIA amp URI AGE 0-17 LARYNGOTRACHEITIS NASAL TRAUMA amp DEFORMITY OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE gt17 OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE 0-17
Geriatrics ALL CASES
Gynecology
PELVIC EVISCERATION RADICAL HYSTERECTOMY amp RADICAL VULVECTOMY FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY W CC UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY WIO CC VAGINA CERVIX amp VULVA PROCEDURES LAP AROSCOPY amp INCISIONAL TUBAL INTERRUPTION ENDOSCOPIC TUBAL INTERRUPTION DampC CONIZATION amp RADIO-IMPLANT FOR MALIGNANCY DampC CONIZATION EXCEPT FOR MALIGNANCY OrnER FEMALE REPRODUCTIVE SYSTEM OR PROCEDURES INFECTIONS FEMALE REPRODUCTIVE SYSTEM MENSTRUAL amp OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
DRG103 DRGl04 DRG105 DRG106 DRG107 DRG108 DRG109
DRG1l0 DRG1l1 DRG112 DRG115 DRG1l6 DRG117 DRG118 DRG121 DRG122 DRG123 DRG124 DRG125 DRG126 DRG127 DRG128 DRG129 DRG130 DRG131 DRG132 DRG133 DRG135 DRG136 DRG137 DRG138 DRG139 DRG140 DRG141middot DRG142 DRG 144 DRG145
r i
f ~
Heart
HEART TRANSPLANT CARDIAC VALVE PROCEDURES W CARDIAC CATH CARDIAC VALVE PROCEDURES WIO CARDIAC CATH CORONARY BYPASS W CARDIAC CATH CORONARY BYPASS WIO CARDIAC CATH OTHER CARDIOTHORACIC PROCEDURES CORONARY BYPASS WIO CARDIAC CATH
MAJOR CARDIOVASCULAR PROCEDURES W CC MAJOR CARDIOVASCULAR PROCEDURES WIO CC PERCUTANEOUS CARDIOVASCULAR PROCEDURES PERM CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK OTH PERM CARDIAC PACEMAKER IMPLANT OR AICD LEAD OR GENERATOR PRO
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT CARDIAC PACEMAKER DEVICE REPLACEMENT CIRCULATORY DISORDERS W AMI amp CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI WIO CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI EXPIRED CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH AND CMPLX DIAG CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH WIO CMPLX DIAG ACUTE amp SUBACUTE ENDOCARDmS HEART FAILURE amp SHOCK DEEP VEIN THROMBOPHLEBITIS CARDIAC ARREST UNEXPLAINED PERIPHERAL VASCULAR DISORDERS W CC PERIPHERAL VASCULAR DISORDERS WIO CC ATHEROSCLEROSIS W CC ATHEROSCLEROSIS WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 W CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGE 0-17 CARDIAC ARRHYTIIMIA amp CONDUCTION DISORDERS W CC CARDIAC ARRHYTHMIA amp CONDUCTION DISORDERS WIO CC ANGINA PECTORIS SYNCOPE amp COLLAPSE W CC SYNCOPE amp COLLAPSE WIO CC OTHER CIRCULATORY SYSTEM DIAGNOSES W CC OTHER CIRCULATORY SYSTEM DIAGNOSES WIO CC
1
DRG286 DRG287 DRG288 DRG289 DRG290 DRG292 DRG293 DRG294 DRG295 DRG296 DRG297
t DRG298 DRG299
DRG300 DRG301
~- --j
DRG316 DRG317 DRG320 DRG321 DRG322 DRG325 DRG326 DRG327 DRG 331 DRG332 DRG333
f
Hormonal Disorders
ADRENAL amp PITUITARY PROCEDURES SKIN GRAFTS amp WOUND DEBRID FOR ENDOC NUTRlT amp METAB DISORDERS OR PROCEDURES FOR OBESITY P ARA1HYROID PROCEDURES 1HYROIDPROCEDURES OrnER ENDOCRINE NUTRIT amp METAB OR PROC W CC 01HER ENDOCRINE NUTRIT amp METAB OR PROC WIO CC DIABETES AGE gt35 DIABETES AGE 0-35 NUTRlTIONAL amp MISC METABOLIC DISORDERS AGEgt17 W CC NUTRITIONAL amp MISC METABOLIC DISORDERS AGE gt17 WIO CC NUTRlTIONAL amp MISC METABOLIC DISORDERS AGE 0-17 INBORN ERRORS OF METABOLISM ENDOCRINE DISORDERS W CC ENDOCRINE DISORDERS WIO CC
Kidney Disease
RENAL FAILURE ADMIT FOR RENAL DISEASE KIDNEY amp URINARY TRACT INFECTIONS AGE gt17 W CC KIDNEY amp URINARY TRACT INFECTIONS AGEgt17 WIO CC KIDNEY amp URINARY TRACT INFECTIONS AGE 0-17 KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 W CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 WIO CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMS AGE 0-17 01HERKIDNEY amp URINARY TRACT DIAGNOSES AGE gt17 W CC 01HER KIDNEY amp URINARY TRACT DIAGNOSESgt 17 WIO CC 01HER KIDNEY amp URINARY TRACT DIAGNOSES AGE 0-17
Neurology and Neurosurgery
DRGl CRANIOTOMY AGE gt17 EXCEPT FOR TRAUMA DRG2 CRANIOTOMY FOR TRAUMA AGEgt17 DRG3 CRANIOTOMY AGE 0-17 DRG4 SPINAL PROCEDURES DRG5 EXTRACRANIAL VASCULAR PROCEDURES DRG6 CARPAL TUNNEL RELEASE DRG7 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC W CC DRG8 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC WIO CC DRG9 SPINAL DISORDERS amp INJURIES DRG12 DEGENERATIVE NERVOUS SYSTEM DISORDERS
j DRG13 MULTIPLE SCLEROSIS amp CEREBELLAR ATAXIA DRG14 SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA DRG15 TRANSIENT ISCHEMIC ArrACK amp PRECEREBRAL OCCLUSIONS DRG16 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC DRG17 NONSPECIFIC CEREBROVASCULAR DISORDERS WIO CC DRG18 CRANIAL amp PERIPHERAL NERVE DISORDERS W CC DRG19 CRANIAL amp PERIPHERAL NERVE DISORDERS WIO CC DRG20 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGmS DRG21 VIRAL MENlNGITIS DRG22 HYPERTENSIVE ENCEPHALOPATHY DRG23 NONTRAUMATICSTUPORampCOMA DRG24 SEIZURE amp HEADACHE AGEgt17 W CC DRG25 SEIZURE amp HEADACHE AGEgt17 WIO CC DRG26 SEIZURE amp HEADACHE AGE 0-17 DRG27 TRAUMATIC STUPOR amp COMA COMA gt1 HR DRG28 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGEgt17 W CC DRG29 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE gt17 WIO CC
imiddot DRG30 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE 0-17 DRG31 CONCUSSION AGEgt17 W CC DRG32 CONCUSSION AGEgt17 WIO CC DRG33 CONCUSSION AGE 0-17 DRG34 OTHER DISORDERS OF NERVOUS SYSTEM W CC DRG35 OTHER DISORDERS OF NERVOUS SYSTEM WIO CC
(
DRG209 DRG210 DRG211 DRG212 DRG213 DRG216 DRG217 DRG218 DRG219 DRG220 DRG221 DRG222 DRG223 DRG224 DRG225 DRG226 DRG227 DRG228 DRG229 DRG230 DRG231 DRG232 DRG233 DRG234 DRG235
j DRG236 DRG237 DRG238 DRG240 DRG241 DRG471 DRG485
DRG491 DRG496 DRG497 DRG498
f DRG501 DRG502 DRG503
Orthopedics
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 W CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 WIO CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0-17 AMPUTATION FOR MUSCULOSKELETAL SYSTEM amp CONN TISSUE DISORDERS BIOPSIES OF MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE WND DEBRID amp SKN GRFT EXCEPT HANDFOR MUSCSKELET amp CONN TISS DIS LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 W CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 WIO CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGE 0-17 KNEE PROCEDURES W CC KNEE PROCEDURES WO CC MAJOR SHOULDERIELBOW PROC OR OTHER UPPER EXTREMITY PROC W CC SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC WIO CC FOOT PROCEDURES SOFT TISSUE PROCEDURES W CC SOFT TISSUE PROCEDURES WIO CC MAJOR THUMB OR JOINT PROCOR OTH HAND OR WRIST PROC W CC HAND OR WRIST PROC EXCEPT MAJOR JOINT PROC WIO CC LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES OF HIP amp FEMUR LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES EXCEPT HIP amp FEMUR ARTHROSCOPY OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC W CC OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC WIO CC FRACTURES OF FEMUR FRACTURES OF HIP amp PELVIS SPRAINS STRAINS amp DISLOCATIONS OF HIP PELVIS amp THIGH OSTEOMYELmS CONNECTIVE TISSUE DISORDERS W CC CONNECTIVE TISSUE DISORDERS WIO CC BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY LIMB REATTACHMENT HIP AND FEMUR PROC FOR MULT SIGNIFICANT
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY COMBINED ANTERIORIPOSTERIOR SPINAL FUSION SPINAL FUSION WI CC SPINAL FUSION WIO CC KNEE PROC WI PDX OF INFECTION WI CC KNEE PROC WI PDX OF INFECTION WOCC KNEE PROC WOPDX OF INFECTION WI CC
~ t L ~
l
DRG76 DRG77 DRG78 DRG79 DRG80 DRG81 DRG85 DRG86 DRG87 DRG88 DRG89 DRG90 DRG91 DRG92 DRG93 DRG94 DRG95 DRG96 DRG97 DRG98 DRG99 DRG100 DRG101 DRG102 DRG475
DRG242 DRG244 DRG245 DRG246 DRG247 DRG256
i_J
Respiratory Disorders
OTHER RESP SYSTEM OR PROCEDURES W CC OTHER RESP SYSTEM OR PROCEDURES WO CC PULMONARYEMBOUSM RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 W CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 WO CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGE 0-17 PLEURAL EFFUSION W CC PLEURAL EFFUSION WO CC PULMONARY EDEMA amp RESPIRATORY F AlLURE CHRONIC OBSTRUCTIVE PULMONARY DISEASE SIMPLE PNEUMONIA amp PLEURISY AGEgt17 W CC SIMPLE PNEUMONIA amp PLEURISY AGEgt17 WO CC SIMPLE PNEUMONIA amp PLEURISY AGE 0-17 INTERSTITIAL LUNG DISEASE W CC INTERSTITIAL LUNG DISEASE W 10 CC PNEUMOTIIORAX W CC PNEUMOTIIORAX WO CC BRONCHmS amp ASTIIMA AGEgt17 W CC BRONCHmS amp ASTIIMA AGEgt17 WO CC BRONCIDTIS amp ASTIIMA AGE 0-17 RESPIRATORY SIGNS amp SYMPTOMS W CC RESPIRATORY SIGNS amp SYMPTOMS WO CC OTHER RESPIRATORY SYSTEM DIAGNOSES W CC OTHER RESPIRATORY SYSTEM DIAGNOSES WO CC RESPIRATORY SYSTEM DIAGNOSIS WITII VENTILATOR SUPPORT
Rheumatology
SEPTIC ARTHRITIS BONE DISEASES amp SPECIFIC ARTHROPATIIIES W CC BONE DISEASES amp SPECIFIC ARTHROPATIDES WO CC NON-SPECIFIC ARTHROPATHIES SIGNS amp SYMPTOMS OF MUSCULOSKELETAL SYSTEM amp CONN TISSUE OTIIER MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE DIAGNOSES
DRG302 DRG303 DRG304 DRG305 DRG306 DRG307 DRG308 DRG309 DRG31O DRG311 DRG312 DRG313 DRG314
DRG315 DRG323 DRG324 DRG328 DRG329 DRG330 DRG334 DRG335 DRG336 DRG337 DRG339 DRG340 DRG341 DRG342 DRG343 DRG348 DRG349 DRG350 DRG351 DRG352
Urology
KIDNEY TRANSPLANT KIDNEYURETER amp MAJOR BLADDER PROCEDURES FOR NEOPLASM KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL W CC KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL WIO CC PROSTATECTOMY W CC PROSTATECTOMY WIO CC MINOR BLADDER PROCEDURES W CC MINOR BLADDER PROCEDURES WIO CC TRANSURETHRAL PROCEDURES W CC TRANSURETHRAL PROCEDURES WIO CC URETHRAL PROCEDURES AGE gt17 W CC URETHRAL PROCEDURES AGEgt17 WIO CC URETHRAL PROCEDURES AGE 0-17 OTHER KIDNEY amp URINARY TRACT OR PROCEDURES URINARY STONES W CC amplOR ESW LTIHOTRIPSY URINARY STONES WIO CC URETHRAL STRICTURE AGEgt17 W CC URETHRAL STRICTURE AGE gt17 WIO CC URETHRAL STRICTURE AGE 0-17 MAJOR MALE PELVIC PROCEDURES W CC MAJOR MALE PELVIC PROCEDURES WIO CC TRANSURETHRAL PROSTATECTOMY W CC TRANSURETHRAL PROSTATECTOMY WIO CC TESTES PROCEDURES NON-MALIGNANCY AGEgt17 TESTES PROCEDURES NON-MALIGNANCY AGE 0-17 PENIS PROCEDURES CIRCUMCISION AGEgt17 CIRCUMCISION AGE 0-17 BENIGN PROSTATIC HYPERTROPHY W CC BENIGN PROSTATIC HYPERTROPHY WIO CC INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM STERILIZATION MALE OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES
AppendixD
f 2001 Sample Physician Questionnaire
( Americas Best Hospitals)
This survey of physicians judgments provides the
basis for the reputation component of the annual
ranking of hospitals for U S News amp World Report
c
Conducted by the National Opinion Research Center at the University of Ctlicago 1155 East 60th Street Chicago IL 60637
( THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with rehabilitation regardless of location or expense (weve provided space for both hospital andlor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
l L Answers to these questions will help Have your patients been helped ormiddot
us to understand the impact of the hindered by the information they have Internet on medica practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions
D Neith~imiddoto Yes
D BothONo D Does notapply
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
D Helped
D Hindered
D Neither
D Both
D I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D A day or two a week
l D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical L company web sites
DYes D No
D Does not apply
Do you ever access medical association web sites
DYes D No
ri D Does not apply L
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet isbullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes D No
Do you allow your patients to communicate with you via electronic mail
DYes o No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes D No
D Does not apply
Thank you again for your participation
r I
l~
National Opinion Research Center at the University of Chicago 1155 East 60th Street Chicago IL 60637
Jbullbullbull
(12th Annual Survey of PhysiciansJ Direct input from physicians is
crucial in evaluating hospital quality_ f
Conducted by the National Opinion Research Center at the University of Chicago 1155 East 60th Street Chica9o IL 60637
l J
(THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with cancer regardless of location or expense (weve provided space for both hospital andor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
Answers to these questions will help Have your patients been helped or us to understand the Impact of the hindered by the information they have Internet on medical practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions o NeitherOmiddotYes o BothD No o Does not apply
-Continued
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
HelpedD HinderedD NeitherD BothD
0 I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D Aday or two a week
D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical company web sites
DYes
D No
D Does not apply
Do you ever access medical association web sites
DYes
D No
D Does not apply
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet is bullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes
D No
Do you allow your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Thank you again for your participation
r
r
1 National Opinion Research Center at th~ University of Chicagobull 0 __ bull bull
1155 East 60th Street Chicago IL 60637
AppendixE
Predicted Mortality APR-DRG Methodology
r
shyi
Introduction to DRGs
The All Patient Refined Diagnosis Related Groups (APR-DRGs) were developed by 3M Health
Information Systems (3M-HIS) in conjunction with the National Association of Childrens Hospitals and
Related Institutions (NACHRI) APR-DRGs expand the basic diagnosis-related group (DRG) structure to
address patient severity of illness risk ofmorta1ity and resource intensity The APR-DRG Version 140
uses the Health Care Financing Administration (HCFA) Version 140 DRG methodology Because APRshy
DRGs are based on DRGs and All Patient DRGs (AP-DRGs) a brief explanation of both structures will
be useful
Current HCFA DRG Structure
Created from Adjacent Diagnosis Related Groups (ADGs) which combine patients into groups
with common characteristics DRGs were developed by Yale University in the 1970s to relate a
hospitals case mix index to the resource demands and associated costs experienced by the hospital
ADGs were created by subdividing an MDC1 into two groups based on the presence or absence of
an operating room procedure Surgical patients identified as those having an operating room procedure
were then classified by type ofprocedure to form surgical ADGs Patients with multiple procedures were
assigned to the highest surgical class Medical patients were divided into smaller groups based on their
principal diagnosis to form medical ADGs
DRGs use ADGs as a base and then further classify patients into selected disease and procedure
categories based on whether or not they have substantial comorbidities or complications (CC)
Approximately 3000 diagnosis codes have been designated by HCFA as substantial CCs (defined by a
list of additional diagnosis codes that a panel of physicians felt would increase the length of stay by at
least one day for 75 percent of the patients) This list covers a broad range of disease conditions and no
differentiation in severity or complexity level was made among the additional diagnoses The patients
age and discharge status were sometimes used in the definition ofDRGs
r
1 Major Diagnostic Categories (MDCs) are broad medical and surgical categories one step hierarchically higher than DRGs (several DRGs roll-up into an MDC) MDCs are divided by body systems such as nervous ear nose and throat and respiratory
Current AP-DRG Structure
In 1987 the New York State Department of Health entered into an agreement with 3M-HIS to
evaluate the applicability of DRGs to a non-Medicare population with a specific focus on neonates and
patients with Human Immunodeficiency Virus (HIV) infections The DRG definitions developed by this
relationship are referred to as the AP-DRGs
The AP-DRGs are modeled after the HCF A DRGs and attempt to improve the DRGs in an effort
to more accurately predict a hospitals resource demands and associated costs for all acute care patients
In the creation ofAP-DRGs the modifications made to the DRG structure can be summarized as follows
bull Except for neonates who die or are transferred within the first few days of life AP-DRGs define six ranges ofbirth weight that represent distinct demands on hospital resources Within each birth weight range neonates are then subdivided based on the presence of a significant operating room procedure and then further subdivided based on presence ofmultiple major minor or other problems
bull Assignment to neonatal MDC is based on age Specifically the AP-DRGs assign a patient to the neonatal MDC when the age of the patient is less than 29 days at admission regardless of the principal diagnosis
bull MDC 25 was created to account for the highly specialized treatment of multiple trauma patients Patients assigned to MDC 25 have at least two significant trauma diagnoses from different body sites
bull MDC 20 for alcohol and substance abuse was restructured to differentiate patients based on the substance being abused
bull Across all MDCs patient with a tracheostomy were put into either of two tracheostomy AP-DRGs tracheostomy performed for therapeutic reasons and tracheostomy representing long-term ventilation
bull All liver bone marrow heart kidney and lung transplant patients were assigned to an AP-DRG independent of the MDC ofthe principal diagnosis
bull For several MDCs a single major comorbidity and complication (CC) AP-DRG was formed across all surgical patients within an MDC and a single major CC AP-DRG was formed across all medical patients within an MDC
I I The AP-DRGs introduced changes to the HCF A DRGs in an attempt tomiddot depart from using the
LJ principal diagnosis as the initial variable for assignment The AP-DRGs were designed to more
accurately group patients into like groups that provide an operational means of defining and measuring a
hospitals case mix complexity
r
All Patient Refined DRGs
APR-DRG Objectives
The primary objective of the RCF A DRG and AP-DRG patient classification systems was to
relate the type ofpatients treated to the hospital resources they consumed This limited focus on resource
intensity does not allow providers to classify patients into other groups for meaningful analysis The
APR-DRG patient classification system goes beyond traditional resource intensity measures and was
designed with the ability to address the following needs
bull Compare hospitals across a wide range ofresource and outcome measures
bull Evaluate differences in inpatient mortality rates
bull Implement and support critical pathways
bull Identify continuous quality improvement initiatives
bull Support internal management and planning systems
bull Manage capitated payment arrangements
To meet these needs the APR-DRG system classifies patients according to severity of illness risk
of mortality and resource intensity Therefore in the APR-DRG classification system a patient is
assigned three distinct descriptors base APR-DRG severity of illness subclass and risk of mortality
subclass
Severity of illness can be defined as the extent of physiologic decompensation or organ system
loss of function experienced by the patient In contrast risk of mortality is defined as the patients
likelihood ofdying
For analyses such as evaluating resource intensity or patient care outcomes the base APR-DRGs
in conjunction with the severity of illness subclass is used For evaluating patient mortality the base
APR-DRGs in conjunction with the risk ofmortality subclass is used
Development of the APR-DRGs
The AP-DRGs were used as the base DRGs in the development of the APR-DRGs because they
were representative of the entire inpatient population and accounted for populations not included in DRGs
at the time of development Several consolidations additions and modifications were made to the APshy
DRGs to form the list of APR-DRGs used in the severity of illness and risk of mortality subclass
assignments
The following list summarizes the revisions made to the AP-DRGs in the creation ofthe APR-DRGs
bull All age CC and major CC splits were consolidated
bull Splits based on discharge status or death were consolidated
bull Definitions based on the presence or absence ofa complicated principal diagnosis were consolidated
bull Additional APR-DRGs were created for pediatric patients
bull APR-DRGs for newborns were completely restructured to create medical and surgical hierarchies within each birth weight range
bull Low volume APR-DRGs were consolidated into other related APR-DRGs
bull APR-DRGs that could be explained by the severity of illness subclasses were consolidated into one APR-DRG
bull Due to risk ofmortality subclasses several APR-DRGs were split to account for significant differences in mortality between patient groups
APR-DRG Severity oflllness Subclass Assignment
With the exception of neonatal patients after a patient has been given an APR-DRG code a
Severity of Illness Subclass is assigned based on the level of the secondary diagnoses presence of certain
non-OR procedures and the interaction among secondary diagnoses age APR-DRG and principal
diagnosis Neonatal patients have their own hierarchical method for determining severity of illness and
will be discussed later The four severity ofillness subclasses are
t l
~~~~~i~~ 1 Minor (Includes non CC)
2 Moderate
3 Major
i L 4 Extreme
The severity of illness subclass is used in conjunction with the patients base APR-DRG for
analysis such as evaluating resource intensity or patient care outcomes A patients severity of illness
subclass should not be used with their DRG because several DRGs may form one APR-DRG Therefore
since severity of illness subclasses correspond to the APR-DRG number and not the DRG it is important
to use the APR-DRG number to accurately interpret data
The process for assigning a patient a severity of illness subclass is a three phase process and is
summarized as follows
Phase
bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further analysis
bull Remaining secondary diagnoses are assigned one of four distinct Standard Severity of lllness Levels Figure 1 presents examples of secondary diagnoses in each severity ofillness leveL
Figure 1 Examples of Secondary Diagnoses by Severity of Illness Level
Minor Benign hypertension acute bronchitis lumbago
Moderate Chronic renal failure viral pneumonia diverticulitis
Major Diabetic ketoacidosis chronic heart failure acute cholecystitis
Extreme Septicemia acute myocardial infarction cerebral vascular accident
bull The Standard Severity of Illness Level is modified for some secondary diagnoses based on age APRshyDRG and presence of non-OR procedures Figure 2 displays an example of modifications to the standard severity ofillness level based on the APR-DRG
Bronchitis and asthma Minor
Chronic renal failure Moderate Diabetes Major LJ
Cardiomegaly Moderate Chronic heart failure Minor
Uncomplicated Minor Vaginal delivery Moderate LJ diabetes
f
f
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Severity of Illness Level is retained This prevents double counting clinically similar diagnoses
bull The Base Severity of Illness Subclass of the patient is set to the highest Standard Severity of lllness Level ofany of the secondary diagnoses
bull Patients with a Base Severity of Illness Subclass of major (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Standard Severity of Illness Level Figure 3 displays the requirements for keeping a severity of illness subclass ofmajor or extreme
Major
Extreme Two or more secondary diagnoses that are extreme or one secondary diagnosis that is extreme and at least two second dia oses that are maor
Phase III bull A minimum Severity of Illness Subclass is established based on the patients principal diagnosis This
accounts for patients assigned to codes that contain both the underlying disease and an associated manifestation of the disease (ie diabetes with hyperosmolar coma) but is only assigned to the APRshyDRG that accounts for the underlying disease
bull A minimum Severity of Illness Subclass is established based on combinations of principal diagnosis and age for specific APR-DRGs
bull A minimum Severity of Illness Subclass is established for some APR-DRGs with certain APR-DRG and non-OR procedure combinations as well as principal diagnosis and non-OR procedure combinations
bull A minimum Severity of Illness Subclass is established based on the presence of certain combinations ofsecondary diagnoses Figure 4 shows the combination of secondary diagnoses necessary to increase the severity of illness subclass to a minimum severity of illness level For example a type 1 combination would be a major bacterial infection with pleural effusion If a diagnosis from both of these categories is present plus at least one other secondary diagnosis that is at least a major severity of illness level then the minimum patient severity of illness subclass will be extreme
Figure 4 Minimum Severity of Illness Requirements
maor second dia osis 2 At least one additional Major
moderate secondary dia osis
3 Specified combinations of At least one additional Major a moderate and a minor moderate secondary cate 0 dia osis
4 Specified combinations of At least two additional Moderate r--1 Two minor cate ories minor second i Ii 5 Specified combinations of
Two moderate cate ories None Major
bull The final patient Severity of Illness Subclass is selected based on the maximum of the Phase II Base Patient Severity of Illness Subclass and the Phase III minimum Severity of Illness Subclass
Both medical and surgical patients are assigned a severity of illness level of 1-4 based on the
assignment process outlined previously
f
r-
I
l
r f
~
l
r 1
APR-DRG Risk of Mortality Subclass Assignment
Similar to the Severity ofIllness Subclass assignment the Risk ofMortality Subclass assignment
is based on the level ofthe secondary diagnoses and the interaction among secondary diagnoses age
APR-DRG and principal diagnosis In general the patients Risk ofMortality Level and Subclass will be
lower than the Severity ofIllness Level and Subclass respectively Neonatal patients have their own
hierarchical method for determining risk ofmortality and will be discussed later The four severity of
illness subclasses are
~~~~~~~G~~pound~) bull~~~~~~~~S~rs~~2bullbullmiddott~ 1 Minor (includes non CC)
2 Moderate
3 Major
4 Extreme
The risk ofmortality subclass is used in conjunction with the patients base APR-DRG for
evaluating patient mortality Like the severity of illness subclass a patients risk ofmortality subclass
should not be used with their DRG because several DRGs may form one APR-DRG Therefore since
risk ofmortality subclasses correspond to the APR-DRG number and not the DRG it is important to use
the APR-DRG number to accurately interpret data
The process for assigning a patient a risk ofmortality subclass is a three phase process and is
summarized as follows
Phase I bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further
analysis
bull Remaining secondary diagnoses are assigned one of four distinct Risk ofMortality Levels
bull The Risk ofMortality Level is modified for some secondary diagnosis based on the patients age and APR-DRG
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Risk ofMortality Level is retained This prevents double counting clinically-similar diagnoses
bull The Base Risk ofMortality Subclass of the patient is set to the highest Risk ofMortality Level ofany of the secondary diagnoses
bull Patients with a Base Risk ofMortality Subclass ofmajor (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Risk ofMortality Level
Phase III
bull A minimum Risk ofMortality Subclass is established based on the patients principal diagnosis This accounts for specific APR-DRGs that have a principal diagnosis indicative of a higher risk ofmortality relative to the other principal diagnoses in the APR-DRG r
i
l ~ bull A minimum Risk ofMortality Subclass is established based on the presence ofcertain combinations of secondary diagnoses
bull The final patient Risk ofMortality Subclass is selected based on the maximum ofthe Phase II Base l
Risk ofMortality Subclass and the Phase III minimum Risk ofMortality Subclass
J
r
AppendixF
f Index of Hospital Quality (lHQ) Scores by Specialty
i
i L
F-~
f laquo
2001
C
ance
r B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
con
sc
ore
R
N s
R
ank
Ho
spit
al
10
0
sco
re
rate
M
embe
r (o
f 7
) D
isch
arg
es
to b
eds
Mem
oria
l S
loan
-Ket
teri
ng
can
cer
Cen
ter
N
ew Y
ork
10
00
7
18
0
93
Y
es
60
51
67
21
2
2 U
niv
ersi
ty 0
1 T
exas
M
D
A
nder
son
Cen
cer
Cen
ter
H
oust
on
98
2
68
5
07
7
Yes
5
0
5103
2
68
3
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
78
3
59
0
69
Y
es
70
15
78
14
2
4 D
ana-
farb
er C
ance
r In
stit
ute
B
osto
n 6
37
3
88
0
81
No
60
21
8 2
27
5
May
o C
lin
ic
Ro
ches
ter
M
inn
5
81
2
50
0
60
Y
es
70
37
11
13
1
(+3
SO)
6 UC
LA M
edic
al C
ente
r
los
Ang
eles
41
0
79
0
56
Y
es
70
12
19
10
8 7
Un
iver
sity
01
Chi
cago
Ho
spit
als
40
6
65
0
66
Y
es
70
14
69
19
4
8 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
401
7
1
07
5
Yes
7
0
3494
1
81
9
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
40
0
91
0
82
Y
es
60
18
44
16
1
10
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
38
5
10
7
09
2
Yes
4
0
1105
1
61
11
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r
Ann
Arb
or
38
4
31
0
42
Y
es
70
16
56
17
9
12
Un
iver
sity
01
was
hing
ton
Med
ical
Cen
ter
S
eatt
le
38
3
79
0
66
Y
es
60
92
6 1
10
13
M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 3
80
8
8
09
5
Yes
7
0
2022
1
38
14
C
lari
an H
ealt
h P
art
ners
In
dia
nap
oli
s 3
78
5
2
07
5
Yes
7
0
2149
1
67
15
U
niv
ersi
ty o
f P
ittS
bu
rgh
Med
ical
Cen
ter
37
4
26
0
56
Y
es
65
23
10
16
7
(+2
SO)
16
Cle
vel
and
Cli
nic
3
62
3
1
07
4
Yes
7
0
2018
1
94
17
R
osw
ell
Par
k C
ance
r In
stit
ute
B
uff
alo
36
1
55
0
85
Y
es
50
16
76
28
7
18
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
35
5
37
0
73
Y
es
60
14
15
14
3
19
Un
iver
sity
of
Ken
tuck
y H
osp
ital
le
xin
gto
n
351
0
5
05
6
Yes
7
0
1047
2
20
20
fo
x C
hase
can
cer
Cen
ter
P
hil
adel
ph
ia
35
0
56
0
83
Y
es
50
10
46
15
8
21
H
lee M
off
itt
can
oer
Cen
ter
T
ampa
F
la
35
0
15
0
65
Y
es
60
16
44
16
8lt
22
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
Cen
ter
Ch
arl
ott
esv
ille
3
49
0
5
061
Y
es
60
13
48
22
7
23
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
34
8
17
0
67
Y
es
70
99
9 2
40
24
S
hand
s H
osp
ital
at
the
Un
iver
sity
of
flo
rid
a
Gei
nes
vil
le
34
7
14
0
46
Y
es
60
10
23
15
7
25
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
34
6
00
0
57
Y
es
60
12
22
191
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
34
4
17
0
67
Y
es
80
16
15
151
27
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
34
3
15
0
66
Y
es
55
14
14
15
8
28
Un
iver
sity
Ho
spit
al o
f A
rkan
sas
li
ttle
Roc
k 3
43
0
5
06
3
Yes
5
5
1287
2
54
29
U
niv
ersi
ty H
osp
ital
D
enve
r 3
42
2
7
05
7
Yes
5
0
431
24
0
30
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
34
2
23
0
49
Y
es
60
44
8 1
72
lt
31
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
34
2
00
0
61
Y
es
70
15
55
15
3
32
Art
hu
r G
Ja
mes
Can
cer
Ho
spit
al
Col
umbu
s
Ohi
o 3
41
0
0
04
8
Yes
5
5
2147
1
56
33
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
34
0
19
0
69
Y
es
70
11
42
13
6
34
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
33
9
00
0
50
Y
es
55
14
81
14
9
35
New
Yor
k P
resb
yte
rian
HO
spit
al
33
7
34
0
86
Y
es
70
31
03
13
2
36
Un
iver
sity
of
cali
forn
ia
San
Fra
nci
soo
Med
ical
Cen
ter
33
5
30
0
71
Yes
6
0
573
17
5
37
fG
M
cGaw
Ho
spit
al a
t lo
yo
la U
niv
ersi
ty
May
woo
d
Ill
3
33
1
6
07
0
Yes
6
0
1023
1
62
38
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
33
3
00
0
62
Y
es
60
12
79
15
2
39
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
-Sal
em
33
3
19
0
84
Y
es
70
20
21
181
40
fa
irv
iew
-Un
iver
sity
Med
ical
Cen
ter
M
inn
eap
oli
s 3
32
0
4
06
2
Yes
5
0
1248
1
56
41
G
reat
er B
alti
mo
re M
edic
al C
ente
r B
alti
mo
re
33
2
00
0
58
Y
es
35
12
39
20
0
42
Un
iver
sity
Ho
spit
als
of
Cle
vel
and
3
30
0
0
06
4
YampS
70
19
71
12
1
43
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
lo
we
Cit
y
32
9
04
0
70
Y
es
70
13
05
13
4
44
St
Jo
hn
S H
osp
ital
S
pri
ng
fiel
d
Ill
3
29
0
0
05
5
Yes
6
0
996
13
3
45
Hen
ry F
ord
Ho
spit
al
Detr
oit
3
27
0
0
07
6
Yes
6
5
1473
1
92
46
B
arn
es-J
ewis
h H
osp
ital
S
t
lou
is
32
6
05
0
74
Y
es
85
27
56
14
9
47
luth
era
n G
ener
al H
ealt
hSys
tem
P
ark
Rid
ge
Ill
3
26
0
0
06
2
Ves
6
0
1420
1
14
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
3
24
0
5
05
0
Yes
7
0
776
10
9
49
Coo
k C
ount
y H
osp
ital
C
hica
go
32
3
04
0
49
Y
es
50
49
1 2
10
50
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
32
2
09
0
90
Y
es
50
13
24
19
2
1
2001
D
iges
tiv
e D
iso
rder
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N
s
Tra
uma
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 8
) D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
59
8
05
9
Yes
8
0
7660
1
31
Yes
2
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
82
3
50
0
63
Y
es
75
31
28
14
2
Yes
3
Cle
vel
and
Cli
nic
6
27
3
05
0
57
Y
es
80
44
75
19
4 N
o 4
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
58
9
29
9
08
7
Yes
8
0
4403
1
38
Y
es
5 M
ount
Sin
ai
Med
ical
Cen
ter
N
ew Y
ork
49
5
23
2
09
8
Yes
8
0
5220
1
57
Y
es
6 UC
LA M
edic
al C
ente
r
Los
A
ngel
es
44
5
18
5
081
Y
es
80
25
40
10
8
Yes
7
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
39
7
14
3
09
0
Yes
8
0
3787
1
81
Yes
8
un
ivers
ity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
37
9
13
2
07
0
Yes
7
0
1596
1
75
N
o 9
Un
iver
sity
of
Chi
oago
Ho
spit
als
37
0
131
0
93
Y
es
80
19
84
19
4
Yes
(+
3 SO
) 10
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
30
6
57
0
61
Y
es
80
91
3 1
98
Y
es
11
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 2
99
5
2
07
5
Yes
8
0
4048
1
67
Y
es
12
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
2
95
7
7
09
9
Yes
8
0
2348
1
61
Yes
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
29
2
47
0
72
Y
es
80
56
89
14
9
Yes
14
U
niv
ersi
ty o
f M
iohi
gan
Med
ical
Cen
ter
Ann
Arb
or
291
3
8
06
8
Yes
8_
0 28
16
17
9
Yes
15
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 2
90
4
9
07
4
Yes
8
0
2636
1
43
Y
es
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
28
0
50
0
74
Y
es
50
20
34
161
Y
es
17
Cla
rian
Hea
lth
part
ners
In
dia
nap
oli
s 2
78
5
2
09
2
Yes
8
0
5286
1
67
Y
es
18
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
27
6
45
0
84
Y
es
80
28
28
15
3
Yes
19
B
eth
Isra
el
Dea
cone
ss M
edio
al C
ente
r
Bos
ton
21
4
34
0
73
Y
es
70
45
27
15
8
Yes
20
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
27
1
30
0
45
Y
es
80
99
2 1
09
Y
es
21
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
N
ew Y
ork
26
5
16
0
49
Y
es
70
26
18
21
2
No
22
New
Yor
k P
resb
yte
rian
Ho
spit
al
26
2
52
1
01
Yes
8
0
4884
1
32
Yes
23
U
niv
ers
ttv o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
26
0
20
0
65
Y
es
80
21
84
13
6 Y
es
(+2
SOI
24
Med
ical
Un
iver
sity
of
Sou
th C
aro
lin
a C
har
lest
on
2
58
6
9
12
0
Yes
7
0
2202
2
09
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
25
1 2
2
07
5
Yes
6
5
2472
1
57
Y
es
26
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
oak
M
ich
2
50
0
8
07
0
Yes
8
0
5809
1
88
Y
es
27
8ay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
49
2
6
07
8
Yes
6
0
4673
1
22
y
es
28
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
24
8
00
0
60
Y
es
70
26
48
191
Y
es
29
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
42
1
4
06
9
Yes
7
5
1677
1
47
Y
es
30
Los
A
ngel
es C
ount
y-U
Sc
Med
ical
Cen
ter
24
2
08
0
37
Y
es
60
39
5 1
67
Y
es
31
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
24
0
18
0
79
Y
es
70
18
25
24
0
Yes
32
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
24
0
39
0
78
y
es
80
11
34
11
0
No
33
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Il
l
23
8
00
0
59
Y
es
60
31
21
11
4
Yes
34
U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
oer
Cen
ter
H
oust
on
23
7
33
0
80
Y
es
60
13
61
26
8
No
35
Lah
ey H
itch
coo
k C
lin
io
Bu
rlin
gto
n
Mas
s
23
6
00
0
67
Y
es
70
26
77
15
2
Yes
36
C
edar
s-S
inai
Med
ical
Cen
ter
L
os A
ngel
es
23
4
27
0
94
Y
es
80
47
95
10
6
Yes
37
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
Sit
y
May
woo
d
Ill
2
34
0
0
06
6
Yes
7
0
2180
1
62
Y
es
38
Mar
y H
itch
coo
k M
emor
ial
Ho
sp
ital
le
ban
on
N
H
23
4
04
0
68
Y
es
70
15
58
19
4
Yes
39
U
niv
ersi
ty o
f C
ali
forn
ie
Dav
is M
edio
al C
ente
r
Sac
ram
ento
2
33
0
0
06
8
Yes
8
0
1751
2
79
Y
es
40
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
iCS
Io
wa
Cit
y
23
3
13
0
77
Y
es
80
19
31
13
4
Yes
41
N
ew E
ngla
nd M
edic
al C
ente
r
Bos
ton
23
3
20
0
82
Y
es
10
11
88
24
2
Yes
42
F
roed
tert
Mem
oria
l L
uth
eran
Ho
spit
al
Mil
wau
kee
23
2
00
0
63
Y
es
70
19
29
14
6
Yes
43
T
hom
as J
eff
ers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
32
0
8
07
6
Yes
1
0
3206
1
23
Y
es
44
Tem
ple
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
30
1
7
01
0
Yes
7
5
1450
1
46
N
o 45
G
reat
er B
alti
mo
re M
edic
al C
ente
r
Bal
tim
ore
2
30
1
2
071
Y
es
SO
24
95
20
0
No
46
Hen
ry F
ord
Ho
spit
al
Detr
oit
2
29
0
8
08
6
Yes
7
5
3475
1
82
Y
es
47
Un
iver
sity
Of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pal
Hil
l 2
29
1
0
081
Y
es
60
29
86
15
2
Yes
48
O
chsn
er F
ou
nd
atio
n H
osp
1ta
l
New
Orl
ean
s 2
28
1
5
07
4
Yes
6
5
2465
1
40
N
o 49
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
F
la
22
S
00
0
62
14
0 7
0
5778
1
67
Y
es
SO
Un
iVer
sity
Ho
spit
al
Den
ver
22
7
11
0
81
Yes
6
0
1151
2
40
Y
es
L r
middotmiddot
2001
E
ar
Nos
e
and
Thr
oat
Bes
t H
osp
ital
Lis
t
Hos
pita
lwid
e T
echn
olog
y R
eput
atio
nal
mo
rtal
ity
C
OTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
sc
ore
rate
M
embe
r (o
f 5)
D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
40
2
08
2
Ves
5
0
26
4
14
2
Yes
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
8S
4
32
4
08
6
Yes
5
0
219
13
4
Ves
3
Mas
saoh
uset
ts E
ye
and
Ear
In
firm
ary
B
osto
n 7
66
2
71
0
11
No
3
0
26
8
18
7
Ves
4
May
o C
lin
io
Roo
hest
er
Min
n
68
2
21
0
07
2
Ves
5
0
502
13
1
Ves
5
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
6
39
1
90
0
82
Y
es
50
28
3 1
79
Y
es
6 U
niv
ersi
ty o
f P
itts
bUrg
h M
edic
al C
ente
r 6
23
1
85
0
84
V
es
50
36
3 1
67
Y
es
7 UC
LA M
edic
al C
ente
r
los
Ang
eles
6
21
1
89
0
83
Y
es
50
2
88
1
08
Y
es
8 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
cano
er C
ente
r H
oust
on
51
6
14
7
08
9
Ves
4
0
124
26
8
No
9 H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
5
05
1
36
1
02
Y
es
50
26
7 1
61
Y
es
10
Cle
vela
nd C
lin
ic
49
5
10
6
06
7
Yes
5
0
23
6
19
4
No
11
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nio
N
ashv
ille
4
64
9
3
09
4
Yes
5
0
28
4
24
0
Yes
12
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
caU
f
46
1
10
8
08
6
Yes
3
0
13
4
16
1
Yes
1
3
Bar
nesmiddot
Jew
ish
Ho
spit
al
St
lo
uis
4
68
9
0
08
2
Yes
5
0
39B
1
49
Y
es
14
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
42
6
10
1
0middot8
7 Y
es
50
8
6
11
0
No
15
M
etho
dist
Ho
spit
al
Hou
ston
4
09
1
02
1
07
Y
es
40
2
30
1
33
No
(+
3 SO
l 16
M
emor
ial
Slo
anmiddotK
ette
rin
g e
ence
r C
ente
r
New
Vor
k 3
91
5
4
07
9
Yes
5
0
24
9
21
2
No
17
Mou
nt S
lnai
Med
ioal
Cen
ter
New
Vor
k 3
86
7
8
11
1
Yes
5
0
31
2
15
7
Yes
18
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
37
9
45
0
79
Y
es
50
16
6 1
57
Y
es
19
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
oo M
edio
al C
ente
r 3
78
6
3
08
5
Ves
4
0
131
17
5
No
20
Duk
e U
niv
ersi
ty M
edio
al C
ente
r D
urha
m
NC
3
50
4
3
09
3
Yes
5
0
15
3
18
1
Ves
21
U
niv
ersi
ty o
f W
isoo
nsin
Ho
spit
al a
nd C
lin
ios
Med
ison
3
40
1
9
07
7
Yes
5
0
23
2
13
6
Yes
22
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
enoe
s C
ente
r C
har
lott
esv
ille
3
39
3
0
08
1
Ves
4
0
195
22
7
No
23
un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 3
37
2
2
07
9
Ves
4
0
18
9
15
2
Yes
(+
2 SO
l 2
4
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
33
4
26
0
77
V
es
50
4
4
19
8
Ves
2
5
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty O
f F
lori
da
Gai
nes
vil
le
33
3
18
0
76
V
es
40
16
7 1
57
Y
es
26
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middot Sal
em
33
1
26
0
92
Y
es
50
2
43
1
61
Y
es
27
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
33
0
29
0
76
Y
es
35
11
2 1
01
V
es
28
H
enry
For
d H
osp
ital
D
etro
it
32
9
05
0
73
Y
es
45
2
14
1
82
V
es
29
st
lo
uis
Un
iver
sity
Ho
spit
al
32
5
12
0
71
Y
es
50
1
13
1
47
Y
es
30
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
w
ashi
ngto
n
DC
3
24
1
7
05
3
Ves
5
0
89
1
0
9middot
Yes
31
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hioa
go
32
3
26
0
92
V
es
40
18
4 1
70
ve
s 32
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
C
hica
go
32
3
20
0
70
V
es
50
14
5 1
14
No
3
3
Fai
rvie
w-U
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
32
3
23
0
79
Y
es
30
3
57
1
56
No
3
4
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
25
0
90
Y
es
50
1
00
1
94
Y
es
35
Un
iver
sity
Ho
spit
al
Den
ver
31
7
15
0
74
Y
es
40
52
2
40
Y
es
36
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
3
17
1
9
08
5
Yes
4
0
19
9
12
3
Yes
3
7
Sum
ma
Hea
lth
syst
em
Akr
on
Ohi
o 3
16
0
0
06
9
Ves
4
0
28
7
14
9
Yes
3
8
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
sa
cram
ento
3
15
0
5
07
6
Ves
5
0
14
3
27
9
Ves
3
9
lOS
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
31
2
13
0
20
Y
es
35
42
1
67
Y
es
40
Val
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
31
2
16
0
92
Y
es
50
2
43
1
53
V
es
41
Un
iver
sity
of
Tex
as M
edio
al B
rano
h H
osp
ital
s
Gal
vest
on
31
1
27
0
91
Yes
4
0
118
15
3
Yes
4
2
Lut
hera
n G
ener
al H
ealt
hsys
tem
P
ark
Rid
ge
Ill
3
09
0
0
07
0
Yes
4
0
212
11
4
Yes
4
3
Un
iver
sity
of
Illi
no
is
Ho
spit
al a
nd C
lin
iCs
Chi
cago
3
06
1
2
06
6
Yes
2
5
87
1
29
Y
es
44
lah
ey H
itoh
oook
Cli
nic
B
url
ing
ton
M
ass
3
05
0
5
07
6
Yes
4
0
138
15
2
Yes
4
5
Art
hur
G
Jam
es C
anoe
I H
osp
ital
C
olum
bus
O
hio
30
4
00
0
57
V
es
40
13
1 1
56
Y
es
46
w
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
30
3
05
0
86
Y
es
40
2
16
1
92
V
es
47
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 3
02
0
4
08
7
Yes
5
0
35
5
16
7
Ves
4
8
wil
liam
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
3
02
0
0
08
5
Yes
5
0
29
6
18
8
Yes
4
9
New
Vor
k Ey
e an
d E
ar
Infi
rmar
y
New
Yor
k 3
02
1
7
00
0
No
35
50
2
63
Y
es
50
F
G
McG
aw H
osp
ital
at
lOll
ola
Un
iver
sity
M
ayw
ood
Il
l
30
0
10
0
87
Y
es
40
16
6 1
62
Y
es
L L
2001
G
eria
tric
s B
est
Ho
spit
al L
ist
Hos
ptta
lwid
e T
echn
olog
y D
isch
arge
S
erv
ice
Ger
iatr
ic
Rep
utat
iona
l m
ort
alit
y
COTH
sc
ore
R
N
s
plan
ning
m
ix
serv
ices
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 8
) to
bed
s (o
f 3
) (o
f 1
0)
(of
7)
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
10
00
3
97
0
83
Y
es
80
1
08
3
6 5
2 JO
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
89
5
33
6
08
2
Yes
8
0
14
2
3 9
4 3
Mou
nt
Sin
ai M
edic
al C
ente
r N
ew Y
ork
73
3
27
6
11
1
Yes
8
0
15
7
3 8
4 4
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
6
11
1
98
0
93
Y
es
80
1
81
3
7 3
5 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
59
4
18
5
09
3
Yes
8
0
13
8
3 8
4 6
May
o C
11ni
c
Roo
hest
er
Min
n
51
1
11
2
07
2
Yes
8
0
13
1
3 1
0
8 7
St
L
ouis
Un
iver
sity
Ho
spit
al
45
2
95
0
71
Y
es
80
1
47
3
4 3
8 Y
alemiddot
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
4
33
1
00
0
92
Y
es
80
1
53
3
1 3
9 C
leve
land
lt1
1nio
4
28
7
0
06
7
Yes
8
0
19
4
3 8
4 10
U
niv
ersi
ty o
f M
ichI
gan
Med
ical
Cen
ter
Ann
Arb
or
42
2
79
0
82
Y
es
80
1
79
3
9 4
11
Bet
h Is
rael
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
11
7
7
08
4
Yes
7
0
15
8
3 9
4 (+
3 SO
) 12
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
68
7
3
08
7
Yes
7
0
11
0
2 6
2 1
3
Un
iver
sity
01
Chi
cago
Ho
spit
als
35
4
50
0
90
Y
es
80
1
94
3
8 4
14
B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
33
6
32
0
82
Y
es
80
1
49
3
9 4
15
U
niv
ersi
ty H
osp
ital
D
enve
r 3
34
2
5
07
4
Yes
7
0
24
0
3 8
5 16
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
28
3
0
08
1
Yes
8
0
14
3
3 7
4 17
R
ush
middotPre
sby
teri
anmiddotS
t L
uke
s M
edic
al C
ente
r C
hica
go
32
5
14
0
70
Y
es
80
1
14
3
9 5
19
u
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co l
led
ical
Cen
ter
32
5
36
0
85
Y
es
70
1
75
3
6 4
(+2
SO)
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
0
34
0
86
Y
es
60
1
61
3
9 3
20
Ho
spit
al o
f th
e U
niv
ersi
ty o
f pe
nnsy
lvan
ia
Ph
ilad
elp
hia
3
16
4
4
10
2
Yes
8
0
16
1
I 8
3 21
U
niv
ersi
ty H
osp
ital
s o
f C
leve
land
3
13
2
5
07
9
Yes
8
0
12
1
2 8
4 2
2
Par
klan
d ll
emor
ial
Ho
spit
al
Dal
las
31
3
1S
0
77
Y
es
80
1
98
3
7 4
23
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middotSai
em
31
1
20
0
92
Y
es
80
1
61
3
10
6
24
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
30
8
05
0
53
Y
es
70
1
09
3
8 4
25
U
niv
ersi
ty o
f Il
lin
Ois
Ho
spit
al a
nd C
lin
ios
C
hioa
go
30
7
11
0
66
Y
es
55
1
29
3
7 4
26
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 3
04
4
1
10
5
Yes
8
0
11
8
3 1
4 2
7
Fai
rvie
wmiddotu
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
30
4
14
0
19
Y
es
60
1
56
3
9 5
28
Sos
ton
Med
ioal
Cen
ter
30
4
16
0
75
Y
es
60
2
10
3
7 4
29
Fra
nci
s S
cott
Key
Med
ical
Cen
ter
Bal
tim
ore
30
4
18
0
80
Y
es
70
0
79
3
8 5
30
S
parr
ow H
osp
ital
and
Hea
lth
Sys
tem
L
anS
ing
M
ich
3
04
0
0
06
5
No
70
1
13
3
10
6
31
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
02
0
8
08
4
Yes
8
0
16
7
3 9
7 3
2
Los
Ang
eles
cou
ntymiddot
uSC
lle
dica
l C
ente
r 3
01
0
3
02
0
Yes
6
5
16
7
3 8
3 3
3
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
98
2
3
09
2
Yes
7
0
17
0
3 9
4 3
4
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
29
7
03
0
68
Y
es
70
1
49
3 9
3 3
5
Coo
k C
ount
y H
osp
ital
C
hica
go
28
6
00
0
55
Y
es
60
2
10
3
7 4
36
U
niv
ersi
ty o
f C
onne
ctic
ut H
ealt
h C
ente
r
Far
min
gton
2
94
4
6
10
0
Yes
6
0
26
0
3 3
2 3
7
Ho
spit
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 2
91
0
0
01
0
Yes
6
0
15
1
3 5
4 3
8
Un
iver
sity
Med
ioal
Cen
ter
Tuc
son
A
riz
2
90
0
0
06
6
Yes
7
0
17
2
3 7
3 3
9
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
28
9
07
0
79
Y
es
70
1
52
3
10
3
40
Thom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
28
9
13
0
85
Y
es
70
1
23
3
9 4
41
Hen
nepi
n C
ount
y M
edic
al C
ente
r
Min
neap
olis
2
89
0
0
06
1
Yes
6
5
10
5
3 7
3 4
2
St
L
uk
es
Ho
spit
al
Ch
este
rfie
ld
Mo
2
88
0
0
06
7
No
70
1
06
3
8 8
43
Aug
usta
Hea
lth
Car
e
Fis
her
svil
le
Va
2
87
0
0
06
5
No
50
1
35
3
8 5
44
John
D
Arc
hbol
d M
emor
ial
Ho
spit
al
Tho
maS
Vil
le
Ga
2
86
0
0
06
3
No
70
0
93
3
7 4
45
F
G
McG
aw H
osp
ital
at
Loy
ola
un
iver
sity
M
ayw
ood
Il
l
28
5
14
0
87
Y
es
70
1
62
3
9 3
46
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
Sac
ralll
ampnt
o 2
84
0
4
07
6
Yes
8
0
27
9
3 6
4 4
7
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
28
4
00
0
70
Y
es
70
1
14
3
7 4
49
Hen
ry F
ord
Ho
spit
al
Det
roit
2
83
0
4
07
3
Yes
7
5
18
2
3 4
4 4
9
Un
iver
sity
of
Vir
gin
ia H
ealt
h Sc
ienc
amps
Cen
ter
Ch
arlo
ttes
vil
le
282
0
3
08
1
Yes
7
0
22
7
3 9
4 50
S
t
Jose
ph H
osp
ital
D
enve
r 2
80
0
0
06
3
No
70
1
03
3
6 3
2001
G
ynec
olog
y B
est
Ho
spit
al L
ist
Hos
p1ta
lwid
e T
echn
olog
y G
ynec
olog
y R
eput
atio
nal
mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
serv
ices
R
ank
Ho
spit
al
IHQ
sc
ore
ra
te
Mem
ber
(of
8)
Dis
char
ges
to b
eds
Cen
ter
(of
4)
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
32
5
0B
2
Yes
8
0
24
0
14
2
Yes
4
2 M
ayo
Cli
nic
R
oche
ster
M
inn
7
53
2
10
0
72
Y
es
80
13
40
13
1
Yes
3
3 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 6
70
1
77
0
81
Y
es
80
4
83
1
43
Y
es
4 4
UCLA
Med
ical
Cen
ter
L
os A
ngel
es
58
3
14
2
08
3
Yes
8
0
310
10
8
Yes
4
5 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
cer
Cen
ter
Hou
ston
5
72
1
59
0
89
Y
es
60
2
34
2
68
No
0
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
49
9
10
9
09
3
Yes
8
0
512
18
1
Yes
4
7 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
49
8
11
0
09
3
Yes
8
0
418
13
8
Yes
4
8 P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 4
89
1
01
0
77
Y
es
80
9
4
19
8
Yes
3
11 Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
4
37
1
00
1
15
Y
es
80
56
0 1
32
Y
es
4 1
0
Un
iver
sity
of
Nor
th C
arol
ina
Ho
spit
als
Cha
pel
Hil
l 4
06
6
1
07
9
Yes
7
0
34
3
15
2
Yes
4
11
Mem
oria
l S
loan
-Ket
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
03
7
4
07
9
Yes
7
0
179
21
2
No
1 1
2
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
3
87
6
7
08
6
Yes
5
0
274
16
1
Yes
2
13
M
agee
-Wom
ens
Ho
spit
al
Pit
tsb
urg
h
38
4
50
0
67
Y
es
65
55
1 1
53
No
3
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
38
3
52
0
82
Y
es
80
3
90
1
79
Y
es
3 15
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
36
5
52
0
92
Y
es
70
29
1 1
70
Y
es
4 (+
3 SD
) 1
6
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
36
3
50
0
92
Y
es
80
34
6 1
53
Y
es
4 17
C
leve
land
Cli
nic
3
59
3
7
06
7
Yes
7
0
711
19
4
No
3 18
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
3
54
5
5
10
2
Yes
8
0
222
16
1
Yes
4
19
Un
iver
sity
of
Chi
cago
Ho
spit
als
35
1
43
0
90
Y
es
80
2
33
1
94
Y
es
4 2
0
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
34
3
50
0
85
Y
es
70
51
1
75
No
3
21
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
33
B
35
0
84
Y
es
B_O
30
2 2
40
Y
es
3 2
2
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
2
12
0
S3
Y
es
80
16
9 1
09
Y
es
4 2
3
Los
Ang
eles
Cou
nty-
uSC
Med
ical
Cen
ter
31
7
12
0
20
Y
es
65
4
0
16
7
Yes
4
24
Bar
nes-
Jew
ish
Ho
spit
al
St
L
ouis
3
16
2
3
08
2
Yes
7
5
62
3
14
9
Yes
4
25
R
ush
-Pre
sby
teri
an-S
t
Luk
es
Med
ical
Cen
ter
Chi
oago
3
15
2
2
07
0
Yes
8
0
30
3
114
No
3
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irmin
gham
3
14
3
1
09
6
Yes
8
0
411
15
1
Yes
4
(+2
SO)
27
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
97
1
9
08
5
Yes
7
0
33
7
12
3
Yes
4
28
U
niv
ersi
ty M
edic
al C
ente
r T
uoso
n A
riz
2
95
0
8
06
6
Yes
7
0
150
17
2
Yes
3
29
U
niv
ersi
ty H
osp
ital
D
enve
r 2
92
1
3
07
4
Ves
6
0
90
2
40
Y
es
4 3
0
Mou
nt S
inai
Med
ical
Cen
ter
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0
317
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31
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29
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57
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56
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3 32
C
ook
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90
0
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5
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6
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21
0
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33
U
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9
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69
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05
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28
8
24
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87
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35
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03
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4
36
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ter
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29
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37
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Yes
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5
37
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14
9
Yes
4
38
B
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niv
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ty M
edic
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6
08
8
Yes
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559
12
2
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4
39
M
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chco
ck M
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Ho
spit
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Leb
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H
28
2
12
0
86
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34
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niv
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ty H
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28
1
38
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09
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93
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41
Wom
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spit
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lan
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nce
28
1
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0
29
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50
5
19
0
63
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4
42
B
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cone
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80
1
2
08
4
Yes
7
0
286
15
8
Yes
3
43
C
lari
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dia
nap
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79
1
1
08
7
Yes
8
0
55
8
16
7
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3
44
Ohi
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tate
un
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sity
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Cen
ter
Col
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77
1
0
07
6
Yes
6
5
157
10
1
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4
45
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75
0
4
08
5
Yes
9
0
59
5
18
9
Yes
4
46
L
uthe
ran
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lths
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m
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k R
idge
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l
27
4
00
0
70
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70
2
60
1
14
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4 4
7
Un
iver
sity
of
Wis
cons
in H
osp
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and
Cli
nic
s
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ison
2
12
1
2
07
7
Yes
7
0
20
7
13
6
Yes
1
48
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
27
1
05
0
76
Y
es
70
2
62
1
57
Y
es
2 4
9
Gre
ater
Bal
tim
ore
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Cen
ter
Bal
tim
ore
27
0
00
0
69
Y
es
55
46
0 2
00
No
4
50
FG
M
oGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
70
1
0
08
7
Yes
7
0
186
16
2
Yes
4
rmiddot--
I
i L
L
2001
H
eart
Bes
t H
osp
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Lis
t
Ran
k H
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1 C
leve
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May
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Min
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3 M
assa
chus
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spit
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4 Jo
hns
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kins
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spit
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tim
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5 B
righ
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nd W
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s H
osp
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B
osto
n 8
Duk
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niv
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ty M
edic
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NC
7
Tex
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In
stit
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Luk
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Epi
scop
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osp
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H
oust
on
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nfo
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niv
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osp
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S
tan
ford
C
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9 Em
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un
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sity
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spit
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Atl
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1
0
Bet
h Is
rael
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11
B
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12
W
illi
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13
Un
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4
Un
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5
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niv
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20
Sum
ma
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21
U
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9
UCLA
Med
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Cen
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3
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Un
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44
Was
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Geo
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5
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28
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28
9
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4
71
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0
12
7
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2
88
0
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6
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8
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54
00
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1
92
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28
7
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44
50
00
0
19
4
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86
0
0
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9
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85
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7
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15
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4
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45
27
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1
59
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6
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15
10
00
0
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9
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28
3
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8
0
31
45
00
00
1
10
N
o
2001
H
oroo
nal
Dis
ord
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Bes
t H
osp
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lis
t
Tec
hnol
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Rep
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tio
nal
M
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alit
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COTH
sc
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RN
s
T
raum
a R
ank
Ho
spit
al
IHQ
sco
re
rate
M
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f 7
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bed
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May
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lin
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10
00
6
12
0
66
Y
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59
13
1
Yes
2
Mas
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27
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John
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B
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4
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36
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17
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43
Y
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Bet
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55
1
13
0
62
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60
11
46
15
8
Ves
6
Un
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of
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gin
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Cen
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Ch
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vil
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45
4
11
5
04
9
Yes
6
0
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2
27
No
7
Un
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sity
of
Cal
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Se
n F
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isco
Med
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Cen
ter
45
3
14
5
07
2
Yes
6
0
416
17
5
No
9 B
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smiddotJe
wis
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Lou
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45
3
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6
09
5
Yes
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Y
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leve
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37
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No
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m
10
U
niv
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ty o
f M
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Med
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Cen
ter
Ann
Arb
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41
6
82
0
66
Y
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8
13
1
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Un
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spit
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41
1
89
0
B2
Y
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70
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1 1
94
Y
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12
UCLA
Med
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Cen
ter
lo
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ngel
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41
0
10
4
00
4
Yes
7
0
752
10
8
Yes
13
u
niv
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ty o
f W
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0
4
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Yes
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Ne
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Pre
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Y
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Yes
15
V
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Yes
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N
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oria
l H
osp
ital
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hica
go
37
5
51
0
73
Y
es
60
97
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70
Y
es
17
Hen
ry F
ord
Ho
spit
al
Det
roit
3
75
1
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05
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Yes
6
5
19
45
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82
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SD)
18
Sta
nfo
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niv
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ty H
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ital
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61
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19
P
arkl
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Yes
2
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Duk
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nive
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edic
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r D
urha
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NC
3
59
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06
8
Yes
7
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6
18
1
Yes
21
U
niv
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ty H
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D
enve
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58
2
5
04
5
Yes
8
0
320
24
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Yes
2
2
was
hing
ton
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spit
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57
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0
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92
Y
es
23
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
35
4
16
0
65
Y
es
70
12
59
16
7
Yes
2
4
Ohi
o S
tate
Un
iver
sity
Med
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Cen
ter
Col
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s 3
47
2
7
05
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Yes
5
5
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Yes
2
5
Ho
spit
al o
f th
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niv
ersi
ty o
f P
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nia
P
hil
adel
ph
ia
34
5
23
0
13
Y
es
70
86
6 1
61
Y
es
26
S
t
lou
is U
niv
ersi
ty H
osp
ital
3
43
0
7
04
0
Yes
1
0
637
14
1
Yes
2
7
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
3
43
1
1
06
4
Yes
1
0
1080
1
51
Y
es
28
U
niv
ersi
ty H
osp
ital
P
ort
lan
d
ore
3
42
2
8
048
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es
60
32
8 0
111
Yes
2
9
Un
iver
sity
of
Tex
as M
edic
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ranc
h H
osp
ital
s
Gal
vest
on
33
9
05
0
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es
60
81
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53
Y
es
30
G
ood
Sam
arit
an R
egio
nal
Med
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Cen
ter
Pho
enix
3
38
1
0
01
7
Yes
7
0
58
0
10
7
Yes
31
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
Cha
pel
Hil
l 3
37
0
6
05
2
Yes
6
0
791
15
2
Yes
32
U
niv
ersi
ty o
f W
isco
nsin
Hos
pita
l an
d C
Hn
ics
Mad
ison
3
37
0
5
03
3
Yes
7
0
519
13
6
Yes
33
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al O
ak
Mio
h
33
7
06
0
80
Y
es
70
14
14
18
8
Yes
3
4
Flo
rid
a H
osp
ital
Med
ical
Cen
ter
Orl
ando
F
la
33
7
00
0
51
No
6
0
1698
1
67
Y
es
35
U
niv
ersi
ty o
f M
aryl
and
Med
ical
sys
tem
B
alti
mor
e 3
36
0
6
05
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Ves
7
0
55
3
111
4 Y
es
36
U
niv
ersi
ty o
f C
alif
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Dav
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edic
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ente
r S
acra
men
to
33
4
06
0
59
Y
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70
55
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19
Y
es
37
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
33
3
05
0
50
Y
es
60
56
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57
Y
es
38
Yal
emiddotN
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
33
2
38
1
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es
10
8
10
1
53
Y
es
39
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
9
00
0
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Y
es
60
76
8 1
14
Y
es
40
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
3
29
0
0
04
9
Yes
5
5
656
13
5
Yes
41
A
lleg
heny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
32
8
00
0
66
Y
es
60
6
10
1
91
Y
es
42
Mou
nt S
inai
Med
ical
Cen
ter
New
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k 3
27
6
4
16
7
Yes
7
0
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1
57
Y
es
43
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
6
05
0
20
Y
es
70
32
9 1
09
Y
es
44
M
emor
ial
Med
ical
Cen
ter
Sav
anna
h G
a
32
6
00
0
48
Y
es
60
5
52
1
42
V
es
45
Med
ical
Col
lege
of
Geo
rgia
Ho
spit
al a
nd C
lin
iC
Aug
usta
3
23
0
0
03
1
Yes
5
0
381
15
0
Yes
46
S
t L
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Med
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Cen
ter
Milw
auke
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is
32
3
00
0
62
Y
es
60
13
70
08
6
Yes
4
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FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
trd
ty
May
woo
d
Ill
3
23
1
0
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1
Yes
6
0
64
3
16
2
Yes
4
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
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lin
ios
Io
wa
Cit
y
32
3
07
0
68
Y
es
70
6
85
1
34
Y
es
49
M
edic
al C
ente
r o
f D
elaw
are
Wil
min
gton
3
21
0
0
08
1
ves
60
12
35
17
5
Ves
50
u
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
32
1
00
0
68
Y
es
70
77
3 1
51
Y
es
- L
2001
K
idne
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isea
se B
est
Ho
spit
al l
ist
Tec
hnol
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Dis
char
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Med
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epu
tati
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Mo
rtal
ity
CO
TH
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re
RN
s
Tra
uma
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S
urg
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k H
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ital
IH
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re
rate
M
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to
beds
C
ente
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eds
Mas
sach
use
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Gen
eral
Ho
spit
al
B
osto
n 1
00
0
27
6
09
5
Yes
5
0
1091
1
36
Y
es
3 83
2
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
95
6
25
6
061
Y
es
50
74
2 1
43
Y
es
3 30
3
May
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lin
iC
Ro
ches
ter
M
inn
82
B
18
5
06
3
Yes
5
0
1217
1
31
Y
es
3 94
4
Cle
vel
and
Cli
nic
8
28
1
94
0
53
Y
es
50
11
24
19
4
No
3 44
5
New
Yor
k P
resb
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rian
Ho
spit
al
80
6
19
6
12
2
Yes
5
0
1617
1
32
Y
es
3 11
1
6 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
77
3
17
4
05
4
Yes
4
5
811
14
2
Yes
3
41
7 UC
LA M
edic
al C
ente
r
Los
Ang
eles
7
26
1
53
0
60
Y
es
50
97
5 1
08
Y
es
3 54
8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
69
6
14
3
07
8
Yes
5
0
1108
1
81
Y
es
3 57
9
Bar
nes
-Jew
ish
Ho
spit
al
S
t
Lou
is
88
7
12
0
05
9
Yes
5
0
1863
1
49
Y
es
3 76
10
U
niv
ersi
ty H
osp
ital
D
enve
r 6
58
1
41
0
61
Yes
4
0
408
24
0
Yes
3
0 11
U
niv
ersi
ty O
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbor
5
89
8
8
05
4
Yes
5
0
922
17
9
Yes
3
60
12
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
iC
Nas
hv
ille
5
78
9
1
04
9
Yes
4
0
850
24
0
Yes
3
28
13
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
56
6
89
0
63
Y
es
40
52
8 1
61
Y
es
3 67
14
P
ark
lan
d M
emor
ial
Ho
spit
al
D
alla
s 56
1
73
0
31
Yes
5
0
660
19
8
Yes
3
39
15
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
41
6
6
06
2
Yes
5
0
1128
1
67
Y
es
3 80
16
U
niv
ersi
ty o
f C
ali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
53
4
74
0
45
Y
es
50
63
1 1
75
N
o 3
35
17
Ho
spit
al o
f th
e U
niv
ersi
ty O
f P
enn
sylv
ania
P
hil
adel
ph
ia
52
8
75
0
73
Y
es
50
96
2 1
61
Yes
3
44
18
Em
ory
Un
iver
sity
Ho
spit
al
A
tlan
ta
52
1
77
0
58
Y
es
45
78
4 0
93
N
o 3
48
19
un
ivers
ity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
51
6
78
0
55
Y
es
50
42
1 1
10
N
o 2
46
(+3
SO)
20
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
47
3
56
0
93
Y
es
40
12
02
15
1
Yes
2
86
21
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
45
3
47
0
61
Yes
5
0
1013
1
58
Y
es
3 0
22
Hen
ry F
ord
Ho
spit
al
Detr
oit
4
47
2
1
05
8
Yes
5
0
1459
1
82
Y
es
3 76
2
3
Un
iver
sity
of
No
rth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
44
5
37
0
48
Y
es
40
10
33
15
2
Yes
3
16
24
F
airv
ieW
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iver
sity
Med
ical
Cen
ter
Min
neap
Oli
s 4
44
5
2
07
2
Yamp
s 5
0
690
15
6
No
3 24
2
5
Un
iver
sity
of
Chi
cago
Ho
spit
als
44
2
31
0
47
Y
es
50
75
8 1
94
Y
es
3 3
0
26
H
erm
ann
Ho
spit
al
Hou
ston
4
24
1
7
03
0
Yes
4
5
668
11
4
Yes
3
54
27
Ru
sh-P
resb
yte
rian
-St
L
uke
s
Med
ical
Cen
ter
C
hica
go
41
8
16
0
37
Y
es
50
12
73
11
4
No
3 49
2
8
New
Eng
land
Med
ical
Cen
ter
8
0st
on
4
16
4
2
07
9
Yes
5
0
330
24
2
Yes
2
30
2
9
Un
iver
sity
of
Cali
forn
ia
Dav
iS M
edic
al C
ente
r
Sac
ram
ento
4
16
2
2
05
5
Yes
5
0
681
27
9
Yes
3
40
30
Yal
e-N
ew H
aven
H
osp
ital
N
ew H
aven
C
onn
4
12
3
8
09
9
Yes
5
0
943
15
3
Yes
3
52
(+2
SO)
31
Los
An
gel
es C
ount
y-U
SC
Med
ical
Cen
ter
40
9
04
0
08
Y
es
45
21
3 1
67
Y
es
3 43
32
S
hand
s H
osp
ital
et
the U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
40
6
34
0
74
Y
es
45
69
9 1
57
Y
es
2 3
0
33
St
L
ou
is U
niv
ersi
ty H
osp
ital
3
99
1
2
041
Y
es
45
58
7 1
47
Y
es
3 43
3
4
Bos
ton
Med
ical
Cen
ter
39
4
15
0
44
Y
es
40
40
5 2
10
Y
es
3 36
35
U
niv
ersi
ty o
f T
exes
Med
ical
Bra
nch
Ho
spit
als
G
alv
esto
n
39
0
05
0
41
Yes
5
0
890
15
3
Yes
3
38
36
Un
iver
sity
Ho
spit
al
Po
rtla
nd
are
3
90
3
4
07
2
Yes
4
5
356
091
Y
es
3 18
37
M
eth
od
ist
Ho
spit
al
Hou
ston
3
89
3
3
10
0
Yes
4
6
796
13
3
No
3 69
38
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
88
0
6
06
0
Yes
5
0
935
17
0 Y
es
3 6
3
39
Fro
edte
rt M
emor
ial
Lu
ther
an H
osp
ital
M
ilw
auke
e 3
87
1
2
05
5
Yes
5
0
784
14
6
Yes
3
35
40
Un
iver
sity
Ho
spit
els
and
Cli
niC
S
Col
umbi
a
Mo
3
87
2
6
06
6
Yes
4
5
374
15
1
Yes
2
30
41
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
niC
S
Chi
cago
3
85
0
0
01
9
Yes
4
5
382
12
9
Yes
3
42
42
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
Ari
z
38
3
00
0
29
Y
es
45
37
6 1
72
Y
es
3 46
43
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
38
3
12
0
41
Y
es
00
81
4 1
68
N
o 91
44
W
illi
am B
eaum
ont
Ho
spit
el
Roy
al O
ak
Mic
h
38
3
03
0
74
Y
es
50
16
88
18
8
Yes
3
60
45
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
3
81
0
5
06
1
Yes
4
5
941
19
4
Yes
3
63
46
Un
iver
sity
01
Wis
con
sin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
7
22
0
82
Y
es
50
82
0 1
36
Y
es
3 32
4
7
Sax
ar C
ount
y H
osp
ital
Dis
tric
t
San
An
ton
io
37
7
16
0
64
Y
es
45
36
8 1
21
Y
es
3 51
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
WaS
hing
ton
D
C
37
7
05
0
43
Y
es
50
39
5 1
09
Y
es
3 53
49
U
niv
ersi
ty 0
1 V
irg
inie
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
3
77
1
4
06
4
Yes
5
0
930
22
7
No
3 34
50
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r
Dal
las
31
5
05
0
72
Y
es
45
97
6 1
22
Y
es
3 86
j r
l
~
2001
N
euro
logy
and
Neu
rosu
rger
y B
est
Ho
spit
al L
ist
Tec
hnol
ogy
Re p
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
so
ore
rate
M
embe
r (o
f 7)
D
isoh
arge
s to
bed
s C
ente
r
1 M
ayo
Cli
nic
R
oche
ster
M
inn
1
00
0
57
5
09
1
Yes
7
0
4763
1
31
Y
es
2 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
83
7
46
0
09
5
Yes
7
0
3705
1
38
Y
es
3 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
74
6
37
2
07
0
Yes
7
0
2641
1
42
Y
es
4 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
7
27
3
73
0
95
Y
as
70
40
78
13
2
Yes
5
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
51
6
24
1
10
0
Yes
6
0
1503
1
75
No
6 C
leve
land
Cli
nic
5
12
1
88
0
65
Y
es
70
33
38
19
4
No
7 B
arne
smiddotJe
wis
h H
osp
ital
S
t l
ou
is
38
9
92
0
81
Y
es
70
46
67
14
9
Yes
8
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
37
4
10
5
09
1
Yes
7
0
22
86
1
61
Y
es
(+3
SD)
9 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
32
4
70
1
02
Y
es
70
29
21
18
1
Yes
1
0
UCLA
Med
ioal
Cen
ter
lo
s A
ngel
es
32
2
64
0
80
Y
es
70
19
67
10
8
Yes
11
M
ount
S
inai
Med
ical
Cen
ter
Ne
w Y
ork
31
7
55
0
85
Y
es
70
23
83
15
7
Yes
12
M
etho
dist
Ho
spit
al
Hou
ston
3
15
6
2
08
6
Yes
6
0
3768
1
33
No
13
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
15
6
6
09
3
Yes
7
0
1925
1
43
Y
es
14
Un
iver
sity
of
Mic
higa
n M
edic
al C
arot
er
Ann
Arb
or
30
4
68
1
06
Y
es
70
17
02
17
9 Y
es
15
S
t J
ose
ph
s H
osp
ital
and
Med
ical
Cen
ter
Pho
enix
3
04
5
2
09
2
Yes
6
0
3336
1
27
Y
es
16
Los
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
29
9
04
0
29
Y
es
55
39
9 1
67
Y
es
17
H
enry
F
ord
Ho
spit
al
Det
roit
2
99
1
3
06
4
Yes
6
5
3299
1
82
Y
es
18
Den
ver
Hea
lth
and
Ho
spit
als
29
5
04
0
16
No
5
5
353
17
0
Yes
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
29
4
49
0
89
Y
es
50
19
06
16
1
Yes
2
0
Dan
amiddotF
arbe
r C
ence
r In
stit
ute
B
osto
n 2
94
0
3
00
0
No
85
6
22
7
No
21
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
29
3
15
0
46
Y
es
70
11
51
10
9
Yes
2
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
29
1
37
0
82
Y
es
70
21
86
13
4
Yes
(+
2 SD
) 2
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
28
8
13
0
36
V
es
60
33
6 2
68
No
2
4
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 2
88
1
8
07
0
Yes
7
0
3234
1
18
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
28
8
27
0
70
Y
es
60
15
98
15
7
Yes
2
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
87
2
1
07
0
Yes
6
0
1970
1
70
Y
es
27
u
niv
ersi
ty H
osp
ital
D
enve
r 2
87
3
3
07
3
Yes
6
0
613
24
0
Yes
2
8
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
28
6
08
0
19
Y
es
70
44
69
16
7
Yes
2
9
Un
iver
sity
of
Vir
gIn
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
28
5
34
0
83
Y
es
60
32
29
22
7
No
30
D
ooto
rs C
Onm
luni
ty H
osp
ital
la
nham
M
d
28
0
00
0
05
No
5
5
901
09
7
No
31
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
2
78
0
0
00
0
Yes
3
0
870
03
4
Ho
32
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 2
77
1
8
07
0
Yes
7
0
896
19
8
Yes
3
3
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
O
ak
Mic
h
27
6
00
0
82
V
es
70
48
44
18
8
Yes
3
4
St
L
uke
s H
osp
ital
N
ewbu
rgh
N
Y
27
5
00
0
02
No
5
0
82
6
08
0
No
35
B
osto
n M
edio
al C
ente
r 2
74
2
5
07
7
Ves
5
0
1255
2
10
Y
es
36
F
airv
ieW
-Uni
vers
ity
Med
ical
Cen
ter
Min
neap
olis
2
74
2
0
06
1
Ves
5
0
1685
1
56
No
37
U
nIv
ersi
ty M
edic
al C
ente
r T
ucso
n
Ari
z
27
4
00
0
50
Y
es
60
86
5 1
72
Y
es
38
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
73
0
0
06
6
Yes
6
0
3299
1
49
Y
es
39
Sc
hwab
Reh
abil
itat
ion
Ho
spit
al
Chi
cago
2
70
0
0
02
3
Yes
2
5
769
04
1 Y
es
40
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
68
0
0
04
9
Yes
5
0
498
21
0
Yes
41
S
t V
ince
nt H
ospI
tal
and
Hea
lth
Cen
ter
In
dia
nap
olb
2
66
0
0
07
0
Yes
6
0
32
89
1
37
Y
es
42
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
Chi
cago
2
65
0
6
05
4
Yes
7
0
1848
1
14
No
4
3
Bet
h Is
rael
Dea
oone
ss M
edio
al C
ente
r B
osto
n 2
65
1
4
08
5
Yes
6
0
2838
1
58
Y
es
44
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
2
64
0
0
00
6
No
35
12
64
03
8
No
45
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
2
63
1
8
08
8
Yes
7
0
1659
2
40
Y
es
46
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
nic
s C
hioa
go
26
2
13
0
62
Y
es
45
83
0 1
29
Y
es
47
H
arpe
r H
osp
ital
D
etro
it
26
1
04
0
55
Y
es
60
20
72
12
6
No
48
E
vans
ton
Nor
thw
este
rn H
ealt
h C
are
E
vans
ton
Il
l
28
1
09
0
75
Y
es
60
29
33
10
2
Yes
4
9
was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
2
59
0
4
07
7
Yes
6
0
2269
1
92
Y
es
50
Car
din
al H
ill
Reh
abil
itat
ion
Ho
spit
al
lex
ing
ton
K
y
25
8
00
0
02
No
0
5
1313
0
55
No
t
2001
O
rth
op
edio
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
GOTH
so
ore
R
N
$
Tra
uma
Ran
k H
osp
ital
IH
O
sco
re
rate
M
embe
r (o
f 5)
D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
49
2
05B
Y
es
50
77
52
13
1
Yes
2
Ho
spit
al f
or
Sp
ecia
l S
urg
ery
N
ew Y
ork
88
3
40
6
01
3
Yes
4
5
6837
1
57
Y
es
3 M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 7
13
3
20
1
01
Y
es
50
34
89
13
8
Yes
4
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
43
1
90
0
73
Y
es
50
16
28
14
2
Yes
5
Cle
vel
and
Cli
nic
5
19
1
73
0
63
Y
es
50
36
20
19
4
No
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
40
1
34
1
07
Y
es
50
28
63
18
1
Yes
7
Har
borv
iew
Med
ical
Cen
ter
S
eatt
le
37
2
101
1
05
Yes
3
5
820
23
3
Yes
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
37
0
75
0
74
Y
es
50
15
09
13
4
Yes
9
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
36
0
84
0
99
Y
es
50
17
57
10
8
Yes
(+
3 SO
) 10
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
2
68
0
56
Y
es
50
97
3 1
10
No
11
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
A
rbor
3
29
3
9
06
8
Yes
5
0
1586
1
79
Y
es
12
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
32
7
43
0
80
Y
es
50
26
80
14
3
Yes
13
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
32
6
48
0
92
Y
es
50
28
72
16
7
Yes
14
B
exar
Cou
nty
Ho
spit
al D
istr
ict
San
Ant
onio
3
24
3
9
04
8
Yes
4
0
645
12
1
Yes
15
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
3
49
0
87
Y
es
30
21
43
161
Y
es
16
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
35
0
67
Y
es
50
11
56
19
4
Yes
17
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
31
8
71
1
23
Y
es
50
58
7 1
98
Y
es
18
Un
iver
sity
Ho
spit
al
Den
ver
31
7
31
0
44
Y
es
40
63
3 2
40
Y
es
19
Bar
nes
middotJew
ish
Ho
spit
al
St
lo
uis
3
11
3
6
08
9
Yes
5
0
2911
1
49
Y
es
20
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f fl
ori
da
Gai
nes
vil
le
30
7
21
05
9
Yes
4
0
1781
1
57
Y
es
21
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
30
5
62
1
04
Y
es
40
92
7 1
75
No
(+
2 SO
) 22
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
03
1
6
05
9
Yes
5
0
1608
2
40
Y
es
23
Ho
spit
al o
f th
e U
niv
ersi
ty o
f p
enn
sylv
ania
P
hil
adel
ph
ia
30
1
45
1
04
Y
es
50
10
76
161
Y
es
24
U
niv
ersi
ty o
f A
labe
ma
Ho
spit
al a
t B
irm
ingh
am
29
9
22
0
73
Y
es
50
15
94
151
Y
es
25
Ho
spit
al f
or
Join
t D
isea
sesmiddot
Ort
ho
ped
ic I
nst
itu
te
New
Yor
k 2
97
4
0
02
5
No
30
21
10
09
3
No
26
SUl1
l1la
Hea
lth
sy
stem
A
kron
O
hio
29
5
05
0
49
Y
es
40
38
99
14
9
Yes
27
Y
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
Onn
2
93
1
2
061
Y
es
50
14
62
15
3
Yes
28
N
ew Y
ork
Pre
sby
teri
an H
osp
ital
2
92
4
5
12
2
Yes
5
0
2394
1
32
Y
es
29
Un
iver
sity
of
Ten
ness
ee M
edic
al C
ente
r
Mem
phis
2
92
4
2
05
4
No
46
90
1
50
No
30
U
niv
ersi
ty o
f W
isco
nsi
n H
osp
ital
and
Cli
nic
s
Mad
ison
2
89
1
1
061
Y
es
50
14
42
13
6
Yes
31
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
sacr
amen
to
28
6
24
0
87
Y
es
50
11
56
27
9
Yes
32
S
t
lou
is U
niv
ersi
ty H
osp
ital
2
83
0
4
04
8
Yes
5
0
819
14
7
Yes
33
R
ushmiddot
Pre
sby
teri
an
-St
lu
kes
Med
ical
Cen
ter
Chi
cago
28
1
25
0
79
Y
es
50
21
23
11
4
No
34
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Ill
28
0
00
0
46
Y
es
40
25
63
11
4
Yes
35
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
2
80
0
6
04
7
Yes
5
0
952
10
9
Yes
36
C
aro
lin
as M
edic
al C
ente
r
Ch
arlo
tte
N
C
28
0
23
1
03
Y
es
50
29
00
18
4
Yes
37
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
27
9
06
0
71
Yes
4
0
2274
1
58
Y
es
38
Coo
k C
ount
y H
osp
ital
C
hica
go
27 _
7 1
2
05
5
Yes
3
0
184
21
0
Yes
39
U
niv
ersi
ty o
f lo
uis
vil
le H
osp
ital
lo
uis
vil
le
Ky
2
76
0
5
04
2
Yes
4
0
317
19
0
Yes
40
A
lleg
hen
y G
ener
al H
osp
ital
P
itts
bu
rgh
2
76
0
0
06
4
Yes
4
0
2161
1
91
Yes
41
H
enry
For
d H
osp
ital
D
etro
it
27
6
00
0_
63
Yes
4
5
1834
1
82
Y
es
42
Un
iver
sity
of
Mia
mi
Jack
son
Mem
oria
l H
osp
ital
2
78
3
0
06
2
Yes
0
0
748
16
8
No
43
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 2
75
0
5
06
6
Yes
4
0
1518
1
52
Y
es
44
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
27
5
00
0
32
Y
es
40
87
1 1
72
Y
es
45
Mar
y H
itch
cock
Mem
oria
l H
osp
ital
le
ban
on
N
H
27
4
00
0
57
Y
es
40
14
30
19
4
Yes
46
B
apti
st M
emor
ial
Ho
spit
al
Mem
phis
2
74
4
5
11
2
No
50
29
14
09
3
Yes
47
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
2
73
1
2
08
6
Yes
4
0
2025
1
70
Yes
48
L
os A
ngel
es C
ou
nty
USC
Med
ical
Cen
ter
27
3
05
0
00
Y
es
35
23
6 1
Il7
Yes
49
M
edic
al C
ente
r o
f C
entr
al M
assa
chu
sett
s W
orc
este
r 2
73
0
0
06
0
Yes
4
5
1285
1
89
Y
es
60
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
middotSal
em
27
3
11
0
92
Y
es
50
21
20
1I
II
Yes
r-
-
2001
R
esp
irat
ory
Dis
ord
ers
Bes
t H
osp
ital
Lis
t Tec
hnol
ogy
Dis
char
ge
Rep
uta
tio
nal
M
ort
ali
ty
COTH
sc
ore
R
N
s T
raum
a p
lan
nin
g
Ran
k H
osp
Ital
IH
Q
sco
re
rate
M
embe
r (o
f 4
) D
isch
arg
es
to b
eds
Cen
ter
(of
3)
1 N
atio
nal
Jew
ish
Cen
ter
D
enve
r 1
00
0
501
0
22
N
o 3
0
121
37
5
No
3 2
May
o C
lin
ic
Ro
ches
ter
M
inn
8
S2
41
1
08
1
Yes
4
0
4391
1
31
Yes
3
3 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
63
3
2B0
0
95
Y
es
40
14
61
14
2
Yes
3
4 B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
54
6
21
2
08
9
Yes
4
0
5329
1
49
Y
es
3 5
Un
iver
sity
Ho
spit
al
Den
ver
45
7
151
0
83
Y
es
40
9
80
2
40
Y
es
3 6
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
43
2
15
0
09
0
Yes
4
0
1015
1
75
N
o 3
7 M
assa
chu
sett
s G
ener
al H
osp
Ital
B
osto
n 43
1
16
4
11
4
Yes
4
0
3306
1
38
V
es
3 8
Cle
vel
and
Cli
nic
4
20
1
24
0
77
Y
es
40
27
32
19
4
No
3 9
Bri
gham
and
WO
men
s H
osp
ital
B
osto
n 3
69
9
0
08
2
Yes
4
0
2526
1
43
V
es
3 10
U
CSIl
Med
ical
Cen
ter
S
an D
iego
3
68
9
1
08
0
Yes
4
0
1130
1
48
Y
es
3 11
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
4
12
0
09
8
Yes
4
0
720
11
0
110
2 12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbo
r 3
48
8
1
08
7
Yes
4
0
1927
1
79
Ves
3
(+3
SO)
13
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
II
C
33
7
96
1
12
Y
es
40
29
49
18
1
Yes
3
14
Bo
sto
n M
edic
al C
ente
r 3
25
3
8
05
7
Yes
4
0
1105
2
10
Y
es
3 15
H
osp
ital
of
the U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
32
3
96
1
15
Y
es
40
15
07
16
1
Ves
3
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
32
2
74
0
95
Y
es
40
16
20
161
Y
es
3 1
7
Un
ivers
ity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
05
6
0
09
7
Yes
4
0
2957
1
67
Y
es
3 18
UC
LA M
edic
al C
ente
r
Los
Ang
eles
2
97
4
1
07
5
Yes
4
0
1910
1
08
Y
es
3 19
V
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
onn
2
95
5
3
09
3
Ves
4
0
2355
1
53
Y
es
3 20
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
85
5
5
10
0
Yes
4
0
1432
1
94
Y
es
3 21
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
28
5
25
0
74
V
es
40
27
79
15
2
Yes
3
(+2
SO)
22
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
27
9
35
0
87
V
es
40
20
51
24
0
Yes
3
23
Los
A
ng
eles
Cou
nty-
USC
Med
ical
Cen
ter
27
5
04
0
18
Y
es
40
46
9 1
67
Y
es
3 24
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
Sac
ram
ento
2
73
1
2
06
7
Yes
4
0
1820
2
79
V
es
3 2
5
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
73
1
0
06
2
Yes
4
0
1475
1
47
Y
es
3 26
C
ook
Cou
nty
Ho
spit
al
C
hica
go
27
3
00
0
49
Y
es
40
11
45
21
0
Yes
3
27
San
Fra
nci
sco
Gen
eral
Ho
spit
al M
edio
al C
ente
r 2
70
5
6
08
7
Yes
2
0
899
11
0
No
3 28
H
enne
pin
Cou
nty
Med
ical
Cen
ter
M
inn
eap
oli
s 2
67
0
0
05
2
Yes
4
0
1959
1
05
Y
es
3 29
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
26
4
07
0
66
Y
es
40
17
63
15
7
Yes
3
30
Geo
r-ge
tow
n U
niv
ersi
ty H
osp
ital
w
ash
ing
ton
D
C
26
2
04
0
59
Y
es
40
99
3 1
09
Y
es
3 31
C
lar-
ian
Hea
lth
Part
ners
In
dia
nap
Oli
S
26
0
12
0
79
Y
es
40
42
95
16
7
Yes
3
32
Ru
sh-P
resb
yte
rian
-St
L
uk
es
Med
ical
Cen
ter
C
hica
go
25
4
28
0
82
Y
es
40
18
56
11
4
No
3 33
H
enry
Fo
rd H
osp
ital
D
etr
oit
2
54
1
4
08
5
Yes
4
0
3875
1
82
Y
es
3 34
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
2
53
2
2
08
3
Yes
4
0
2302
2
27
No
3
35
W
est
Jeff
ers
on
Med
ical
Cen
ter
M
arre
ro
La
2
52
0
0
05
3
No
40
14
94
11
3
Ves
3
36
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
251
0
0
07
1
Yes
4
0
6185
1
49
Y
es
3 37
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
iCS
M
adis
on
25
0
05
0
70
Y
es
40
14
28
13
6
Yes
3
38
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
50
0
4
07
2
Yes
4
0
1071
1
72
Y
es
3 39
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
sity
M
ayw
ood
Ill
2
49
1
8
08
6
Yes
4
0
1415
1
62
V
es
3 40
U
niv
ersi
ty o
f Il
lin
ois
Ho
spit
al a
nd C
11
nic
s
Chi
cago
2
49
0
5
06
6
Yes
3
5
779
12
9
Yes
3
41
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
46
0
0
06
3
Yes
3
5
1677
1
01
Yes
3
42
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
2
45
3
7
10
3
Yes
4
0
2116
1
51
Ves
2
43
Har
bo
rvie
w M
edic
al C
ente
r
Seett
le
24
4
24
0
89
Y
es
30
80
5 2
33
Y
es
3 44
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
2
44
2
3
09
2
Ves
4
0
1334
1
34
Y
es
3 45
T
rum
an M
adic
al C
ente
r-W
est
K
ansa
s C
ity
M
o
24
4
00
0
64
Y
es
35
99
1 1
14
Y
es
3 46
M
emor
ial
Med
ical
Cen
ter
S
avan
nah
G
a
24
2
00
0
71
Y
es
40
14
03
14
2
Yes
3
47
Tou
ro
Infi
rmar
y
lew
Orl
ean
s 24
1
00
0
65
V
es
40
14
07
06
5
Ves
3
48
St
Jo
sep
h H
osp
ital
D
enve
r 2
41
0
0
05
5
No
40
25
11
10
3
No
3 49
L
os A
ng
eles
Cou
nty-
Har
bor-
UC
LA
Med
ical
Cen
ter
24
0
13
0
10
No
4
0
420
16
5
Yes
2
50
Bay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
40
1
2
08
7
Ves
4
0
3026
1
22
V
es
3
-
J 1
2001
R
heum
atol
ogy
Bes
t H
osp
ital
lis
t
Hos
pita
lwid
e T
echn
olog
y D
isch
arge
R
epu
tati
on
al
mo
rtal
ity
CO
TH
sco
re
RN
s
plan
ning
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 5
) to
bed
s (o
f 3
)
May
o C
lin
ic
Roo
hest
er
Min
n
10
00
4
96
0
72
Y
es
50
1
31
3
2 Jo
hns
Hop
kins
Has
p ta
l 8
alti
mo
rs
85
9
38
0
08
2
Yes
5
0
14
2
3 3
Ho
spt
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 8
09
2
70
0
10
Y
es
45
1
57
3
4 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 7
17
2
54
0
81
Y
es
50
1
43
3
5 C
leve
land
Cli
nic
6
76
2
03
0
67
Y
es
50
1
94
3
6 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
66
4
22
1
09
3
Yes
5
0
1 3
8
3 7
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
66
2
21
2
08
3
Yes
5
0
10
8
3 B
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
64
1
20
8
09
6
Yes
5
0
15
1
2 9
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
5
68
1
34
0
93
Y
es
50
1
81
3
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co M
edic
al C
ente
r 5
58
1
23
0
85
Y
es
40
1
75
3
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
5
37
1
12
0
86
Y
es
30
1
61
3
12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
52
1
82
0
82
Y
es
50
1
79
3
(+3
SD)
13
B
arne
s-Je
wis
h H
osp
ital
S
t
lou
is
49
2
57
0
82
Y
es
50
1
49
3
14
H
osp
ital
fo
r Jo
int
Dis
ease
s-O
rtho
pedi
c In
stit
ute
N
ew Y
ork
48
9
59
0
55
No
3
0
09
3
3 1
5
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 4
86
7
8
10
5
Yes
5
0
11
8
3 1
6
los
Ang
eles
Cou
nty-
USC
Med
ical
can
ter
48
4
00
0
20
Y
es
35
1
S7
3
17
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
47
7
46
0
84
Y
es
50
1
67
3
la
St
lu
kes
Ho
spit
al
New
burg
h
NY
4
74
0
0
00
1
No
35
0
80
3
19
U
niv
ersi
ty H
osp
ital
D
enve
r 4
70
3
6
07
4
Yes
-4
0
24
0
3 2
0
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
46
9
32
0
77
Y
es
50
1
98
3
21
Doc
tors
Com
mun
ity H
osp
ital
L
anha
m
Md
4
69
0
0
00
7
No
35
0
97
2
(+2
SO)
22
Den
ver
Hea
lth
and
Ho
spit
als
48
1
00
0
21
No
4
0
17
0
2 2
3
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
46
6
53
1
02
Y
es
50
1
61
3
24
R
ehab
ilit
atio
n I
nst
itu
te o
f C
hica
go
46
3
00
0
03
Y
es
25
0
34
2
25
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
DC
4
62
0
9
05
3
Yes
5
0
10
9
3 2
6
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
4
58
0
0
00
9
No
25
0
38
3
27
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
45
4
39
0
92
Y
es
40
1
70
3
28
T
he
Inst
itu
te f
or
Reh
abil
itat
ion
and
Res
earc
h H
oust
on
45
3
00
0
13
No
1
5
06
9
3 2
9
Un
iver
sity
of
Chi
cago
Ho
spit
als
45
2
29
0
90
Y
es
50
1
94
3
30
C
ard
inal
Hil
l R
ehab
ilit
atio
n H
osp
ital
L
exin
gton
K
y
44
9
00
0
01
No
0
5
05
5
3 31
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
47
2
6
08
4
Yes
4
0
15
8
3 3
2
Reh
abil
itat
ion
In
stit
ute
of
Mic
higa
n
Det
roit
4
47
0
0
01
2
No
25
0
39
2
33
S
t
lou
is U
niv
ersi
ty H
osp
ital
4
44
0
4
07
1
Yes
5
0
14
7
3 3
4
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
44
4
05
0
66
Y
es
40
1
72
3
35
Coo
k C
ount
y H
osp
ital
C
hica
go
44
3
00
0
55
Y
es
30
2
10
)
36
Su
nnyv
iew
Ho
spit
al a
nd R
ehab
ilit
atio
n C
ente
r S
chen
ecta
dy
NY
4
42
0
0
00
7
No
10
0
43
2
37
B
osto
n M
edic
al C
ente
r 4
39
1
6
07
5
Yes
3
0
21
0
3 3
8
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
niC
S
Mad
ison
4
39
0
8
07
7
Yes
5
0
13
6
3 3
9
Hil
lsid
e R
ehab
ilit
atio
n H
osp
ital
W
arre
n
Ohi
o 4
38
0
0
01
2
No
15
0
30
2
40
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
4
36
1
4
08
6
Yes
5
0
13
4
3 41
U
niv
ersi
ty o
f M
aryl
and
Med
ical
Sys
tem
B
alti
mor
e 4
35
1
6
09
2
Yes
5
0
19
4
3 4
2
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hiO
4
35
0
0
06
8
Yes
4
0
14
9
3 4
3
UCSD
Med
ical
Cen
ter
San
Die
go
43
5
26
0
90
Y
es
30
1
48
3
44
R
ush
-pre
sby
teri
an-S
t
luk
es
Med
ical
can
ter
Chi
cago
4
34
0
0
07
0
Yes
5
0
11
4
3 4
5
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
43
4
15
0
92
Y
es
50
1
53
3 4
6
Hen
ry F
ord
Ho
spit
al
Det
roit
4
34
0
0
07
3
Yes
4
5
18
2
3 4
7
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
can
ter
S
acra
men
to
43
4
00
0
76
Y
es
50
2
19
3
48
H
enne
pin
coun
ty M
edic
al c
ante
r M
inne
apol
is
43
2
00
0
61
Y
es
35
1
05
3
49
W
est
Jeff
erso
n M
edic
al C
ente
r M
arre
ro
lao
43
2
00
0
55
No
4
0
11
3
3 5
0
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
43
2
09
0
87
Y
es
50
1
67
3
~
-
2001
U
rolo
gy B
est
Has
pi ta
l li
st
Tec
hnol
ogy
Rep
uta
tio
nal
M
Ort
alit
y CO
TH
sco
re
RN
s
Tra
uma
Ran
k H
osp
ital
IH
O so
ore
rate
M
embe
r (o
f 8
) D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
70
7
07
8
Yes
7
5
1231
1
42
Y
es
2 C
leve
land
Cli
nio
6
94
4
14
0
50
Y
es
80
1
61
8
19
4
No
3 M
ayo
Cli
nic
R
oche
ster
M
inn
6
80
3
92
0
50
Y
es
80
3
81
8
13
1
Yes
4
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
50
0
25
7
12
3
Yes
8
0
14
50
1
08
Y
es
5 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
4
41
1
79
0
79
Y
es
80
30
61
13
2
Yes
6
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
35
1
73
0
56
Y
es
70
11
61
21
2
No
1 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
13
1
49
0
81
Y
es
80
1
75
8
18
1
Yes
8 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
40
7
15
3
09
6
Yes
8
0
1401
1
38
Y
es
9 B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
iS
39
0
12
9
08
2
Yes
8
0
1778
1
49
Y
es
10
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
38
5
15
2
12
9
Yes
5
0
973
16
1
Yes
11
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
co M
edic
al C
ente
r 3
57
1
07
0
62
Y
es
70
78
3 1
75
No
(+
3 SO
) 1
2
Met
hodi
st H
osp
ital
H
oust
on
33
8
10
9
11
0
Yes
6
5
1381
1
33
No
1
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
33
0
10
8
11
1
Yes
6
0
69
0
26
8
No
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
32
0
60
0
78
Y
es
80
1
28
5
17
9
Yes
1
5
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
31
0
54
0
86
Y
es
80
14
97
16
7
Yes
1
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
07
3
7
04
8
Yas
7
0
95
9
17
0
Yes
1
7
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
30
0
31
0
55
Y
es
80
12
74
16
1
Yes
(+
2 SD
) 1
6
Van
der
bil
t U
niv
ersi
ty H
osp
ital
an
d C
11ni
c
Nas
hv
ille
2
92
5
6
11
5
Yes
7
0
83
3
24
0
Yes
1
9
Lah
ey H
itch
cock
Cli
nic
B
url
ing
ton
M
ass
2
91
2
7
05
4
Yes
7
0
886
15
2
Yes
2
0
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
28
7
51
1
09
Y
es
80
69
7 1
43
Y
as
21
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
28
8
41
0
65
Y
es
80
2
83
1
98
Y
es
22
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
seatt
le
27
9
27
0
24
Y
es
80
5
32
1
10
No
2
3
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
cen
ter
Ch
arlo
ttes
vil
le
27
7
28
0
51
Y
es
70
73
2 2
27
No
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddot S
alem
2
77
1
8
07
7
Yes
8
0
957
16
1
Yes
2
5
Shan
ds H
osp
ital
at
the
Un
iver
sity
of
Flo
rid
a
Gai
nes
vil
le
27
7
15
0
57
Y
es
65
90
5 1
57
Y
es
26
Car
oli
nas
Med
ical
Cen
ter
C
har
lott
e
N C
2
78
0
0
03
3
Yes
8
0
908
18
4
Yes
27
U
niv
ersl
ty o
f W
isco
nsin
Hos
pita
l an
d C
lin
ios
Mad
ison
2
74
0
5
04
5
Yes
8
0
1151
1
36
Y
es
28
Ne
w Y
ork
Un
iver
sity
Med
ioal
Cen
ter
27
3
16
0
66
Y
es
80
16
70
11
8
Yes
2
9
Hen
ry F
ord
Ho
spit
al
Det
roit
2
72
0
0
04
3
Yes
7
5
1079
1
82
Y
es
30
U
niv
ersi
ty H
osp
ital
D
enve
r 2
70
1
0
00
0
Yes
6
0
371
24
0
Y9$
31
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
67
1
4
06
9
Yes
7
0
1011
1
23
Y
es
32
Y
ale-
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
2
67
0
5
06
8
Yes
8
0
98
4
15
3
Yes
33
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
26
7
00
0
42
Y
es
60
9
17
1
92
Y
es
34
A
lban
y M
adic
al C
ente
r A
lban
y
NY
2
66
0
5
04
7
Yes
6
0
77
3
16
7
Yes
3
5
36
Lo
s A
ngel
es C
ount
ymiddotU
SC M
edic
al C
ente
r W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
26
5
26
4
14
0
0
00
0
06
2
Yes
Y
es
60
8
0
65
1
73
0
16
7
18
8
Yes
Y
es
37
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edio
al C
ente
r
Sao
ram
ento
2
64
1
0
05
1
Yes
8
0
412
27
9
Yes
3
8
Nor
th S
hore
Un
iver
sity
Ho
spit
al
Man
hass
et
NY
2
63
0
0
05
5
Yes
8
0
35
4
12
7
Yes
3
9
Sum
ma
Ilea
lth
Sys
tem
A
kron
O
hio
26
2
00
0
04
5
Yes
6
5
775
14
9
Yes
4
0
St
L
ouis
Un
iver
sity
Ho
spit
al
26
1
18
0
72
Y
es
75
4
25
1
47
Y
es
41
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
26
0
21
0
66
Y
es
70
1
12
9
09
3
No
42
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
25
9
00
0
26
Y
es
65
3
56
1
72
Y
es
43
U
niv
ersi
ty o
f L
ou
isv
ille
Ho
spit
al
Lo
uis
vil
le
Ky
2
58
0
8
00
0
Yes
6
0
28
1
90
Y
es
44
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
2
57
0
0
05
9
Yes
6
0
96
5
13
5
Yes
4
5
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
57
1
4
09
9
Yes
7
0
84B
1
62
Y
es
46
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
25
6
04
0
77
Y
es
75
83
3 1
94
Y
es
47
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
25
6
09
0
78
Y
es
60
80
1 1
52
Y
es
48
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
56
2
0
10
9
Yes
8
0
701
19
4
Yes
4
9
Bex
ar C
ount
y H
osp
ital
Dis
trio
t
San
Ant
onio
2
56
0
5
00
0
Yes
8
5
229
12
1
Yes
5
0
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
25
5
13
0
57
Y
es
80
34
9 1
09
Yes
~
l
i i
f
AppendixG
r bull Reputational Rankings for Special-Service Hospitals
i
I
I L
1~
r-
2001
E
yes
Rep
uta
tio
nal
Sco
re
Rep
uta
tio
nal
R
ank
Ho
spit
al
soo
re
Joh
ns
Hop
kins
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spit
al
(Wilm
er
Eye
In
stit
ute
)
Bal
tim
ore
71
2
2 U
niv
ersi
ty o
f M
iam
i (B
asC
om
Pal
mer
Ey
e In
stit
ute
) 6
46
3
Wil
ls E
VQ
Hos
pita
l--
h
ilad
llip
hia
57
0
(+3
l
4 M
assa
chu
sett
s E
ye
and
Ear
In
firm
ary
B
osto
n 4
00
5
UCLA
Med
ioal
Cen
ter
(JII
IIIS
Ste
in E
ye
Inst
itu
te)
lo
s A
ngeJ
es
30
3
(+2
SO)
6 U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nio
s
Iow
a C
ity
1
93
7
USC
Un
iver
sity
Ho
spit
al
(Doh
eny
Eye
In
stit
ute
)
los
Ang
eles
1
03
8
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
B3
9
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
BO
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
66
11
M
ayo
Cli
nic
R
och
este
r
Min
n
63
12
N
ew Y
ork
Eye
an
d E
ar I
nfi
rmar
y
61
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
58
14
C
lev
elan
d C
lin
ic
54
16
M
eth
od
ist
Ho
spit
al
(Cul
len
Eye
Inst
itu
te)
H
oust
on
39
16
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
17
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
6
I
-~
r
middot
2001
P
edia
trio
s R
epu
tati
on
al S
core
Ran
k H
osp
ital
Ch
ild
ren
s H
osp
ital
Bos
ton
2 C
hil
dre
ns
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spit
al o
f P
hil
adel
ph
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3 Jo
hns
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kins
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BaU
iID
ore
4 C
hil
dre
ns
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al o
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bu
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5
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11
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cago
12
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r M
inn
13
U
niv
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a11
forn
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San
Fra
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Med
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cen
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14
UCLA
(M
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los
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15
lu
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Sta
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16
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use
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Gen
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Ho
spit
al
Bos
ton
17
Duk
e U
niv
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ty M
edio
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ente
r
Dur
ham
N
C
18
Ch
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ren
s H
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and
Med
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Cen
ter
S
eatt
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19
Ch
ild
ren
s N
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nal
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Cen
ter
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ton
D
C
20
U
niv
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ty o
f M
iam
i Ja
ckso
n M
emor
ial
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spit
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21
Ch
ild
ren
s H
osp
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B
uff
alo
N
Y bull
22
Un
iver
sity
of
Mic
higa
n H
osp
ital
s
Ann
Arb
or
23
St
Ch
rist
op
her
s H
osp
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hil
adel
ph
ia
24
Met
ho
dis
t H
osp
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H
oust
on
Rep
uta
tio
nal
S
core
49
4
38
9
27
4
12
2
11
6
10
9
10
9
99
9
4
89
8
7
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7
2
62
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4
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ank
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31
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pre
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25
2
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ter
M
inn
8
8
10
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
6
11
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nfo
rd U
niv
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ty H
osp
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S
tan
ford
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ali
f
52
12
S
hepp
ard
and
Eno
ch P
ratt
Ho
spit
al
Bal
tim
ore
52
13
U
niv
ersi
ty o
f C
ali
forn
ia
san
Fra
nci
sco
Med
ical
Cen
ter
46
14
U
nv
ars
ity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
4
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e
15
Ho
spit
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f th
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niv
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ity
of
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nsy
lvan
ia
Ph
ilad
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3
7
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Mou
nt S
inai
-NY
U M
edic
al C
ente
r
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k 3
5
17
Cle
vel
and
Cli
nic
3
1
l r-shy
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R
ehab
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n R
epu
tati
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al S
core
Rep
uta
tio
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R
ank
Ho
spit
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re
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cago
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37
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In
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fo
r R
ehab
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n a
nd
Res
earc
h
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ston
3
74
3
Un
iver
sity
of
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hina
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ioal
Cen
ter
$l
I1It
tle
32
9
___j+
3 S
O)
4 K
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or
Reh
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est
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8
5 M
ayo
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och
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r
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6 C
raig
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spit
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Eng
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c()l~
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2 SO
l 7
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Yor
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8
Ohi
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Cen
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11
1
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as J
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7
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Sp
auld
ing
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Ho
spit
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ton
69
13
N
atio
nal
Rs
hab
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n H
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ashi
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8
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nt
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ai M
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ns
Hop
kins
Ho
spit
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16
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Ein
stei
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ed
Cen
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(Mos
s R
ehab
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osp
)
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niv
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heph
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tlan
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1
9
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iver
sity
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spit
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Den
ver
31
2
0
Ho
spit
al o
f th
e U
niv
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f P
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sylv
ania
P
hil
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31
L
AppendixH
The 2001 Honor Roll
Lj
l
r
t
The Honor Roll
To lend additional perspective we have constructed a measure called the Honor Roll to
indicate excellence across a broad range ofspecialties
To be listed on the Honor Roll a hospital has to rank at least 2 standard deviations
(SD s) above the mean in at least 6 ofthe 16 specialties A hospitals ranking in the Honor
Roll is based on points assigned as follows
bull For ranking between 2 and 3 standard deviations above the mean in a specialty a
hospital receives one point
bull For ranking at least 3 standard deviations above the mean a hospital receives two
points
We chose to use a standard deviation based criteria rather than simply adding up a
hospitals rankings in individual specialties for three reasons (1) the number ofoutstanding
hospitals varies from specialty to specialty (2) setting a threshhold is more informative because
it establishes a level ofalmost excellent and (3) it gives some measure ofthe distance
between hospitals which rankings do not
f
middot1
THE 2001 HONOR ROLL
16
Mayo Clinic Rochester Minn 27 13 1
Massachusetts General Hospital Boston 26 12 2
4 Cleveland Clinic 23 11 1
5 UCLA Medical Center Los Angeles 22 8 6
6 Duke University Medical Center Durham NC 20 8 4
7 Barnes-Jewish Hospital St Louis 18 6 6
7 University of Michigan Medical Center Ann Arbor 18 6 6
7 University of California San Francisco Medical Center 18 7 4
10 Stanford University Hospital Stanford Calif 17 6 5
11 Brigham and Womens Hospital Boston 16 6 4
12 University of Washington Medical Center Seattle 12 4 4
13 New York Presbyterian Hospital 12 5 2
14 Hospital of the University of Pennsylvania Philadelphia 11 3 5
15 University of Chicago Hospitals 9 1 7
16 University QfPittsburgh Medical Center 9 2 5 1 1
l
i
In the final section we outline new directions anticipated for the index For a more
exhaustive review of the foundation as well as the development and use of the individual
measures and the composite index see ItBest Hospitals A Description of the Methodology for
the Index ofHospital Quality3
shy
J
r
5
IL The Index ofHospital Quality
A Universe Defmition
We have implemented a two-stage approach to defining eligible hospitals for each of the
IHQ specialty lists
First eligible hospitals must be considered tertiary-care centers To be identified as a
tertiary-care hospital a hospital must meet at least one of the following criteria
bull COTH membership or
bull medical school affiliation or
bull a score of9 or higher on our hospital-wide high-technology index
(Appendix A)
Using these criteria we identified 1878 tertiary-care hospitals that were eligible for any of the
thirteen IHQ-based rankings Once the eligible hospitals were identified data for these hospitals
were drawn from the 1999 AHA Annual Survey As with any data collection effort the AHA
Annual Survey database is incomplete due to nonresponding hospitals Although it did not affect
the analysis this year we have a procedure to allow eligible hospitals that are nonresponders to
the current AHA Annual Survey to remain in our database First for all previously ranked
hospitals that are nonresponders to the current survey we average the two prior years ofdata and
substitute the result for the missing data Two-year non-responders that lack data both from the
current survey and from the previous two surveys are ranked without any structure data
Although nonresponding hospitals need to be treated separately for the IHQ analysis it is
unnecessary to do so for the four reputation-only lists
We then created separate analytic universes for each of the 13 IHQ-driven specialties
using criteria such as specialty-specific technology or facilities and a minimum number of
discharges across appropriate DRGs (Figure 1) However hospitals with a non-zero reputational
score were deemed eligible for ranking even if they had insufficient volume (discharges) in a
specialty
The flow chart in Figure 2 illustrates the eligibility process
6
Figure 1 1999 Universe Definition by Specialty
~pec~~ltyi bull Number ()fllospit~ Imiddotimiddotf~~ifji~t~~f~frl~~~~~~~~~fmiddot ~~ bull~~ bullbull ~ f~middot~~~~ ~ ~~)~~~~ ~~~ Imiddotmiddot~ lt IA~~~~~ri1j~(~~tl = ~-~ ~~~~~f~~-~)~~lt-)-_~- ~~ ~ ~ v~_~ ~_~~ ~~
Cancer minimum of 380 discharges for relevant DRGs or 935 non-zero reputation score
Digestive disorders minimum of734 discharges for relevant DRGs or non- 1394 zero reputation score
Ear nose and minimum of37 discharges for relevant DRGs or non- 1371 throat zero reputation score
Geriatrics score of 1 or more on the geriatrics service index and 1412 minimum of 5947 discharges for all DRGs or nonshy
zero reputation score
Gynecology minimum of 52 discharges for relevant DRGs or non- 1356 zero reputation score
have a cardiac catheterization lab or Heart offer open heart surgery or 853
offer angioplasty and minimum of 245 surgical discharges for relevant
DRGs or non-zero reputation score
Hormonal Minimum of3615 discharges for relev 944 disorders non-zero reputation score
Kidney disease Minimum of 185 discharges for relev 1389 non-zero reputation score
Neurology and Minimum of464 discharges for rete 1408 Neurosurgery non-zero reputation score Orthopedics Minimum of392 discharges for relevant DRGs or 1406
non-zero reputation score Respiratory Minimum of881 discharges for relevant DRGs or 1409
disorders non-zero reputation score Rheumatology Minimum of22 discharges for relevant DRGs or non- 1376
zero reputation score Urology Minimum of 133 discharges for relevant DRGs or 1370
non-zero reputation score
7
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B Composite Measure of Structure
The structural dimension defines the tools and environment available to care providers in
treating patients It represents the possibilities of care for a patient and physician Healthcare
research overwhelmingly supports the use of a measure of structure in assessing quality of care
However no prior research has revealed a single indicator of quality that summarizes all others
or that adequately represents the structure construct on its own Thus the structural component
must be represented by a composite variable comprising different measures that are specialtyshy
specific and are weighted relative to each other
For the 2001 index all structural elements other than volume are derived from the 1999
AHA Annual Survey of Hospitals database and are described below For specific mapping of
variables to the AHA data elements see Appendix B
COTH membership This dichotomous variable indicates membership in the Council of
Teaching Hospitals
Technology indices In 2001 we added medical and surgical intensive care beds to
the list of nephrology elements All other technology elements for all other specialties are
unchanged A complete list of the technologies considered for each specialty can be found in
AppendixA
Since the 1996 version of the index we have allowed our technology indices to reflect
the real cost of high-technology services While providing a service inside the hospital is
convenient for patients the cost may be unacceptable to some hospitals Many hospitals
provide access to technology services through the hospitals health system a local community
network or a contractual arrangement or joint venture with another provider in the
community We have taken this into account by giving hospitals that provide a service such as
ultrasound on-site one full point for that element hospitals that provide the service locally
through a formal arrangement receive a half-point A hospital receives no more than one point
for each element of the index
Volume The volume measure reflects the total number of medical or surgical (or both
when appropriate) discharges in the appropriate specialty-specific ORO groupings submitted for
HCF A reimbursement In the heart specialty surgical discharges indicates volume Data from
the three most recent years is pooled The ORO groupings are shown in Appendix C
9
RNs to beds The number of beds is defined by the AHA as beds set up and staffed at
the end of the reporting period Only nurses who have graduated with RN degrees from
approved schools of nursing and who are currently registered by their state are considered
Nurses must be full-time (35 hoursweek or more) and on staff Private-duty nurses nursing
staff whose salary is financed entirely by outside sources (eg an agency or a research grant)
and LPNs are not counted Registered nurses more appropriately classified in other
occupational categories (eg supervisory nurses facility administrators) also are not counted
Trauma In 1992 the annual US News survey of board-certified physicians ranked the
presence of an emergency room and a hospitals trauma provider level high on a list of hospital
quality indicators Physicians in nine specialties ranked trauma as one of the top five indicators
of quality The indications of these specialists and resultant high factor loadings supported the
inclusion of this data for heart hormonal disorders digestive disorders gynecology kidney
disease neurology and neurosurgery orthopedics ear nose and throat respiratory disorders and
urology
The trauma indicator is dichotomous and reflects two variables from the AHA database
whether the hospital has a certified trauma center in the hospital and the level of the trauma
center To receive credit for trauma services hospitals must provide either Level 1 or Level 2
trauma services in-hospital (as opposed to providing trauma services only as part of a health
system network or joint venture) Levell trauma service is defined as a regional resource
trauma center which is capable of providing total care for every aspect of injury and plays a
leadership role in trauma research and education4 Level 2 is defined by the AHA as a
community trauma center which is capable ofproviding trauma care to all but the most severely
injured patients who require highly specialized care4
Discharge planning The three elements of discharge planning are patient-education
services case management services and patient representative services TA service must be
provided in-hospital to receive credit
Service mix This indicator ranges from 0 to 10 points and comprises alcoholdrug abuse
or dependency inpatient care hospice home health services social work services reproductive
health services psychiatric education services womens health centerservices and psychiatric
consultationlliaison services Services must be provided within the hospital We do not award a
half-point for items in this measure
10
L
Geriatric services This indicator ranges from 0 to 7 points and comprises arthritis
treatment centers adult day care programs patient representative services geriatric services
meals on wheels assisted living and transportation to health facilities Again to receive credit
for a service it must be provided in-hospital
Gynecology services This indicator was introduced in 19975 It provides a means to
better rate the quality of services a hospital provides for its gynecological and obstetric patients
High factor loadings provide support to this variables inclusion With a range of 0 to 4 the
services included are obstetric care reproductive health care birthing rooms and womens
health center The half-point scheme used for the technology indices was not employed for this
indicator
Medicalsurgical intensive care beds This indicator is new in 2001 it surfaced as an
important factor for the nephrology specialty The AHA database provides the number of
medical and surgical intensive care beds per facility To be counted beds must be physically
located within the hospital and set up and staffed at the end of the reporting period
To combine these structural variables we weight the elements to create a flnal
composite measure Using factor analysis we force a one-factor solution and use the resultant
loadings as weight values for each variable in the composite structural measure The
relative weight assigned to each element varies from specialty to specialty and from one release
to the next within specialty Figure 3 provides the factor weights assigned to each element for
the 2001 release
11
F
Fig
ure
3 F
acto
r Lo
adin
g by
Spe
cial
ty
CO
TH
Imiddot
Tec
hnic
al
V
olum
e R
Ns
lBed
s D
is-
Goomiddot
Inde
xes
chan
ze
Can
cer
73
59
70
70
Dig
esti
ve d
isor
ders
69
52
60
63
Ear
nos
e a
nd th
roat
72
54
64
63
Ger
iatr
ics
35
81
Gyn
ecol
ogy
61
71
I H
eart
72
62
65
61
I
56
Hor
mon
al d
isor
ders
71
53
56
65
I
63
Kid
ney
dise
ase
63
66
62
57
I 54
Neu
rolo
gy a
nd n
euro
surg
ery
68
54
62
66
62
Ort
hope
dics
69
46
54
66
63
Res
pira
tory
dis
orde
rs
50
73
31
51
58
Rhe
umat
olog
y 45
82
Uro
logy
73
49
C Process
The process dimension of the quality equation is the sum or net effect of physicians
clinical decision-making Physicians clinical choices about the use of medication or diagnostic
tests admission to the hospital or one ofits units and length ofstay account for a large fraction
of the outcomes experienced by patients However measurements ofprocess on a national scale
are extremely difficult to obtain In order to measure process we rely on an alternative measure
to act as a proxy for process We contend that when a qualified expert identifies a hospital as
one of the best he or she is in essence endorsing the process choices made at that hospital
Thus we use the nomination of a hospital by a board-certified specialist as a measure off process In order to collect these nominations we conduct an annual survey of board-certified
f - physicians As in past releases we have pooled nominations for the past three years [1999-2001] I to arrive at the process measure i
Survey sample The sample for the 2001 survey consists of 2550 board-certified
physicians selected from the American Medical Associations (AMA) Physician Masterfile of
811000 physicians From within the Masterfile we selected a target population of 194916
board-certified physicians who met the eligibility requirements listed in Figure 4 Stratifying by
region and by specialty within region we selected a probability (random) sample of 150
t l physicians from each of 17 specialty areas for a total of 2550 physicians The final sample
r includes both non-federal and federal medical and osteopathic physicians residing in the 50
states and the District ofColumbia Figure 4 displays the list of specialties surveyed in 2001
f Eligibility requirements We defined a probability sample of physicians who could
properly represent the 17 specialty groupings delineated by us News amp World Report We
used two rules of eligibility one related to a mapping between the 17 specialties and the AMAs
list of 85 self-designated specialties and the second related to a mapping between these 85
specialties and the 23 member boards of the American Boards ofMedical Specialties (ABMS)
Under the first rule we linked each of the 17 specialties to one or more relevant AMA
specialties from the list of AMA self-designated practice specialty codes Physicians who
designated a primary specialty in one of the 17 specialties were preliminarily eligible for the
survey Under the second rule the physicians must also be certified by the corresponding
member board of the ABMS Figure 4 displays the correspondence between the specialty [ specified for US News amp World Report AMA self-designated specialty and the corresponding
member board
13
Figure 4 Physician Sample Mapping
us NEWS SPECIALTY
Cancer
r Digestive disorders
Ear nose and throat
Eyes
Geriatrics
i
Gynecology L
Heart
Hormonal disorders
Kidney disease
Neurology and Neurosurgery
-l ~
Orthopedics
Pediatrics
Psychiatry
Rehabilitation
Respiratory disorders
Rheumatology
Urology
I AMAKEY CODE
HEMl22 ON24
GEl
OTO48
OPW46
FPG38 IMG38
GYN21 OBG42
CD08 CDS08
END14 DW12
NEP
N36 NS
ORS85
PO55 ADUOI
P63
PW62
PUD
RHU174
Ul91
AMASELF-middot DESIGNATED
Hematology Oncology
Gastroenterology
Otolaryngology
Ophthalmology
Geriatrics
Gynecology Obstetrics amp gynecology
Cardiovascular diseases Cardiovascular surgery
Endocrinology Diabetes
Nephrology
Neurology Neurological surgery
Orthopedic surgery
Pediatrics Adolescent medicine
Psychiatry
Physical medicine amp rehabilitation
Pulmonary diseases
Rheumatology
Urological surgery
14
AMERICAN BOARD OF
Internal medicine Internal medicine
almedicine
Otolaryngology
Ophthalmology
Internal medicine
Obstetrics amp gynecology Obstetrics amp gynecology
Internal medicine Surgery
Internal medicine Internal medicine
Internal Medicine
Psychiatry amp neurology
Orthopedic surgery
Pediatrics Pediatrics
Psychiatry amp neurology
Physical medicine amp rehabilitation
Internal medicine
I Internal medicine
Urology
r -
l
r
to
f -
1 bull
Stratification To compensate for the widely varying number of eligible physicians
across the targeted specialties we used different probabilities of selection for each grouping and
used proportionate stratification across the four United States Census regions (West Northeast
South and North Central) Within each of the 17 strata we achieved a sample that was also
geographically representative of the spread ofphysicians across the country
2001 physician survey Sampled physicians were mailed a three-page questionnaire (see
Appendix D) a cover letter and a prepaid return envelope We also included a token incentive
in the form of a two-dollar bilL One week after the initial survey mailing a reminder postcard
was sent to the sampled physicians Two weeks following the reminder mailing we sent a
second mailing to nonrespondents including the questionnaire a cover letter and a business reply
envelope Three weeks after the second mailing we re-sent the questionnaire to nonrespondents
This third mailing was sent by Federal Express and included the questionnaire a cover letter and
a business reply envelope
2001 questionnaire redesign In consultation with Dr Donald Dillman of Washington
State University a noted questionnaire designer we revised the physical layout of the project
questionnaire (Appendix D) so that respondents could read and complete it more easily We
believe that the redesign had appreciable impact on this years response rate (below and Figure
5)
Response rate Of the 2550 physicians surveyed for this years report 1377 physicians
returned a useable questionnaire a response rate of 547 percent (Response rate is calculated as
the ratio of completed questionnaires to the total eligible in accordance with standard practice
any member of the sample found to be ineligible was removed from the denominator of the
equation for calculation purposes) Figure 5 shows response rates by specialty for the three years
used for the 2001 index
2001 experiments NORC conducted two experiments as part of the physician survey
for 2001 Briefly the experiments were 1) a Web version of the survey permitting direct onshy
line response for physicians and 2) a comparison of explicit citations of the Americas Best
Hospitals project for US News amp World Report and implicit references to the 12th Annual
15
Survey of Physicians conducted for US News amp World Report Citations appeared on both the
cover letters and questionnaire cover As with last years experimental launching of the Web
version this years version was used successfully by a small number of respondents We plan to
evaluate the cost-effectiveness ofthis strategy before using it again next year With regard to the
project citation experiment half of the physicians in each specialty were told explicitly that their
responses would be used to rank hospitals in Americas Best Hospitals issue of US News amp
World Report and the other half were told that they were participating in an annual survey of
physicians for US News amp World Report Our comparison of the explicit and implicit project
citations indicated no difference in response rates The difference in the number of survey
questionnaires returned by each group within each specialty ranged from 1 to 8 Figure 5 [
details the total number of surveys returned for each specialty
16
r
~
r-
lt
ance
r ig
esti
ve d
isor
ders
orm
onal
dis
orde
rs
idne
y di
seas
e
euro
logy
and
esp
irat
ory
diso
rder
s gy
Fig
ure
5 R
espo
nse
Rat
e b
y Y
ear
(150
sam
pled
phy
sici
ans
per
spe
cial
ty p
erye
ar)
n 70
71
82
75
84
70
62
68
62
78
r
Weighting Weighting was carried out in two steps First weights were assigned to
physicians that reflected the probabilities of selection within specialty groups and the overall
rates ofresponse within these groups Second the weights from the first step were poststratified
using the two-dimensional contingency table of specialty (17 categories) by census region
(Northeast Midwest South and West) To check the weights we ~nfinned that the sum across
the sample of the weights in each cell of the classifications (specialty x region) equaled the
population size
D Outcome
Many healthcare professionals have decried the use of mortality rates because of
limitations in the methods used to adjust for risk Nonetheless research strongly suggests a
positive correlation between a risk-adjusted mortality rate that is better than average and overall
quality8-17 Based on these findings we used adjusted mortality rate as the outcome measure for
our quality of care model All predicted mortality rates were provided by Solucient Inc of
Evanston Ill using the All Patient Refined Diagnosis Related Group (APR-DRG) method
designed by 3M Health Information Systems The APR-DRG adjusts expected deaths for
severity of illness by means of principle diagnosis and categories of secondary diagnoses A
detailed description of the full APR-DRG methodology is provided in Appendix E Solucient
applied this method to the pooled 1997 1998 and 1999 data set of reimbursement claims made to
HCF A by hospitals These complete data sets were the most current available
2001 DRG refmements We annually review the DRG-groupings for every specialty In 2001
we chose to conduct a thorough examination of the DRG groupings in heart and orthopedics
Because we anticipated likely changes as a result we conducted two independent reviews
Solucient conducted a review of each specialty and an independent consultant shy
a cardiologist and an orthopedic surgeon--conducted a review in his specialty Where the two
reviews agreed as they did in each of the two specialties we implemented the recommended
changes Revisions for each specialty are detailed below
18
Heart DRGs Three DRGs were added
109 = Coronary bypass wlo cardiac cath
124 =Circulatory disorders except AMI w cardiac cath and complex diag
125 =Circulatory disorders except AMI w cardiac cath and wlo complex diag
Orthopedic DRGs Two DRGs were deleted and six were added
DeletedDRGs
214 =Back amp neck procedures wI CC
215 =Back amp neck procedures wlo CC
AddedDRGs
496 =Combined anteriorlposterior spinal fusion
497 = Spinal fusion wI CC r 498 = Spinal fusion wlo CC 501 =Knee proc wI pdx ofinfection wi CC
502 =Knee proc wI pdx ofinfection wlo CC
503 =Knee proc wlo pdx ofinfection
As in previous years we used an all-cases mortality rate for four specialties (geriatrics
gynecology ear nose and throat and rheumatology) rather than a specialty-specific rate either
because the number of hospitals with sufficient discharges in the particular DRG-grouping was
too low or because the DRG groupings proved to be less robust than was desired Appendix C r -
lists the DRGs for each specialty
In 2000 we modified the construction of the outcome measure The IRQ is the final
score for each hospital in the specialty rankings It gives equal weight to process (represented by
reputation) outcome (mortality) and structure (volume technology and other elements of the
hospital environment) The numbers produced for each of these three measures however differ
greatly in magnitude and in range or variability Without correcting for that the final score
even when the three measures are weighted equally would be distorted
19
Pre-2000 solution For each specialty prior to 2000 the calculated mortality ratio for each
hospital was inverted--the ratio of actual to expected deaths was divided into 1 so that as with
other measures higher meant better For example a better-than-expected mortality ratio of 08
would produce an inverted result of 125 a worse-than-expected ratio of 12 would produce an
inverted result of 083 (The published rankings continued to display the ratio of actual to
expected deaths) Then the scores for reputation mortality and structure were standardized or
adjusted so that the degree ofvariability in each measure was the same
A difficulty with this approach was that inverting caused very low mortality ratios to
distort the outcome (Inverted a mortality ratio of 025 produces a score of 4 a ratio of 005
produces a score of 20 and a ratio of 001 produces a score of 100) If instead of being divided
into 1 the mortality ratio is subtracted from I-this could be called reverse scoring-such extremes r
are eliminated Using reverse scoring a mortality ratio of 025 produces a score of 075 a ratio
of 005 produces a score of 095 and a ratio of 001 produces a mortality score of 99 This
maintains the magnitudes of the differences and avoids extreme values Accordingly the new
rankingsreflect reverse scoring in mortality To dampen the effect of year-to-year fluctuations
mortality scores will be averaged over three years
Finally scores at the extremes in mortality and in certain structural measures were
trimmed to eliminate the influence ofvery wide variation Figure 6 gives the percentile at which
each of the mortality distributions was trimmed
Lj Figure 6 Percentile at Which Each Mortality Distribution Was Trimmed
Specialty
Cancer
Digestive disorders
Ear nose and throat
Geriatrics
Gynecology
Heart
Hormonal disorders l ~
Percentile
95
99
95
99
99
95
95
Specialty Percentile
Kidney disease 99
Neurology and neurosurgery 99
Orthopedics 95
Respiratory disorders 99
Rheumatology 99
Urology 90
20
l
A second round of standardizing also was added in 2000 after trimming extremes
Previously this second standardization was not perfonned resulting in trimmed measures having
less influence on the final score than other measures did Restandardizing restores the balance so
that trimmed and untrimmed measures have the same influence
Phase-in The changes described affect the final scores so they are phased in over two
years For 2000 each hospitalts final score averaged pre-2000 and current methodologies As
before the top hospital in each specialty received a score of 100 with other hospitals scaled
down from that figure
In 2001 the phase-in is complete with the 2001 mortality ratios fully reflecting the
revised methodology
J
--
21
E Calculation of the Index
i
The calculation of the IRQ for each hospital (other than in specialties ranked solely on
reputation) considers equally the three dimensions of quality of care structure process and
outcome Although all three measures represent a specific aspect of quality a single score not
only provides an easier-to-use result but yields a more accurate portrayal of overall quality than
would the three aspects individually
Therefore in computing the final scores for a particular specialty the reputational score
mortality scores and the collective set of structural indicators receive arithmetically equivalent
importance
The total fonnula for calculation of the specialty-specific IHQs is
where
IHQi = Index for Hospital Quality for specialty i
Sl-n = Structural indicators (STRUCTURE)
F = Factor loading
P = Nomination score (PROCESS)
M = Standardized mortality ratio (OUTCOME)
The general fonnula for deriving the index scores for tertiary-level hospitals is the same
as it began in 1993 Each of the three components--structure process and outcomes--is
considered equally in determining the final overall score For presentation purposes we
standardized raw scores then equated the raw IRQ scores as computed above to a 100-point
scale where the top hospital in each specialty received a score of 100
The mean and standard deviation of each of the 17 specialties are listed in Figure 7
Note that for the four reputation-only rankings mean and standard deviation of the reputational
score are presented This data further illustrates that the spread of IRQ scores produces a very
small number of hospitals two and three standard deviations above the mean Horizontal lines
in each of the 17 specialty lists in Appendices F and G indicate the cutoff points of two and
three standard deviations above the mean
22
We could not calculate scores for hospitals that provide care in eyes pediatrics
psychiatry or rehabilitation because data for robust and meaningful structural and outcomes
measures are not available for these specialties Thus as shown in Appendix G we rank
hospitals in these specialties solely by reputation Although the four reputation-only specialties
are ranked without the Index of Hospital Quality standard deviations of the reputational scores
are still useful in identifying truly superior hospitals (in terms of statistically relevant nomination
scores)
Figure 7 Mean and Standard Deviations ofIHQ and Reputational Scores
Mean Standard deviation 1 SD above Z SDs above 3 SDs above the mean the mean the mean
~- IHQScore
Cancer 2390 652 3042 3694 4346
Digestive disorders 1514 538 2052 2590 3128
Ear nose and throat 2064 647 2711 3358 4005
Geriatrics 2049 588 2637 3225 3813 Gynecology 1857 598 2455 3053 3651
Heart 2079 674 2753 3427 4101 Hormonal disorders 2545 574 3119 3693 4267 Kidney disease 2600 758 3358 4116 4874
Neurology and 1781 562 2343 2905 3467 neurosurgery Orthopedicsmiddot 1960 539 2499 3038 3577I Respiratory disorders 1665 569 I 2234 2805 3372 Rheumatology 3768 454 4222 4676 5130 Urology 1930 502 2432 2934 3436
Reputational Score
lEyes 455 1272 1727 2999 4271 [pediatrics 299 659 958 1617 2276 psychiatry 252 524 776 1300 1824 Rehabilitation 287 777 1064 1841 2618
23
III Directions for Future Releases
The US News Index has since its inception used the most rigorous methodology
available to define measure and combine the components of quality incorporated in its
construction Over the next few years we plan to subject each of the components (process
outcome and structure) to a searching re-examination We are aware that the skewed
distribution of the reputation scores can appear to give an inappropriate advantage to hospitals
that obtain a high percentage ofnominations and we will continue to examine the way in which
the reputation scores are used to define the process score We intend to test and evaluate
different transformations of the raw scores to see whether a transformation would produce a
bull i superior measure With regard to outcome the refinement of definitions of non-fatal outcomesshy
particularly in some specialties-suggests incorporating some of these measures into outcome
scores We will continue to refine and develop our measures of technology for the structural
component Finally we will re-examine the way in which the three components are combined
into the IHQ There may be ways to maintain the principle of equal weight for the three
components while improving the method ofcombining them
We will also examine the possibility of extending the evaluation of the four specialties
that are currently ranked only on reputation to incorporate appropriate structure and outcome
measures
As in years past we welcome input from users of the index in charting new directions
Readers and users are encouraged to contact the authors with suggestions and questions
j bull
24
l
lmiddot
References 1 Donabedian A Evaluating the quality of medical care The Milbank Memorial Fund Quarterly
1966 44166-203
2 Donabedian A Promoting quality through evaluating the process of patient care Med Care 1968 6181
3 Hill CA Winfrey KL Rudolph BA Best Hospitals A description of the methodology for the index ofhospital quality Inquiry 1997 34(1)80-90
4 American Hospital Association 1996 Annual Survey of Hospitals Data Base Documentation Manual
5 Ehrlich RH Hill CA Winfrey KL 1997 Survey oBest Hospitals Chicago NORC 1997
6 Hill CA Winfrey KL1995 Survey on Best Hospitals Chicago NORC 1995
7 Palella FJ Jr Delaney KM Moorman AC Loveless MO Fuhrer J Satten GA Aschman DJ Holmberg SD Declining Morbidity and Mortality Among Patients With Advanced Human Immunodeficiency Virus Infection N Engl J Med 1998 338853-860
8 United States Department of Health and Human Services Medicare hospital mortality information HCFA publication 01-002 Report prepared by Otis R Bowen and William L Roper Washington DCUSGPO 1987
9 Blumberg MS Comments on HCFA hospital death rate statistical outliers HSR Health Services Research 1987 21715-40
10 Dubois RW Brook RH Rogers WH Adjusted hospital death rates a potential screen or the quality ofmedical care MPH 1987 771162-6
11 Gillis KD Hixson JS Efficacy of statistical outlier analysis for monitoring quality of care Journal oBusiness and Economic Statistics 1991 9241-52
12 Green J Wintfield N Sharkey P Passman LJ The importance of severity of illness in assessing hospital mortality JAMA 1990 263241-6
13 Green J Passman LJ Wintfield N Analyzing hospital mortality the consequences ofdiversity in patient mix JAMA 1991 2651849-53
14 Greenfield S Aronow HU ElashoffRM Watanabe D Flaws in mortality data the hazards of ignoring comorbid disease JAMA 1988 2602253-7
15 Rosen HM Green BA The HCFA excess mortality lists a methodological critique Hospital and Health Services Administration 1987 2119-24
16 Flood AB Scott WR Conceptual and methodological issues in measuring the quality of care in hospitals In Hospital structure and performance Baltimore Johns Hopkins University Press 1987
17 Iezzoni LI Ash AS Coffinan GA Moskowitz MA Predicting in-hospital mortality a comparison of severity measurement approaches Med Care 1992 30347-59
25
Appendix A
Technology Indices by Specialty t
1
All Hospital Index
17 elements (used to define eligible hospitals)
r
Cancer
7 Elements
AnRioplasty Cardiac Catheterization Lab
Cardiac Intensive Care Beds
Computed Tomography Scanner
Diagnostic Radioisotope Facility
Diagnostic Mammography Services
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
MedicaVSurgical Intensive Care
Neonatal Intensive Care Beds
Open Heart Surgery
Pediatric Intensive Care Beds
Positron Emission Tomography Scanner
ReprQductive Health
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraphy Scanner Magnetic Resonance Imaging
Oncology Services
Pediatric Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
I Digestive disorders
8 Elements Computed Tomography Scanner Diagnostic Radioisotope Facility
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound i
X-ray Radiation Therapy
Ear Nose and Throat
5 Elements Comouted Tomorrraohv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
Heart
9 Elements Angioplasty Cardiac Catheterization Lab
Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Open Heart Surgery
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
j
Hormonal disorders
7 Elements
Geriatrics
8 Elements
Gynecology
8 Elements
Computed TomoRraphv Scanner Diagnostic Radioisotope Facility
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Cardiac Catheterization Lab Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraDhv Scanner Diagnostic Mammography Services
Magnetic Resonance Imaging
Neonatal Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Kidney disease
5 Elements
Neurology and f Neurosurgery t j
7 Elements
t
l
Orthopedics
5 Elements I t
Respiratory disorders 4 Elements
Extracorporeal Shock Wave Lithiotripter Ultrasound
Computed Tomography Scanner
Diagnostic Radioisotope FacUity
Transplant Services
Computed Tomography Scanner Diagnostic Radioisotope FacUity
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed Tomolraphv Scanner Magnetic Resonance Imaging
Positron Emissions Tomography Scanner
Single Photon Emissions Computed Tomography
Ultrasound
Computed Tomographv Scanner Diagnostic Radioisotope FacUity
Radiation Therapy
Ultrasound
Rheumatology
5 Elements Computed TomoJraphv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
Urology
8 Elements Extracorporeal Shock Wave Lithiotripter X-ray Radiation Therapy
Computed Tomography Scanner
Diagnostic Radioisotope Facility
i Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
(
i
AppendixB
Structural Variable Map
f
L
r
t bull
r
tJ
L
The following variables used to construct structural elements of the 2001 IHQ were taken from the 1999 Annual Survey of Hospitals Data Base published by the American Hospital Association
ALL HOSP~TAL ~NDBX - used to define hospital eligibility 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ~GIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICBDHOS=l half point if CICBDSYS CICBDNET or CICBDVEN=l 1 point if CTS CNHOS=1 half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if MSICHOS=l half point if MSICSYS MSICNET or MSICVEN=l 1 point if NICBDHOS=l half point if NICBDSYS NICBDNET or NICBDVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PEDBDHOS=l half point if PEDBDSYS PEDBDNET or PEDBDVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if REPROHOS=l half point if REPROSYS REPRONET or REPROVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Cancer Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if ONCOLHOS=l half point if ONCOLSYS ONCOLNET or ONCOLVEN=l 1 point if PEDICHOS=l half point if PEDICSYS PEDICNET or PEDICVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
Digestive Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Ear I Nose and Throat Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRIVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
1
Heart Technology Index 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ANGIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNETor CICVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Hormonal Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRlHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Geriatrics Technology Index 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNET or ClCVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETROS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Gynecology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if NICHOS=l half point if NICSYS NICNET or NlCVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Kidney Disease Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=lhalf point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if TPLNTHOS=l half point if TPLNTSYS TPLNTNET or TPLNTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Neurology and Neurosurgery Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Orthopedics TeChn610gy ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Respiratory Disorders Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Rheumatology Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Urology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
r
I
Discharge Planning COTH ] point if CMNGTHOS=] Yes if MAPP8=1 ] point if PATEDHOS=] 1 point if PATRPHOS=l RN I s to Beds
Full-time Registered Nurses Geriatric Services (FTRNTF) divided by Total Hospital 1 point if ADULTHOS=l Beds (HOSPBD) ] point if ARTHCHOS=l 1 point if ASSTLHOS=l Trauma ] point if GERSVHOS=l Yes if TRAUML90=] or 2 and 1 point if MEALSHOS=l TRAUMHOS=l 1 point if PATRPHOS=l 1 point if TPORTHOS=l
Gynecology Services 1 point if BROOMHOS=l 1 point if OBLEV=2 or 3 and OBHOS=] 1 point if REPROHOS=l
l ~
1 point if WOMHCHOS=l r ~
Service Mix ] point if ALCHHOS=l ] point if COUTRHOS=l 1 point if HOMEHHOS=l ] point if HOSPCHOS=l ] point if PSYEDHOS=] 1 point if PSYLSHOS=] 1 point if REPROHOS=l ] point if SOCWKHOS=] ] point if WOMHCHOS=]
l
i
1
[ l
AppendixC
Diagnosis-Related Group (DRG) Groupings l by Specialty
r 1
DRG10 DRGll DRG64 DRG82 DRGl72 DRG173 DRG199 DRG203 DRG239
DRG257 DRG258 DRG259 DRG260 DRG274
r 1 DRG275 DRG338 DRG344 DRG346 DRG347 DRG354 DRG355 DRG357 DRG366 DRG367 DRG400 DRG401 DRG402 DRG403 DRG404 DRG405 DRG409 DRG410 DRG411 DRG412 DRG413 DRG414
r 1 DRG473 DRG492
1
U
I 1
LJ
Cancer
NERVOUS SYSTEM NEOPLASMS W CC NERVOUS SYSTEM NEOPLASMS WIO CC EAR NOSE MOUTH amp TIIROAT MALIGNANCY RESPIRATORY NEOPLASMS DIGESTIVE MALIGNANCY W CC DIGESTIVE MALIGNANCY WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS PAlHOLOGICAL FRACTURES amp MUSCULOSKELETAL amp CONN TISS MALIGNANCY TOTAL MASTECTOMY FOR MALIGNANCY W CC TOTAL MASTECTOMY FOR MALIGNANCY WIO CC SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC SUBTOTAL MASTECTOMY FOR MALIGNANCY WIO CC MALIGNANT BREAST DISORDERS W CC MALIGNANT BREAST DISORDERS WIO CC TESTES PROCEDURES FOR MALIGNANCY OTHER MALE REPRODUCTIVE SYSTEM OR PROCEDURES FOR MALIGNANCY MALIGNANCY MALE REPRODUCTIVE SYSTEM W CC MALIGNANCY MALE REPRODUCTIVE SYSTEM WIO CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG W CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG WIO CC UTERINE amp ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY MALIGNANCY FEMALE REPRODUCTIVE SYSTEM W CC_ MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WIO CC LYMPHOMA amp LEUKEMIA W MAJOR OR PROCEDURE LYMPHOMA amp NONmiddotACUTE LEUKEMIA W OTHER OR PROC W CC LYMPHOMA amp NON-ACUTE LEUKEMIA W OTHER OR PROC WIO CC LYMPHOMA amp NON-ACUTE LEUKEMIA W CC LYMPHOMA amp NON-ACUTE LEUKEMIA WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGE 0-17 RADIOlHERAPY CHEMOTHERAPY WIO ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS HISTORY OF MALIGNANCY WIO ENDOSCOPY HISTORY OF MALIGNANCY W ENDOSCOPY OlHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGEgt17 CHEMOTHERAPY W ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS
DRG146 DRG147 DRG148 DRG149 DRG150 DRG151 DRG152 DRG153 DRG154 DRG155 DRG156 DRG170
l i DRG171 DRG174 DRG175
L DRG176 DRG177 DRG178 DRG179 DRG180 DRG181 DRG182 DRG183 DRG184 DRG188
l DRG189 DRG190 DRG191
i J DRG192 DRG193 DRG194 DRG195 DRG196 DRG197
t
LeJ DRG198 DRG200 DRG201 DRG202 DRG204 DRG205 DRG206 DRG207 DRG208 DRG493 DRG494
Digestive Disorders
RECTAL RESECTION W CC RECTAL RESECTION WIO CC MAJOR SMALL amp LARGE BOWEL PROCEDURES W CC MAJOR SMALL amp LARGE BOWEL PROCEDURES WIO CC PERITONEAL ADHESIOLYSIS W CC PERITONEAL ADHESIOLYSIS WIO CC MINOR SMALL amp LARGE BOWEL PROCEDURES W CC MINOR SMALL amp LARGE BOWEL PROCEDURES WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE gt17 W CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGEgt17 WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE 0-17 OTHER DIGESTIVE SYSTEM OR PROCEDURES W CC OTHER DIGESTIVE SYSTEM OR PROCEDURES WO CC G HEMORRHAGE W CC GJ HEMORRHAGE WIO CC COMPLICATED PEPTIC ULCER UNCOMPLICATED PEPTIC ULCER W CC UNCOMPLICATED PEPTIC ULCER WIO CC INFLAMMATORY BOWEL DISEASE GI OBSTRUCTION W CC GI OBSTRUCTIONWO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 W CC ESOPHAGmS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 WIO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGE 0-17 OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 W CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 WIO CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0-17 PANCREAS LIVER amp SHUNT PROCEDURES W CC PANCREAS LIVER amp SHUNT PROCEDURES W 10 CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE W CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE WIO CC CHOLECYSTECTOMY W CDE W CC CHOLECYSTECTOMY W CDE WIO CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE W CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY OTHER HEPATOBILIARY OR PANCREAS OR PROCEDURES CIRRHOSIS amp ALCOHOLIC HEPATITIS DISORDERS OF PANCREAS EXCEPT MALIGNANCY DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEP A W CC DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEPA WIO CC DISORDERS OF THE BILIARY TRACT W CC DISORDERS OF THE BILIARY TRACT WO CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE W CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE WO CC
DRG49 DRG50 DRG51 DRG55 DRG57 DRG58 DRG61 DRG62 DRG63 DRG65 DRG66 DRG67
DRG68
DRG69 DRG70 DRG71 DRG72 DRG73 DRG74
DRG353 DRG356 DRG358 DRG359 DRG360 DRG361 DRG362 DRG363 DRG364 DRG365 DRG368 DRG369
Ear Nose and Throat
MAJOR HEAD amp NECK PROCEDURES SIALOADENECTOMY SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY MISCELLANEOUS EAR NOSE MOUTH amp TIiROAT PROCEDURES TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGEgt17 TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGE 0-17 MYRINGOTOMY W TUBE INSERTION AGE gt17 MYRINGOTOMY W TUBE INSERTION AGE 0-17 OTHER EAR NOSE MOUTH amp TIiROAT OR PROCEDURES DYSEQUILIBRIUM EPISTAXIS EPIGLOTTITIS
OTITIS MEDIA amp URI AGEgt17 W CC OTITIS MEDIA amp URI AGEgt17 WIO CC OTITIS MEDIA amp URI AGE 0-17 LARYNGOTRACHEITIS NASAL TRAUMA amp DEFORMITY OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE gt17 OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE 0-17
Geriatrics ALL CASES
Gynecology
PELVIC EVISCERATION RADICAL HYSTERECTOMY amp RADICAL VULVECTOMY FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY W CC UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY WIO CC VAGINA CERVIX amp VULVA PROCEDURES LAP AROSCOPY amp INCISIONAL TUBAL INTERRUPTION ENDOSCOPIC TUBAL INTERRUPTION DampC CONIZATION amp RADIO-IMPLANT FOR MALIGNANCY DampC CONIZATION EXCEPT FOR MALIGNANCY OrnER FEMALE REPRODUCTIVE SYSTEM OR PROCEDURES INFECTIONS FEMALE REPRODUCTIVE SYSTEM MENSTRUAL amp OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
DRG103 DRGl04 DRG105 DRG106 DRG107 DRG108 DRG109
DRG1l0 DRG1l1 DRG112 DRG115 DRG1l6 DRG117 DRG118 DRG121 DRG122 DRG123 DRG124 DRG125 DRG126 DRG127 DRG128 DRG129 DRG130 DRG131 DRG132 DRG133 DRG135 DRG136 DRG137 DRG138 DRG139 DRG140 DRG141middot DRG142 DRG 144 DRG145
r i
f ~
Heart
HEART TRANSPLANT CARDIAC VALVE PROCEDURES W CARDIAC CATH CARDIAC VALVE PROCEDURES WIO CARDIAC CATH CORONARY BYPASS W CARDIAC CATH CORONARY BYPASS WIO CARDIAC CATH OTHER CARDIOTHORACIC PROCEDURES CORONARY BYPASS WIO CARDIAC CATH
MAJOR CARDIOVASCULAR PROCEDURES W CC MAJOR CARDIOVASCULAR PROCEDURES WIO CC PERCUTANEOUS CARDIOVASCULAR PROCEDURES PERM CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK OTH PERM CARDIAC PACEMAKER IMPLANT OR AICD LEAD OR GENERATOR PRO
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT CARDIAC PACEMAKER DEVICE REPLACEMENT CIRCULATORY DISORDERS W AMI amp CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI WIO CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI EXPIRED CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH AND CMPLX DIAG CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH WIO CMPLX DIAG ACUTE amp SUBACUTE ENDOCARDmS HEART FAILURE amp SHOCK DEEP VEIN THROMBOPHLEBITIS CARDIAC ARREST UNEXPLAINED PERIPHERAL VASCULAR DISORDERS W CC PERIPHERAL VASCULAR DISORDERS WIO CC ATHEROSCLEROSIS W CC ATHEROSCLEROSIS WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 W CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGE 0-17 CARDIAC ARRHYTIIMIA amp CONDUCTION DISORDERS W CC CARDIAC ARRHYTHMIA amp CONDUCTION DISORDERS WIO CC ANGINA PECTORIS SYNCOPE amp COLLAPSE W CC SYNCOPE amp COLLAPSE WIO CC OTHER CIRCULATORY SYSTEM DIAGNOSES W CC OTHER CIRCULATORY SYSTEM DIAGNOSES WIO CC
1
DRG286 DRG287 DRG288 DRG289 DRG290 DRG292 DRG293 DRG294 DRG295 DRG296 DRG297
t DRG298 DRG299
DRG300 DRG301
~- --j
DRG316 DRG317 DRG320 DRG321 DRG322 DRG325 DRG326 DRG327 DRG 331 DRG332 DRG333
f
Hormonal Disorders
ADRENAL amp PITUITARY PROCEDURES SKIN GRAFTS amp WOUND DEBRID FOR ENDOC NUTRlT amp METAB DISORDERS OR PROCEDURES FOR OBESITY P ARA1HYROID PROCEDURES 1HYROIDPROCEDURES OrnER ENDOCRINE NUTRIT amp METAB OR PROC W CC 01HER ENDOCRINE NUTRIT amp METAB OR PROC WIO CC DIABETES AGE gt35 DIABETES AGE 0-35 NUTRlTIONAL amp MISC METABOLIC DISORDERS AGEgt17 W CC NUTRITIONAL amp MISC METABOLIC DISORDERS AGE gt17 WIO CC NUTRlTIONAL amp MISC METABOLIC DISORDERS AGE 0-17 INBORN ERRORS OF METABOLISM ENDOCRINE DISORDERS W CC ENDOCRINE DISORDERS WIO CC
Kidney Disease
RENAL FAILURE ADMIT FOR RENAL DISEASE KIDNEY amp URINARY TRACT INFECTIONS AGE gt17 W CC KIDNEY amp URINARY TRACT INFECTIONS AGEgt17 WIO CC KIDNEY amp URINARY TRACT INFECTIONS AGE 0-17 KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 W CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 WIO CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMS AGE 0-17 01HERKIDNEY amp URINARY TRACT DIAGNOSES AGE gt17 W CC 01HER KIDNEY amp URINARY TRACT DIAGNOSESgt 17 WIO CC 01HER KIDNEY amp URINARY TRACT DIAGNOSES AGE 0-17
Neurology and Neurosurgery
DRGl CRANIOTOMY AGE gt17 EXCEPT FOR TRAUMA DRG2 CRANIOTOMY FOR TRAUMA AGEgt17 DRG3 CRANIOTOMY AGE 0-17 DRG4 SPINAL PROCEDURES DRG5 EXTRACRANIAL VASCULAR PROCEDURES DRG6 CARPAL TUNNEL RELEASE DRG7 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC W CC DRG8 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC WIO CC DRG9 SPINAL DISORDERS amp INJURIES DRG12 DEGENERATIVE NERVOUS SYSTEM DISORDERS
j DRG13 MULTIPLE SCLEROSIS amp CEREBELLAR ATAXIA DRG14 SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA DRG15 TRANSIENT ISCHEMIC ArrACK amp PRECEREBRAL OCCLUSIONS DRG16 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC DRG17 NONSPECIFIC CEREBROVASCULAR DISORDERS WIO CC DRG18 CRANIAL amp PERIPHERAL NERVE DISORDERS W CC DRG19 CRANIAL amp PERIPHERAL NERVE DISORDERS WIO CC DRG20 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGmS DRG21 VIRAL MENlNGITIS DRG22 HYPERTENSIVE ENCEPHALOPATHY DRG23 NONTRAUMATICSTUPORampCOMA DRG24 SEIZURE amp HEADACHE AGEgt17 W CC DRG25 SEIZURE amp HEADACHE AGEgt17 WIO CC DRG26 SEIZURE amp HEADACHE AGE 0-17 DRG27 TRAUMATIC STUPOR amp COMA COMA gt1 HR DRG28 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGEgt17 W CC DRG29 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE gt17 WIO CC
imiddot DRG30 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE 0-17 DRG31 CONCUSSION AGEgt17 W CC DRG32 CONCUSSION AGEgt17 WIO CC DRG33 CONCUSSION AGE 0-17 DRG34 OTHER DISORDERS OF NERVOUS SYSTEM W CC DRG35 OTHER DISORDERS OF NERVOUS SYSTEM WIO CC
(
DRG209 DRG210 DRG211 DRG212 DRG213 DRG216 DRG217 DRG218 DRG219 DRG220 DRG221 DRG222 DRG223 DRG224 DRG225 DRG226 DRG227 DRG228 DRG229 DRG230 DRG231 DRG232 DRG233 DRG234 DRG235
j DRG236 DRG237 DRG238 DRG240 DRG241 DRG471 DRG485
DRG491 DRG496 DRG497 DRG498
f DRG501 DRG502 DRG503
Orthopedics
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 W CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 WIO CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0-17 AMPUTATION FOR MUSCULOSKELETAL SYSTEM amp CONN TISSUE DISORDERS BIOPSIES OF MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE WND DEBRID amp SKN GRFT EXCEPT HANDFOR MUSCSKELET amp CONN TISS DIS LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 W CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 WIO CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGE 0-17 KNEE PROCEDURES W CC KNEE PROCEDURES WO CC MAJOR SHOULDERIELBOW PROC OR OTHER UPPER EXTREMITY PROC W CC SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC WIO CC FOOT PROCEDURES SOFT TISSUE PROCEDURES W CC SOFT TISSUE PROCEDURES WIO CC MAJOR THUMB OR JOINT PROCOR OTH HAND OR WRIST PROC W CC HAND OR WRIST PROC EXCEPT MAJOR JOINT PROC WIO CC LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES OF HIP amp FEMUR LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES EXCEPT HIP amp FEMUR ARTHROSCOPY OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC W CC OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC WIO CC FRACTURES OF FEMUR FRACTURES OF HIP amp PELVIS SPRAINS STRAINS amp DISLOCATIONS OF HIP PELVIS amp THIGH OSTEOMYELmS CONNECTIVE TISSUE DISORDERS W CC CONNECTIVE TISSUE DISORDERS WIO CC BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY LIMB REATTACHMENT HIP AND FEMUR PROC FOR MULT SIGNIFICANT
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY COMBINED ANTERIORIPOSTERIOR SPINAL FUSION SPINAL FUSION WI CC SPINAL FUSION WIO CC KNEE PROC WI PDX OF INFECTION WI CC KNEE PROC WI PDX OF INFECTION WOCC KNEE PROC WOPDX OF INFECTION WI CC
~ t L ~
l
DRG76 DRG77 DRG78 DRG79 DRG80 DRG81 DRG85 DRG86 DRG87 DRG88 DRG89 DRG90 DRG91 DRG92 DRG93 DRG94 DRG95 DRG96 DRG97 DRG98 DRG99 DRG100 DRG101 DRG102 DRG475
DRG242 DRG244 DRG245 DRG246 DRG247 DRG256
i_J
Respiratory Disorders
OTHER RESP SYSTEM OR PROCEDURES W CC OTHER RESP SYSTEM OR PROCEDURES WO CC PULMONARYEMBOUSM RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 W CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 WO CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGE 0-17 PLEURAL EFFUSION W CC PLEURAL EFFUSION WO CC PULMONARY EDEMA amp RESPIRATORY F AlLURE CHRONIC OBSTRUCTIVE PULMONARY DISEASE SIMPLE PNEUMONIA amp PLEURISY AGEgt17 W CC SIMPLE PNEUMONIA amp PLEURISY AGEgt17 WO CC SIMPLE PNEUMONIA amp PLEURISY AGE 0-17 INTERSTITIAL LUNG DISEASE W CC INTERSTITIAL LUNG DISEASE W 10 CC PNEUMOTIIORAX W CC PNEUMOTIIORAX WO CC BRONCHmS amp ASTIIMA AGEgt17 W CC BRONCHmS amp ASTIIMA AGEgt17 WO CC BRONCIDTIS amp ASTIIMA AGE 0-17 RESPIRATORY SIGNS amp SYMPTOMS W CC RESPIRATORY SIGNS amp SYMPTOMS WO CC OTHER RESPIRATORY SYSTEM DIAGNOSES W CC OTHER RESPIRATORY SYSTEM DIAGNOSES WO CC RESPIRATORY SYSTEM DIAGNOSIS WITII VENTILATOR SUPPORT
Rheumatology
SEPTIC ARTHRITIS BONE DISEASES amp SPECIFIC ARTHROPATIIIES W CC BONE DISEASES amp SPECIFIC ARTHROPATIDES WO CC NON-SPECIFIC ARTHROPATHIES SIGNS amp SYMPTOMS OF MUSCULOSKELETAL SYSTEM amp CONN TISSUE OTIIER MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE DIAGNOSES
DRG302 DRG303 DRG304 DRG305 DRG306 DRG307 DRG308 DRG309 DRG31O DRG311 DRG312 DRG313 DRG314
DRG315 DRG323 DRG324 DRG328 DRG329 DRG330 DRG334 DRG335 DRG336 DRG337 DRG339 DRG340 DRG341 DRG342 DRG343 DRG348 DRG349 DRG350 DRG351 DRG352
Urology
KIDNEY TRANSPLANT KIDNEYURETER amp MAJOR BLADDER PROCEDURES FOR NEOPLASM KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL W CC KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL WIO CC PROSTATECTOMY W CC PROSTATECTOMY WIO CC MINOR BLADDER PROCEDURES W CC MINOR BLADDER PROCEDURES WIO CC TRANSURETHRAL PROCEDURES W CC TRANSURETHRAL PROCEDURES WIO CC URETHRAL PROCEDURES AGE gt17 W CC URETHRAL PROCEDURES AGEgt17 WIO CC URETHRAL PROCEDURES AGE 0-17 OTHER KIDNEY amp URINARY TRACT OR PROCEDURES URINARY STONES W CC amplOR ESW LTIHOTRIPSY URINARY STONES WIO CC URETHRAL STRICTURE AGEgt17 W CC URETHRAL STRICTURE AGE gt17 WIO CC URETHRAL STRICTURE AGE 0-17 MAJOR MALE PELVIC PROCEDURES W CC MAJOR MALE PELVIC PROCEDURES WIO CC TRANSURETHRAL PROSTATECTOMY W CC TRANSURETHRAL PROSTATECTOMY WIO CC TESTES PROCEDURES NON-MALIGNANCY AGEgt17 TESTES PROCEDURES NON-MALIGNANCY AGE 0-17 PENIS PROCEDURES CIRCUMCISION AGEgt17 CIRCUMCISION AGE 0-17 BENIGN PROSTATIC HYPERTROPHY W CC BENIGN PROSTATIC HYPERTROPHY WIO CC INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM STERILIZATION MALE OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES
AppendixD
f 2001 Sample Physician Questionnaire
( Americas Best Hospitals)
This survey of physicians judgments provides the
basis for the reputation component of the annual
ranking of hospitals for U S News amp World Report
c
Conducted by the National Opinion Research Center at the University of Ctlicago 1155 East 60th Street Chicago IL 60637
( THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with rehabilitation regardless of location or expense (weve provided space for both hospital andlor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
l L Answers to these questions will help Have your patients been helped ormiddot
us to understand the impact of the hindered by the information they have Internet on medica practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions
D Neith~imiddoto Yes
D BothONo D Does notapply
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
D Helped
D Hindered
D Neither
D Both
D I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D A day or two a week
l D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical L company web sites
DYes D No
D Does not apply
Do you ever access medical association web sites
DYes D No
ri D Does not apply L
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet isbullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes D No
Do you allow your patients to communicate with you via electronic mail
DYes o No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes D No
D Does not apply
Thank you again for your participation
r I
l~
National Opinion Research Center at the University of Chicago 1155 East 60th Street Chicago IL 60637
Jbullbullbull
(12th Annual Survey of PhysiciansJ Direct input from physicians is
crucial in evaluating hospital quality_ f
Conducted by the National Opinion Research Center at the University of Chicago 1155 East 60th Street Chica9o IL 60637
l J
(THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with cancer regardless of location or expense (weve provided space for both hospital andor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
Answers to these questions will help Have your patients been helped or us to understand the Impact of the hindered by the information they have Internet on medical practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions o NeitherOmiddotYes o BothD No o Does not apply
-Continued
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
HelpedD HinderedD NeitherD BothD
0 I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D Aday or two a week
D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical company web sites
DYes
D No
D Does not apply
Do you ever access medical association web sites
DYes
D No
D Does not apply
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet is bullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes
D No
Do you allow your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Thank you again for your participation
r
r
1 National Opinion Research Center at th~ University of Chicagobull 0 __ bull bull
1155 East 60th Street Chicago IL 60637
AppendixE
Predicted Mortality APR-DRG Methodology
r
shyi
Introduction to DRGs
The All Patient Refined Diagnosis Related Groups (APR-DRGs) were developed by 3M Health
Information Systems (3M-HIS) in conjunction with the National Association of Childrens Hospitals and
Related Institutions (NACHRI) APR-DRGs expand the basic diagnosis-related group (DRG) structure to
address patient severity of illness risk ofmorta1ity and resource intensity The APR-DRG Version 140
uses the Health Care Financing Administration (HCFA) Version 140 DRG methodology Because APRshy
DRGs are based on DRGs and All Patient DRGs (AP-DRGs) a brief explanation of both structures will
be useful
Current HCFA DRG Structure
Created from Adjacent Diagnosis Related Groups (ADGs) which combine patients into groups
with common characteristics DRGs were developed by Yale University in the 1970s to relate a
hospitals case mix index to the resource demands and associated costs experienced by the hospital
ADGs were created by subdividing an MDC1 into two groups based on the presence or absence of
an operating room procedure Surgical patients identified as those having an operating room procedure
were then classified by type ofprocedure to form surgical ADGs Patients with multiple procedures were
assigned to the highest surgical class Medical patients were divided into smaller groups based on their
principal diagnosis to form medical ADGs
DRGs use ADGs as a base and then further classify patients into selected disease and procedure
categories based on whether or not they have substantial comorbidities or complications (CC)
Approximately 3000 diagnosis codes have been designated by HCFA as substantial CCs (defined by a
list of additional diagnosis codes that a panel of physicians felt would increase the length of stay by at
least one day for 75 percent of the patients) This list covers a broad range of disease conditions and no
differentiation in severity or complexity level was made among the additional diagnoses The patients
age and discharge status were sometimes used in the definition ofDRGs
r
1 Major Diagnostic Categories (MDCs) are broad medical and surgical categories one step hierarchically higher than DRGs (several DRGs roll-up into an MDC) MDCs are divided by body systems such as nervous ear nose and throat and respiratory
Current AP-DRG Structure
In 1987 the New York State Department of Health entered into an agreement with 3M-HIS to
evaluate the applicability of DRGs to a non-Medicare population with a specific focus on neonates and
patients with Human Immunodeficiency Virus (HIV) infections The DRG definitions developed by this
relationship are referred to as the AP-DRGs
The AP-DRGs are modeled after the HCF A DRGs and attempt to improve the DRGs in an effort
to more accurately predict a hospitals resource demands and associated costs for all acute care patients
In the creation ofAP-DRGs the modifications made to the DRG structure can be summarized as follows
bull Except for neonates who die or are transferred within the first few days of life AP-DRGs define six ranges ofbirth weight that represent distinct demands on hospital resources Within each birth weight range neonates are then subdivided based on the presence of a significant operating room procedure and then further subdivided based on presence ofmultiple major minor or other problems
bull Assignment to neonatal MDC is based on age Specifically the AP-DRGs assign a patient to the neonatal MDC when the age of the patient is less than 29 days at admission regardless of the principal diagnosis
bull MDC 25 was created to account for the highly specialized treatment of multiple trauma patients Patients assigned to MDC 25 have at least two significant trauma diagnoses from different body sites
bull MDC 20 for alcohol and substance abuse was restructured to differentiate patients based on the substance being abused
bull Across all MDCs patient with a tracheostomy were put into either of two tracheostomy AP-DRGs tracheostomy performed for therapeutic reasons and tracheostomy representing long-term ventilation
bull All liver bone marrow heart kidney and lung transplant patients were assigned to an AP-DRG independent of the MDC ofthe principal diagnosis
bull For several MDCs a single major comorbidity and complication (CC) AP-DRG was formed across all surgical patients within an MDC and a single major CC AP-DRG was formed across all medical patients within an MDC
I I The AP-DRGs introduced changes to the HCF A DRGs in an attempt tomiddot depart from using the
LJ principal diagnosis as the initial variable for assignment The AP-DRGs were designed to more
accurately group patients into like groups that provide an operational means of defining and measuring a
hospitals case mix complexity
r
All Patient Refined DRGs
APR-DRG Objectives
The primary objective of the RCF A DRG and AP-DRG patient classification systems was to
relate the type ofpatients treated to the hospital resources they consumed This limited focus on resource
intensity does not allow providers to classify patients into other groups for meaningful analysis The
APR-DRG patient classification system goes beyond traditional resource intensity measures and was
designed with the ability to address the following needs
bull Compare hospitals across a wide range ofresource and outcome measures
bull Evaluate differences in inpatient mortality rates
bull Implement and support critical pathways
bull Identify continuous quality improvement initiatives
bull Support internal management and planning systems
bull Manage capitated payment arrangements
To meet these needs the APR-DRG system classifies patients according to severity of illness risk
of mortality and resource intensity Therefore in the APR-DRG classification system a patient is
assigned three distinct descriptors base APR-DRG severity of illness subclass and risk of mortality
subclass
Severity of illness can be defined as the extent of physiologic decompensation or organ system
loss of function experienced by the patient In contrast risk of mortality is defined as the patients
likelihood ofdying
For analyses such as evaluating resource intensity or patient care outcomes the base APR-DRGs
in conjunction with the severity of illness subclass is used For evaluating patient mortality the base
APR-DRGs in conjunction with the risk ofmortality subclass is used
Development of the APR-DRGs
The AP-DRGs were used as the base DRGs in the development of the APR-DRGs because they
were representative of the entire inpatient population and accounted for populations not included in DRGs
at the time of development Several consolidations additions and modifications were made to the APshy
DRGs to form the list of APR-DRGs used in the severity of illness and risk of mortality subclass
assignments
The following list summarizes the revisions made to the AP-DRGs in the creation ofthe APR-DRGs
bull All age CC and major CC splits were consolidated
bull Splits based on discharge status or death were consolidated
bull Definitions based on the presence or absence ofa complicated principal diagnosis were consolidated
bull Additional APR-DRGs were created for pediatric patients
bull APR-DRGs for newborns were completely restructured to create medical and surgical hierarchies within each birth weight range
bull Low volume APR-DRGs were consolidated into other related APR-DRGs
bull APR-DRGs that could be explained by the severity of illness subclasses were consolidated into one APR-DRG
bull Due to risk ofmortality subclasses several APR-DRGs were split to account for significant differences in mortality between patient groups
APR-DRG Severity oflllness Subclass Assignment
With the exception of neonatal patients after a patient has been given an APR-DRG code a
Severity of Illness Subclass is assigned based on the level of the secondary diagnoses presence of certain
non-OR procedures and the interaction among secondary diagnoses age APR-DRG and principal
diagnosis Neonatal patients have their own hierarchical method for determining severity of illness and
will be discussed later The four severity ofillness subclasses are
t l
~~~~~i~~ 1 Minor (Includes non CC)
2 Moderate
3 Major
i L 4 Extreme
The severity of illness subclass is used in conjunction with the patients base APR-DRG for
analysis such as evaluating resource intensity or patient care outcomes A patients severity of illness
subclass should not be used with their DRG because several DRGs may form one APR-DRG Therefore
since severity of illness subclasses correspond to the APR-DRG number and not the DRG it is important
to use the APR-DRG number to accurately interpret data
The process for assigning a patient a severity of illness subclass is a three phase process and is
summarized as follows
Phase
bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further analysis
bull Remaining secondary diagnoses are assigned one of four distinct Standard Severity of lllness Levels Figure 1 presents examples of secondary diagnoses in each severity ofillness leveL
Figure 1 Examples of Secondary Diagnoses by Severity of Illness Level
Minor Benign hypertension acute bronchitis lumbago
Moderate Chronic renal failure viral pneumonia diverticulitis
Major Diabetic ketoacidosis chronic heart failure acute cholecystitis
Extreme Septicemia acute myocardial infarction cerebral vascular accident
bull The Standard Severity of Illness Level is modified for some secondary diagnoses based on age APRshyDRG and presence of non-OR procedures Figure 2 displays an example of modifications to the standard severity ofillness level based on the APR-DRG
Bronchitis and asthma Minor
Chronic renal failure Moderate Diabetes Major LJ
Cardiomegaly Moderate Chronic heart failure Minor
Uncomplicated Minor Vaginal delivery Moderate LJ diabetes
f
f
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Severity of Illness Level is retained This prevents double counting clinically similar diagnoses
bull The Base Severity of Illness Subclass of the patient is set to the highest Standard Severity of lllness Level ofany of the secondary diagnoses
bull Patients with a Base Severity of Illness Subclass of major (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Standard Severity of Illness Level Figure 3 displays the requirements for keeping a severity of illness subclass ofmajor or extreme
Major
Extreme Two or more secondary diagnoses that are extreme or one secondary diagnosis that is extreme and at least two second dia oses that are maor
Phase III bull A minimum Severity of Illness Subclass is established based on the patients principal diagnosis This
accounts for patients assigned to codes that contain both the underlying disease and an associated manifestation of the disease (ie diabetes with hyperosmolar coma) but is only assigned to the APRshyDRG that accounts for the underlying disease
bull A minimum Severity of Illness Subclass is established based on combinations of principal diagnosis and age for specific APR-DRGs
bull A minimum Severity of Illness Subclass is established for some APR-DRGs with certain APR-DRG and non-OR procedure combinations as well as principal diagnosis and non-OR procedure combinations
bull A minimum Severity of Illness Subclass is established based on the presence of certain combinations ofsecondary diagnoses Figure 4 shows the combination of secondary diagnoses necessary to increase the severity of illness subclass to a minimum severity of illness level For example a type 1 combination would be a major bacterial infection with pleural effusion If a diagnosis from both of these categories is present plus at least one other secondary diagnosis that is at least a major severity of illness level then the minimum patient severity of illness subclass will be extreme
Figure 4 Minimum Severity of Illness Requirements
maor second dia osis 2 At least one additional Major
moderate secondary dia osis
3 Specified combinations of At least one additional Major a moderate and a minor moderate secondary cate 0 dia osis
4 Specified combinations of At least two additional Moderate r--1 Two minor cate ories minor second i Ii 5 Specified combinations of
Two moderate cate ories None Major
bull The final patient Severity of Illness Subclass is selected based on the maximum of the Phase II Base Patient Severity of Illness Subclass and the Phase III minimum Severity of Illness Subclass
Both medical and surgical patients are assigned a severity of illness level of 1-4 based on the
assignment process outlined previously
f
r-
I
l
r f
~
l
r 1
APR-DRG Risk of Mortality Subclass Assignment
Similar to the Severity ofIllness Subclass assignment the Risk ofMortality Subclass assignment
is based on the level ofthe secondary diagnoses and the interaction among secondary diagnoses age
APR-DRG and principal diagnosis In general the patients Risk ofMortality Level and Subclass will be
lower than the Severity ofIllness Level and Subclass respectively Neonatal patients have their own
hierarchical method for determining risk ofmortality and will be discussed later The four severity of
illness subclasses are
~~~~~~~G~~pound~) bull~~~~~~~~S~rs~~2bullbullmiddott~ 1 Minor (includes non CC)
2 Moderate
3 Major
4 Extreme
The risk ofmortality subclass is used in conjunction with the patients base APR-DRG for
evaluating patient mortality Like the severity of illness subclass a patients risk ofmortality subclass
should not be used with their DRG because several DRGs may form one APR-DRG Therefore since
risk ofmortality subclasses correspond to the APR-DRG number and not the DRG it is important to use
the APR-DRG number to accurately interpret data
The process for assigning a patient a risk ofmortality subclass is a three phase process and is
summarized as follows
Phase I bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further
analysis
bull Remaining secondary diagnoses are assigned one of four distinct Risk ofMortality Levels
bull The Risk ofMortality Level is modified for some secondary diagnosis based on the patients age and APR-DRG
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Risk ofMortality Level is retained This prevents double counting clinically-similar diagnoses
bull The Base Risk ofMortality Subclass of the patient is set to the highest Risk ofMortality Level ofany of the secondary diagnoses
bull Patients with a Base Risk ofMortality Subclass ofmajor (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Risk ofMortality Level
Phase III
bull A minimum Risk ofMortality Subclass is established based on the patients principal diagnosis This accounts for specific APR-DRGs that have a principal diagnosis indicative of a higher risk ofmortality relative to the other principal diagnoses in the APR-DRG r
i
l ~ bull A minimum Risk ofMortality Subclass is established based on the presence ofcertain combinations of secondary diagnoses
bull The final patient Risk ofMortality Subclass is selected based on the maximum ofthe Phase II Base l
Risk ofMortality Subclass and the Phase III minimum Risk ofMortality Subclass
J
r
AppendixF
f Index of Hospital Quality (lHQ) Scores by Specialty
i
i L
F-~
f laquo
2001
C
ance
r B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
con
sc
ore
R
N s
R
ank
Ho
spit
al
10
0
sco
re
rate
M
embe
r (o
f 7
) D
isch
arg
es
to b
eds
Mem
oria
l S
loan
-Ket
teri
ng
can
cer
Cen
ter
N
ew Y
ork
10
00
7
18
0
93
Y
es
60
51
67
21
2
2 U
niv
ersi
ty 0
1 T
exas
M
D
A
nder
son
Cen
cer
Cen
ter
H
oust
on
98
2
68
5
07
7
Yes
5
0
5103
2
68
3
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
78
3
59
0
69
Y
es
70
15
78
14
2
4 D
ana-
farb
er C
ance
r In
stit
ute
B
osto
n 6
37
3
88
0
81
No
60
21
8 2
27
5
May
o C
lin
ic
Ro
ches
ter
M
inn
5
81
2
50
0
60
Y
es
70
37
11
13
1
(+3
SO)
6 UC
LA M
edic
al C
ente
r
los
Ang
eles
41
0
79
0
56
Y
es
70
12
19
10
8 7
Un
iver
sity
01
Chi
cago
Ho
spit
als
40
6
65
0
66
Y
es
70
14
69
19
4
8 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
401
7
1
07
5
Yes
7
0
3494
1
81
9
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
40
0
91
0
82
Y
es
60
18
44
16
1
10
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
38
5
10
7
09
2
Yes
4
0
1105
1
61
11
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r
Ann
Arb
or
38
4
31
0
42
Y
es
70
16
56
17
9
12
Un
iver
sity
01
was
hing
ton
Med
ical
Cen
ter
S
eatt
le
38
3
79
0
66
Y
es
60
92
6 1
10
13
M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 3
80
8
8
09
5
Yes
7
0
2022
1
38
14
C
lari
an H
ealt
h P
art
ners
In
dia
nap
oli
s 3
78
5
2
07
5
Yes
7
0
2149
1
67
15
U
niv
ersi
ty o
f P
ittS
bu
rgh
Med
ical
Cen
ter
37
4
26
0
56
Y
es
65
23
10
16
7
(+2
SO)
16
Cle
vel
and
Cli
nic
3
62
3
1
07
4
Yes
7
0
2018
1
94
17
R
osw
ell
Par
k C
ance
r In
stit
ute
B
uff
alo
36
1
55
0
85
Y
es
50
16
76
28
7
18
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
35
5
37
0
73
Y
es
60
14
15
14
3
19
Un
iver
sity
of
Ken
tuck
y H
osp
ital
le
xin
gto
n
351
0
5
05
6
Yes
7
0
1047
2
20
20
fo
x C
hase
can
cer
Cen
ter
P
hil
adel
ph
ia
35
0
56
0
83
Y
es
50
10
46
15
8
21
H
lee M
off
itt
can
oer
Cen
ter
T
ampa
F
la
35
0
15
0
65
Y
es
60
16
44
16
8lt
22
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
Cen
ter
Ch
arl
ott
esv
ille
3
49
0
5
061
Y
es
60
13
48
22
7
23
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
34
8
17
0
67
Y
es
70
99
9 2
40
24
S
hand
s H
osp
ital
at
the
Un
iver
sity
of
flo
rid
a
Gei
nes
vil
le
34
7
14
0
46
Y
es
60
10
23
15
7
25
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
34
6
00
0
57
Y
es
60
12
22
191
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
34
4
17
0
67
Y
es
80
16
15
151
27
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
34
3
15
0
66
Y
es
55
14
14
15
8
28
Un
iver
sity
Ho
spit
al o
f A
rkan
sas
li
ttle
Roc
k 3
43
0
5
06
3
Yes
5
5
1287
2
54
29
U
niv
ersi
ty H
osp
ital
D
enve
r 3
42
2
7
05
7
Yes
5
0
431
24
0
30
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
34
2
23
0
49
Y
es
60
44
8 1
72
lt
31
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
34
2
00
0
61
Y
es
70
15
55
15
3
32
Art
hu
r G
Ja
mes
Can
cer
Ho
spit
al
Col
umbu
s
Ohi
o 3
41
0
0
04
8
Yes
5
5
2147
1
56
33
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
34
0
19
0
69
Y
es
70
11
42
13
6
34
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
33
9
00
0
50
Y
es
55
14
81
14
9
35
New
Yor
k P
resb
yte
rian
HO
spit
al
33
7
34
0
86
Y
es
70
31
03
13
2
36
Un
iver
sity
of
cali
forn
ia
San
Fra
nci
soo
Med
ical
Cen
ter
33
5
30
0
71
Yes
6
0
573
17
5
37
fG
M
cGaw
Ho
spit
al a
t lo
yo
la U
niv
ersi
ty
May
woo
d
Ill
3
33
1
6
07
0
Yes
6
0
1023
1
62
38
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
33
3
00
0
62
Y
es
60
12
79
15
2
39
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
-Sal
em
33
3
19
0
84
Y
es
70
20
21
181
40
fa
irv
iew
-Un
iver
sity
Med
ical
Cen
ter
M
inn
eap
oli
s 3
32
0
4
06
2
Yes
5
0
1248
1
56
41
G
reat
er B
alti
mo
re M
edic
al C
ente
r B
alti
mo
re
33
2
00
0
58
Y
es
35
12
39
20
0
42
Un
iver
sity
Ho
spit
als
of
Cle
vel
and
3
30
0
0
06
4
YampS
70
19
71
12
1
43
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
lo
we
Cit
y
32
9
04
0
70
Y
es
70
13
05
13
4
44
St
Jo
hn
S H
osp
ital
S
pri
ng
fiel
d
Ill
3
29
0
0
05
5
Yes
6
0
996
13
3
45
Hen
ry F
ord
Ho
spit
al
Detr
oit
3
27
0
0
07
6
Yes
6
5
1473
1
92
46
B
arn
es-J
ewis
h H
osp
ital
S
t
lou
is
32
6
05
0
74
Y
es
85
27
56
14
9
47
luth
era
n G
ener
al H
ealt
hSys
tem
P
ark
Rid
ge
Ill
3
26
0
0
06
2
Ves
6
0
1420
1
14
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
3
24
0
5
05
0
Yes
7
0
776
10
9
49
Coo
k C
ount
y H
osp
ital
C
hica
go
32
3
04
0
49
Y
es
50
49
1 2
10
50
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
32
2
09
0
90
Y
es
50
13
24
19
2
1
2001
D
iges
tiv
e D
iso
rder
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N
s
Tra
uma
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 8
) D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
59
8
05
9
Yes
8
0
7660
1
31
Yes
2
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
82
3
50
0
63
Y
es
75
31
28
14
2
Yes
3
Cle
vel
and
Cli
nic
6
27
3
05
0
57
Y
es
80
44
75
19
4 N
o 4
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
58
9
29
9
08
7
Yes
8
0
4403
1
38
Y
es
5 M
ount
Sin
ai
Med
ical
Cen
ter
N
ew Y
ork
49
5
23
2
09
8
Yes
8
0
5220
1
57
Y
es
6 UC
LA M
edic
al C
ente
r
Los
A
ngel
es
44
5
18
5
081
Y
es
80
25
40
10
8
Yes
7
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
39
7
14
3
09
0
Yes
8
0
3787
1
81
Yes
8
un
ivers
ity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
37
9
13
2
07
0
Yes
7
0
1596
1
75
N
o 9
Un
iver
sity
of
Chi
oago
Ho
spit
als
37
0
131
0
93
Y
es
80
19
84
19
4
Yes
(+
3 SO
) 10
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
30
6
57
0
61
Y
es
80
91
3 1
98
Y
es
11
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 2
99
5
2
07
5
Yes
8
0
4048
1
67
Y
es
12
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
2
95
7
7
09
9
Yes
8
0
2348
1
61
Yes
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
29
2
47
0
72
Y
es
80
56
89
14
9
Yes
14
U
niv
ersi
ty o
f M
iohi
gan
Med
ical
Cen
ter
Ann
Arb
or
291
3
8
06
8
Yes
8_
0 28
16
17
9
Yes
15
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 2
90
4
9
07
4
Yes
8
0
2636
1
43
Y
es
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
28
0
50
0
74
Y
es
50
20
34
161
Y
es
17
Cla
rian
Hea
lth
part
ners
In
dia
nap
oli
s 2
78
5
2
09
2
Yes
8
0
5286
1
67
Y
es
18
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
27
6
45
0
84
Y
es
80
28
28
15
3
Yes
19
B
eth
Isra
el
Dea
cone
ss M
edio
al C
ente
r
Bos
ton
21
4
34
0
73
Y
es
70
45
27
15
8
Yes
20
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
27
1
30
0
45
Y
es
80
99
2 1
09
Y
es
21
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
N
ew Y
ork
26
5
16
0
49
Y
es
70
26
18
21
2
No
22
New
Yor
k P
resb
yte
rian
Ho
spit
al
26
2
52
1
01
Yes
8
0
4884
1
32
Yes
23
U
niv
ers
ttv o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
26
0
20
0
65
Y
es
80
21
84
13
6 Y
es
(+2
SOI
24
Med
ical
Un
iver
sity
of
Sou
th C
aro
lin
a C
har
lest
on
2
58
6
9
12
0
Yes
7
0
2202
2
09
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
25
1 2
2
07
5
Yes
6
5
2472
1
57
Y
es
26
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
oak
M
ich
2
50
0
8
07
0
Yes
8
0
5809
1
88
Y
es
27
8ay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
49
2
6
07
8
Yes
6
0
4673
1
22
y
es
28
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
24
8
00
0
60
Y
es
70
26
48
191
Y
es
29
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
42
1
4
06
9
Yes
7
5
1677
1
47
Y
es
30
Los
A
ngel
es C
ount
y-U
Sc
Med
ical
Cen
ter
24
2
08
0
37
Y
es
60
39
5 1
67
Y
es
31
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
24
0
18
0
79
Y
es
70
18
25
24
0
Yes
32
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
24
0
39
0
78
y
es
80
11
34
11
0
No
33
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Il
l
23
8
00
0
59
Y
es
60
31
21
11
4
Yes
34
U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
oer
Cen
ter
H
oust
on
23
7
33
0
80
Y
es
60
13
61
26
8
No
35
Lah
ey H
itch
coo
k C
lin
io
Bu
rlin
gto
n
Mas
s
23
6
00
0
67
Y
es
70
26
77
15
2
Yes
36
C
edar
s-S
inai
Med
ical
Cen
ter
L
os A
ngel
es
23
4
27
0
94
Y
es
80
47
95
10
6
Yes
37
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
Sit
y
May
woo
d
Ill
2
34
0
0
06
6
Yes
7
0
2180
1
62
Y
es
38
Mar
y H
itch
coo
k M
emor
ial
Ho
sp
ital
le
ban
on
N
H
23
4
04
0
68
Y
es
70
15
58
19
4
Yes
39
U
niv
ersi
ty o
f C
ali
forn
ie
Dav
is M
edio
al C
ente
r
Sac
ram
ento
2
33
0
0
06
8
Yes
8
0
1751
2
79
Y
es
40
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
iCS
Io
wa
Cit
y
23
3
13
0
77
Y
es
80
19
31
13
4
Yes
41
N
ew E
ngla
nd M
edic
al C
ente
r
Bos
ton
23
3
20
0
82
Y
es
10
11
88
24
2
Yes
42
F
roed
tert
Mem
oria
l L
uth
eran
Ho
spit
al
Mil
wau
kee
23
2
00
0
63
Y
es
70
19
29
14
6
Yes
43
T
hom
as J
eff
ers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
32
0
8
07
6
Yes
1
0
3206
1
23
Y
es
44
Tem
ple
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
30
1
7
01
0
Yes
7
5
1450
1
46
N
o 45
G
reat
er B
alti
mo
re M
edic
al C
ente
r
Bal
tim
ore
2
30
1
2
071
Y
es
SO
24
95
20
0
No
46
Hen
ry F
ord
Ho
spit
al
Detr
oit
2
29
0
8
08
6
Yes
7
5
3475
1
82
Y
es
47
Un
iver
sity
Of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pal
Hil
l 2
29
1
0
081
Y
es
60
29
86
15
2
Yes
48
O
chsn
er F
ou
nd
atio
n H
osp
1ta
l
New
Orl
ean
s 2
28
1
5
07
4
Yes
6
5
2465
1
40
N
o 49
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
F
la
22
S
00
0
62
14
0 7
0
5778
1
67
Y
es
SO
Un
iVer
sity
Ho
spit
al
Den
ver
22
7
11
0
81
Yes
6
0
1151
2
40
Y
es
L r
middotmiddot
2001
E
ar
Nos
e
and
Thr
oat
Bes
t H
osp
ital
Lis
t
Hos
pita
lwid
e T
echn
olog
y R
eput
atio
nal
mo
rtal
ity
C
OTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
sc
ore
rate
M
embe
r (o
f 5)
D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
40
2
08
2
Ves
5
0
26
4
14
2
Yes
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
8S
4
32
4
08
6
Yes
5
0
219
13
4
Ves
3
Mas
saoh
uset
ts E
ye
and
Ear
In
firm
ary
B
osto
n 7
66
2
71
0
11
No
3
0
26
8
18
7
Ves
4
May
o C
lin
io
Roo
hest
er
Min
n
68
2
21
0
07
2
Ves
5
0
502
13
1
Ves
5
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
6
39
1
90
0
82
Y
es
50
28
3 1
79
Y
es
6 U
niv
ersi
ty o
f P
itts
bUrg
h M
edic
al C
ente
r 6
23
1
85
0
84
V
es
50
36
3 1
67
Y
es
7 UC
LA M
edic
al C
ente
r
los
Ang
eles
6
21
1
89
0
83
Y
es
50
2
88
1
08
Y
es
8 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
cano
er C
ente
r H
oust
on
51
6
14
7
08
9
Ves
4
0
124
26
8
No
9 H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
5
05
1
36
1
02
Y
es
50
26
7 1
61
Y
es
10
Cle
vela
nd C
lin
ic
49
5
10
6
06
7
Yes
5
0
23
6
19
4
No
11
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nio
N
ashv
ille
4
64
9
3
09
4
Yes
5
0
28
4
24
0
Yes
12
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
caU
f
46
1
10
8
08
6
Yes
3
0
13
4
16
1
Yes
1
3
Bar
nesmiddot
Jew
ish
Ho
spit
al
St
lo
uis
4
68
9
0
08
2
Yes
5
0
39B
1
49
Y
es
14
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
42
6
10
1
0middot8
7 Y
es
50
8
6
11
0
No
15
M
etho
dist
Ho
spit
al
Hou
ston
4
09
1
02
1
07
Y
es
40
2
30
1
33
No
(+
3 SO
l 16
M
emor
ial
Slo
anmiddotK
ette
rin
g e
ence
r C
ente
r
New
Vor
k 3
91
5
4
07
9
Yes
5
0
24
9
21
2
No
17
Mou
nt S
lnai
Med
ioal
Cen
ter
New
Vor
k 3
86
7
8
11
1
Yes
5
0
31
2
15
7
Yes
18
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
37
9
45
0
79
Y
es
50
16
6 1
57
Y
es
19
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
oo M
edio
al C
ente
r 3
78
6
3
08
5
Ves
4
0
131
17
5
No
20
Duk
e U
niv
ersi
ty M
edio
al C
ente
r D
urha
m
NC
3
50
4
3
09
3
Yes
5
0
15
3
18
1
Ves
21
U
niv
ersi
ty o
f W
isoo
nsin
Ho
spit
al a
nd C
lin
ios
Med
ison
3
40
1
9
07
7
Yes
5
0
23
2
13
6
Yes
22
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
enoe
s C
ente
r C
har
lott
esv
ille
3
39
3
0
08
1
Ves
4
0
195
22
7
No
23
un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 3
37
2
2
07
9
Ves
4
0
18
9
15
2
Yes
(+
2 SO
l 2
4
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
33
4
26
0
77
V
es
50
4
4
19
8
Ves
2
5
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty O
f F
lori
da
Gai
nes
vil
le
33
3
18
0
76
V
es
40
16
7 1
57
Y
es
26
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middot Sal
em
33
1
26
0
92
Y
es
50
2
43
1
61
Y
es
27
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
33
0
29
0
76
Y
es
35
11
2 1
01
V
es
28
H
enry
For
d H
osp
ital
D
etro
it
32
9
05
0
73
Y
es
45
2
14
1
82
V
es
29
st
lo
uis
Un
iver
sity
Ho
spit
al
32
5
12
0
71
Y
es
50
1
13
1
47
Y
es
30
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
w
ashi
ngto
n
DC
3
24
1
7
05
3
Ves
5
0
89
1
0
9middot
Yes
31
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hioa
go
32
3
26
0
92
V
es
40
18
4 1
70
ve
s 32
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
C
hica
go
32
3
20
0
70
V
es
50
14
5 1
14
No
3
3
Fai
rvie
w-U
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
32
3
23
0
79
Y
es
30
3
57
1
56
No
3
4
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
25
0
90
Y
es
50
1
00
1
94
Y
es
35
Un
iver
sity
Ho
spit
al
Den
ver
31
7
15
0
74
Y
es
40
52
2
40
Y
es
36
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
3
17
1
9
08
5
Yes
4
0
19
9
12
3
Yes
3
7
Sum
ma
Hea
lth
syst
em
Akr
on
Ohi
o 3
16
0
0
06
9
Ves
4
0
28
7
14
9
Yes
3
8
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
sa
cram
ento
3
15
0
5
07
6
Ves
5
0
14
3
27
9
Ves
3
9
lOS
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
31
2
13
0
20
Y
es
35
42
1
67
Y
es
40
Val
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
31
2
16
0
92
Y
es
50
2
43
1
53
V
es
41
Un
iver
sity
of
Tex
as M
edio
al B
rano
h H
osp
ital
s
Gal
vest
on
31
1
27
0
91
Yes
4
0
118
15
3
Yes
4
2
Lut
hera
n G
ener
al H
ealt
hsys
tem
P
ark
Rid
ge
Ill
3
09
0
0
07
0
Yes
4
0
212
11
4
Yes
4
3
Un
iver
sity
of
Illi
no
is
Ho
spit
al a
nd C
lin
iCs
Chi
cago
3
06
1
2
06
6
Yes
2
5
87
1
29
Y
es
44
lah
ey H
itoh
oook
Cli
nic
B
url
ing
ton
M
ass
3
05
0
5
07
6
Yes
4
0
138
15
2
Yes
4
5
Art
hur
G
Jam
es C
anoe
I H
osp
ital
C
olum
bus
O
hio
30
4
00
0
57
V
es
40
13
1 1
56
Y
es
46
w
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
30
3
05
0
86
Y
es
40
2
16
1
92
V
es
47
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 3
02
0
4
08
7
Yes
5
0
35
5
16
7
Ves
4
8
wil
liam
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
3
02
0
0
08
5
Yes
5
0
29
6
18
8
Yes
4
9
New
Vor
k Ey
e an
d E
ar
Infi
rmar
y
New
Yor
k 3
02
1
7
00
0
No
35
50
2
63
Y
es
50
F
G
McG
aw H
osp
ital
at
lOll
ola
Un
iver
sity
M
ayw
ood
Il
l
30
0
10
0
87
Y
es
40
16
6 1
62
Y
es
L L
2001
G
eria
tric
s B
est
Ho
spit
al L
ist
Hos
ptta
lwid
e T
echn
olog
y D
isch
arge
S
erv
ice
Ger
iatr
ic
Rep
utat
iona
l m
ort
alit
y
COTH
sc
ore
R
N
s
plan
ning
m
ix
serv
ices
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 8
) to
bed
s (o
f 3
) (o
f 1
0)
(of
7)
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
10
00
3
97
0
83
Y
es
80
1
08
3
6 5
2 JO
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
89
5
33
6
08
2
Yes
8
0
14
2
3 9
4 3
Mou
nt
Sin
ai M
edic
al C
ente
r N
ew Y
ork
73
3
27
6
11
1
Yes
8
0
15
7
3 8
4 4
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
6
11
1
98
0
93
Y
es
80
1
81
3
7 3
5 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
59
4
18
5
09
3
Yes
8
0
13
8
3 8
4 6
May
o C
11ni
c
Roo
hest
er
Min
n
51
1
11
2
07
2
Yes
8
0
13
1
3 1
0
8 7
St
L
ouis
Un
iver
sity
Ho
spit
al
45
2
95
0
71
Y
es
80
1
47
3
4 3
8 Y
alemiddot
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
4
33
1
00
0
92
Y
es
80
1
53
3
1 3
9 C
leve
land
lt1
1nio
4
28
7
0
06
7
Yes
8
0
19
4
3 8
4 10
U
niv
ersi
ty o
f M
ichI
gan
Med
ical
Cen
ter
Ann
Arb
or
42
2
79
0
82
Y
es
80
1
79
3
9 4
11
Bet
h Is
rael
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
11
7
7
08
4
Yes
7
0
15
8
3 9
4 (+
3 SO
) 12
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
68
7
3
08
7
Yes
7
0
11
0
2 6
2 1
3
Un
iver
sity
01
Chi
cago
Ho
spit
als
35
4
50
0
90
Y
es
80
1
94
3
8 4
14
B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
33
6
32
0
82
Y
es
80
1
49
3
9 4
15
U
niv
ersi
ty H
osp
ital
D
enve
r 3
34
2
5
07
4
Yes
7
0
24
0
3 8
5 16
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
28
3
0
08
1
Yes
8
0
14
3
3 7
4 17
R
ush
middotPre
sby
teri
anmiddotS
t L
uke
s M
edic
al C
ente
r C
hica
go
32
5
14
0
70
Y
es
80
1
14
3
9 5
19
u
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co l
led
ical
Cen
ter
32
5
36
0
85
Y
es
70
1
75
3
6 4
(+2
SO)
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
0
34
0
86
Y
es
60
1
61
3
9 3
20
Ho
spit
al o
f th
e U
niv
ersi
ty o
f pe
nnsy
lvan
ia
Ph
ilad
elp
hia
3
16
4
4
10
2
Yes
8
0
16
1
I 8
3 21
U
niv
ersi
ty H
osp
ital
s o
f C
leve
land
3
13
2
5
07
9
Yes
8
0
12
1
2 8
4 2
2
Par
klan
d ll
emor
ial
Ho
spit
al
Dal
las
31
3
1S
0
77
Y
es
80
1
98
3
7 4
23
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middotSai
em
31
1
20
0
92
Y
es
80
1
61
3
10
6
24
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
30
8
05
0
53
Y
es
70
1
09
3
8 4
25
U
niv
ersi
ty o
f Il
lin
Ois
Ho
spit
al a
nd C
lin
ios
C
hioa
go
30
7
11
0
66
Y
es
55
1
29
3
7 4
26
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 3
04
4
1
10
5
Yes
8
0
11
8
3 1
4 2
7
Fai
rvie
wmiddotu
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
30
4
14
0
19
Y
es
60
1
56
3
9 5
28
Sos
ton
Med
ioal
Cen
ter
30
4
16
0
75
Y
es
60
2
10
3
7 4
29
Fra
nci
s S
cott
Key
Med
ical
Cen
ter
Bal
tim
ore
30
4
18
0
80
Y
es
70
0
79
3
8 5
30
S
parr
ow H
osp
ital
and
Hea
lth
Sys
tem
L
anS
ing
M
ich
3
04
0
0
06
5
No
70
1
13
3
10
6
31
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
02
0
8
08
4
Yes
8
0
16
7
3 9
7 3
2
Los
Ang
eles
cou
ntymiddot
uSC
lle
dica
l C
ente
r 3
01
0
3
02
0
Yes
6
5
16
7
3 8
3 3
3
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
98
2
3
09
2
Yes
7
0
17
0
3 9
4 3
4
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
29
7
03
0
68
Y
es
70
1
49
3 9
3 3
5
Coo
k C
ount
y H
osp
ital
C
hica
go
28
6
00
0
55
Y
es
60
2
10
3
7 4
36
U
niv
ersi
ty o
f C
onne
ctic
ut H
ealt
h C
ente
r
Far
min
gton
2
94
4
6
10
0
Yes
6
0
26
0
3 3
2 3
7
Ho
spit
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 2
91
0
0
01
0
Yes
6
0
15
1
3 5
4 3
8
Un
iver
sity
Med
ioal
Cen
ter
Tuc
son
A
riz
2
90
0
0
06
6
Yes
7
0
17
2
3 7
3 3
9
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
28
9
07
0
79
Y
es
70
1
52
3
10
3
40
Thom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
28
9
13
0
85
Y
es
70
1
23
3
9 4
41
Hen
nepi
n C
ount
y M
edic
al C
ente
r
Min
neap
olis
2
89
0
0
06
1
Yes
6
5
10
5
3 7
3 4
2
St
L
uk
es
Ho
spit
al
Ch
este
rfie
ld
Mo
2
88
0
0
06
7
No
70
1
06
3
8 8
43
Aug
usta
Hea
lth
Car
e
Fis
her
svil
le
Va
2
87
0
0
06
5
No
50
1
35
3
8 5
44
John
D
Arc
hbol
d M
emor
ial
Ho
spit
al
Tho
maS
Vil
le
Ga
2
86
0
0
06
3
No
70
0
93
3
7 4
45
F
G
McG
aw H
osp
ital
at
Loy
ola
un
iver
sity
M
ayw
ood
Il
l
28
5
14
0
87
Y
es
70
1
62
3
9 3
46
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
Sac
ralll
ampnt
o 2
84
0
4
07
6
Yes
8
0
27
9
3 6
4 4
7
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
28
4
00
0
70
Y
es
70
1
14
3
7 4
49
Hen
ry F
ord
Ho
spit
al
Det
roit
2
83
0
4
07
3
Yes
7
5
18
2
3 4
4 4
9
Un
iver
sity
of
Vir
gin
ia H
ealt
h Sc
ienc
amps
Cen
ter
Ch
arlo
ttes
vil
le
282
0
3
08
1
Yes
7
0
22
7
3 9
4 50
S
t
Jose
ph H
osp
ital
D
enve
r 2
80
0
0
06
3
No
70
1
03
3
6 3
2001
G
ynec
olog
y B
est
Ho
spit
al L
ist
Hos
p1ta
lwid
e T
echn
olog
y G
ynec
olog
y R
eput
atio
nal
mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
serv
ices
R
ank
Ho
spit
al
IHQ
sc
ore
ra
te
Mem
ber
(of
8)
Dis
char
ges
to b
eds
Cen
ter
(of
4)
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
32
5
0B
2
Yes
8
0
24
0
14
2
Yes
4
2 M
ayo
Cli
nic
R
oche
ster
M
inn
7
53
2
10
0
72
Y
es
80
13
40
13
1
Yes
3
3 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 6
70
1
77
0
81
Y
es
80
4
83
1
43
Y
es
4 4
UCLA
Med
ical
Cen
ter
L
os A
ngel
es
58
3
14
2
08
3
Yes
8
0
310
10
8
Yes
4
5 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
cer
Cen
ter
Hou
ston
5
72
1
59
0
89
Y
es
60
2
34
2
68
No
0
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
49
9
10
9
09
3
Yes
8
0
512
18
1
Yes
4
7 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
49
8
11
0
09
3
Yes
8
0
418
13
8
Yes
4
8 P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 4
89
1
01
0
77
Y
es
80
9
4
19
8
Yes
3
11 Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
4
37
1
00
1
15
Y
es
80
56
0 1
32
Y
es
4 1
0
Un
iver
sity
of
Nor
th C
arol
ina
Ho
spit
als
Cha
pel
Hil
l 4
06
6
1
07
9
Yes
7
0
34
3
15
2
Yes
4
11
Mem
oria
l S
loan
-Ket
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
03
7
4
07
9
Yes
7
0
179
21
2
No
1 1
2
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
3
87
6
7
08
6
Yes
5
0
274
16
1
Yes
2
13
M
agee
-Wom
ens
Ho
spit
al
Pit
tsb
urg
h
38
4
50
0
67
Y
es
65
55
1 1
53
No
3
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
38
3
52
0
82
Y
es
80
3
90
1
79
Y
es
3 15
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
36
5
52
0
92
Y
es
70
29
1 1
70
Y
es
4 (+
3 SD
) 1
6
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
36
3
50
0
92
Y
es
80
34
6 1
53
Y
es
4 17
C
leve
land
Cli
nic
3
59
3
7
06
7
Yes
7
0
711
19
4
No
3 18
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
3
54
5
5
10
2
Yes
8
0
222
16
1
Yes
4
19
Un
iver
sity
of
Chi
cago
Ho
spit
als
35
1
43
0
90
Y
es
80
2
33
1
94
Y
es
4 2
0
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
34
3
50
0
85
Y
es
70
51
1
75
No
3
21
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
33
B
35
0
84
Y
es
B_O
30
2 2
40
Y
es
3 2
2
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
2
12
0
S3
Y
es
80
16
9 1
09
Y
es
4 2
3
Los
Ang
eles
Cou
nty-
uSC
Med
ical
Cen
ter
31
7
12
0
20
Y
es
65
4
0
16
7
Yes
4
24
Bar
nes-
Jew
ish
Ho
spit
al
St
L
ouis
3
16
2
3
08
2
Yes
7
5
62
3
14
9
Yes
4
25
R
ush
-Pre
sby
teri
an-S
t
Luk
es
Med
ical
Cen
ter
Chi
oago
3
15
2
2
07
0
Yes
8
0
30
3
114
No
3
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irmin
gham
3
14
3
1
09
6
Yes
8
0
411
15
1
Yes
4
(+2
SO)
27
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
97
1
9
08
5
Yes
7
0
33
7
12
3
Yes
4
28
U
niv
ersi
ty M
edic
al C
ente
r T
uoso
n A
riz
2
95
0
8
06
6
Yes
7
0
150
17
2
Yes
3
29
U
niv
ersi
ty H
osp
ital
D
enve
r 2
92
1
3
07
4
Ves
6
0
90
2
40
Y
es
4 3
0
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 2
92
3
2
11
1
Yes
8
0
317
15
7
Yes
4
31
Art
hur
G
Jam
es C
ance
r H
osp
ital
C
olum
bus
O
hio
29
1
00
0
57
Y
es
70
1
73
1
56
Y
es
3 32
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
90
0
0
05
5
Yes
6
0
69
21
0
Yes
4
33
U
niv
ersi
ty o
f C
alif
orn
ia
Irv
ine
Med
ical
Cen
ter
Ora
nge
2B
9
30
0
82
Y
es
60
69
1
05
Y
es
1 3
4
Un
iver
sity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
28
8
24
0
87
Y
es
80
2
07
1
10
No
4
35
S
tbull
Jose
ph H
osp
ital
D
enve
r 2
88
0
8
05
3
No
70
2
89
1
03
No
4
36
C
edar
smiddotS
inai
Med
ical
Cen
ter
Lo
s A
ngel
es
29
4
29
1
07
Y
es
BO
S
02
10
6
Yes
4
37
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
83
0
0
06
8
Yes
6
5
37
6
14
9
Yes
4
38
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r D
alla
s 2
8S
1
6
08
8
Yes
6
5
559
12
2
Yes
4
39
M
ary
Hit
chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
28
2
12
0
86
V
es
70
2
34
1
94
Y
es
4 4
0
emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
28
1
38
0
90
Y
es
80
2
09
0
93
No
0
41
Wom
en a
nd
Infa
nts
Ho
spit
al O
f R
hode
Is
lan
d
Pro
vide
nce
28
1
04
0
29
Y
es
50
5
19
0
63
No
4
42
B
eth
Isra
el
Oea
cone
ss M
edic
al C
ente
r B
osto
n 2
80
1
2
08
4
Yes
7
0
286
15
8
Yes
3
43
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 2
79
1
1
08
7
Yes
8
0
55
8
16
7
Yes
3
44
Ohi
o S
tate
un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
77
1
0
07
6
Yes
6
5
157
10
1
Yes
4
45
W
illi
am
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
2
75
0
4
08
5
Yes
9
0
59
5
18
9
Yes
4
46
L
uthe
ran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
27
4
00
0
70
Y
es
70
2
60
1
14
Y
es
4 4
7
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nic
s
Mad
ison
2
12
1
2
07
7
Yes
7
0
20
7
13
6
Yes
1
48
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
27
1
05
0
76
Y
es
70
2
62
1
57
Y
es
2 4
9
Gre
ater
Bal
tim
ore
Med
ical
Cen
ter
Bal
tim
ore
27
0
00
0
69
Y
es
55
46
0 2
00
No
4
50
FG
M
oGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
70
1
0
08
7
Yes
7
0
186
16
2
Yes
4
rmiddot--
I
i L
L
2001
H
eart
Bes
t H
osp
ital
Lis
t
Ran
k H
osp
ital
1 C
leve
land
Cli
nic
2
May
o C
11ni
o
Roc
hest
er
Min
n
3 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
4 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
5 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
7
Tex
as H
eart
In
stit
ute
-St
Luk
es
Epi
scop
al H
osp
ital
H
oust
on
B
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
9 Em
ory
un
iver
sity
Ho
spit
al
Atl
anta
1
0
Bet
h Is
rael
Dea
oone
ss M
edic
al C
tlnt
er
Bos
ton
11
B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
is
12
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
13
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
1
4
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
1
5
Lah
ey H
itch
oock
Cli
nic
B
url
ing
ton
M
ass
1
6
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
1
7
Orl
ando
Reg
iona
l M
edic
al C
ente
r O
rlan
do
Fla
18
Hen
ry F
ord
Ho
spit
al
Det
roit
1
9
Thom
as
Jeff
erso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
20
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
21
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
2
2
Bos
ton
Med
ical
Cen
ter
2
3
St
Lou
is U
niv
ersi
ty H
osp
ital
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddotS
alem
2
5
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
6
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
2
7
Mou
nt
Sin
ai M
edic
al C
ente
r
New
Yor
k
28
N
ew Y
ork
pre
sby
teri
an H
osp
ital
2
9
UCLA
Med
ioal
Cen
ter
Los
Ang
eles
3
0
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nio
s
Mad
ison
31
L
uthe
ran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
Fla
33
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
4
Un
iver
sity
of
Was
hing
ton
Mad
ical
Cen
ter
Sea
ttle
3
5
Ru
sh-P
resb
yte
rian
middotSt
L
uke
s M
edic
al C
ente
r C
hica
go
36
S
t
Lu
ke
s H
osp
ital
B
ethl
ehem
P
a
37
S
enta
ra N
orfo
lk G
ener
al H
osp
ital
N
orfo
lk
Va
3
8
St
Vin
cent
Ho
spit
al a
nd H
ealt
h C
ente
r
Ind
ian
apo
lis
3
9
How
ard
Un
iver
sity
Ho
spit
al
Was
hing
ton
4
0
Ced
ars-
Sin
ai M
edic
al C
ente
r
LOS
Ang
eles
41
S
inai
Ho
spit
al o
f B
alti
mor
e
42
S
pect
rum
Hea
lth
Gra
nd R
apid
s
Mio
h
43
N
orth
Sho
re U
niv
ersi
ty H
osp
ital
M
anha
sset
N
V
44
Was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
45
M
ary
Hit
chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
46
Geo
rget
own
Un
iver
sity
Ho
spit
al
waS
hing
ton
D
C
47
M
edic
al C
ente
r o
f D
elaw
are
Wilm
ingt
on
48
C
hri
st H
osp
ital
C
inci
nn
ati
4
9
St
Tho
mas
Ho
spit
al
Nas
hv
illa
5
0
Lan
kena
u H
osp
ital
W
ynne
woo
d
Ill
Tec
hnol
ogy
R
epu
tati
on
al
Mo
rtal
ity
CO
TH
sco
re
Su
rgic
al
RN
s
Tra
uma
IH
Q
sco
re
rate
M
embe
r (o
f 9
) vo
lum
e to
bed
s C
tlnt
er
10
00
6
42
0
65
Y
es
90
9
07
30
00
0
19
4
No
90
9
55
5
01
2
Yes
9
0
82
78
00
00
1
31
Y
es
63
4
31
6
08
2
Yes
9
0
52
05
00
00
1
38
Y
es
58
1
29
1
09
1
Yes
9
0
34
79
00
00
1
42
Y
es
57
1
26
2
08
5
Yes
9
0
43
21
00
00
1
43
Y
es
53
4
21
3
08
1
Yes
9
0
58
92
00
00
1
81
Y
as
45
3
19
3
09
4
Yes
B
O
60
27
00
00
1
33
No
4
32
1
56
0
91
Y
es
70
3
00
60
00
0
16
1
Yes
(+
3 SO
) 3
15
1
14
0
91
Y
es
90
4
66
90
00
0
09
3
No
35
9
87
0
94
Y
es
80
5
60
80
00
0
15
8
Yes
3
55
5
0
08
0
Yes
9
0
39
87
00
00
1
49
Y
es
(+2
SO)
34
2
37
0
84
Y
es
90
8
66
70
00
0
18
8
Yes
3
34
6
8
09
9
Yes
9
0
51
54
00
00
1
51
Y
es
32
8
61
0
83
Y
es
80
9
82
00
00
1
75
No
3
18
0
6
07
0
Yes
8
0
29
03
00
00
1
52
Y
es
31
8
13
0
66
Y
es
90
1
37
00
00
1
98
Y
es
31
4
00
0
70
Y
es
90
2
81
60
00
0
12
8
Yes
3
12
0
0
07
2
Yes
8
5
18
58
00
00
1
82
Y
es
30
7
21
0
90
Y
es
80
1
82
90
00
0
12
3
Yes
3
05
0
0
07
2
Yes
8
0
22
46
00
00
1
49
Y
es
30
5
28
0
94
Y
es
90
4
71
80
00
0
16
7
Yes
3
03
1
0
07
6
Yes
7
0
17
60
00
00
2
10
Y
es
30
2
08
0
76
V
es
90
1
15
30
00
0
14
7
Yes
3
02
0
3
08
3
Yes
9
0
39
93
00
00
1
61
Y
es
30
1
06
0
74
Y
es
80
1
09
30
00
0
17
2
Yes
3
00
1
7
09
1
Yes
9
0
26
91
00
00
1
79
Y
es
29
8
47
1
06
Y
es
90
4
25
30
00
0
15
7
Yes
2
91
6
1
11
1
Yes
9
0
57
76
00
00
1
32
Y
es
29
5
37
0
92
Y
es
90
1
50
40
00
0
10
8
Yes
2
95
0
0
07
6
Ves
9
0
15
10
00
00
1
36
Y
es
29
3
00
0
72
Y
es
80
1
70
90
00
0
11
4
Yes
2
93
0
3
07
5
No
80
1
09
16
00
00
1
61
Y
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29
3
14
0
89
Y
es
90
1
73
80
00
0
24
0
Yes
2
92
1
07
1
16
Y
es
80
1
20
80
00
0
11
0
No
29
2
14
0
76
Y
es
90
1
41
50
00
0
11
4
No
29
1
00
0
76
Y
es
80
3
29
80
00
0
08
7
Yes
2
91
0
0
08
2
Yes
8
0
55
75
00
00
1
51
Y
es
28
9
06
0
84
Y
es
80
8
04
80
00
0
13
7
Yes
2
89
0
0
06
5
Yes
9
0
25
60
00
0
11
0
Yes
2
89
3
5
09
9
Yes
9
0
39
64
00
00
1
06
Y
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28
9
00
0
76
Y
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80
2
03
30
00
0
12
1
Yes
2
89
0
0
07
9
Yes
8
0
28
37
00
00
1
06
Y
es
28
9
06
0
87
Y
es
90
4
71
00
00
0
12
7
Yes
2
88
0
0
08
6
Yes
8
0
89
54
00
00
1
92
Y
es
28
7
00
0
84
Y
es
80
2
44
50
00
0
19
4
YeS
2
86
0
0
06
0
Yes
8
0
79
90
00
0
10
9
Yes
2
85
0
0
08
7
Yes
8
0
40
88
00
00
1
15
Y
es
28
4
00
0
70
N
o 8
5
45
27
00
00
1
59
N
o 2
83
0
6
07
6
No
80
8
15
10
00
0
19
9
No
28
3
00
0
71
No
8
0
31
45
00
00
1
10
N
o
2001
H
oroo
nal
Dis
ord
ers
Bes
t H
osp
ital
lis
t
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
RN
s
T
raum
a R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (O
f 7
) D
isch
arge
s to
bed
s C
ente
r
May
o C
lin
ic
Roc
hest
er
Min
n
10
00
6
12
0
66
Y
es
70
14
59
13
1
Yes
2
Mas
sach
uset
ts G
ener
al H
OSp
tal
B
osto
n 9
89
5
27
0
91
Y
es
70
l1
B3
13
B
Yes
3
John
s H
opki
ns H
osp
ital
B
alti
mor
e 5
96
2
52
0
64
Y
es
70
B
07
14
2
Yes
4
Bri
gham
and
Wom
en s
H
osp
ital
B
osto
n 5
36
2
05
0
72
Y
es
70
6
17
1
43
Y
es
I
Bet
h Is
rael
Dee
cone
ss M
edic
al C
ente
r B
osto
n 4
55
1
13
0
62
Y
es
60
11
46
15
8
Ves
6
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
45
4
11
5
04
9
Yes
6
0
1029
2
27
No
7
Un
iver
sity
of
Cal
ifo
rnia
Se
n F
ranc
isco
Med
ical
Cen
ter
45
3
14
5
07
2
Yes
6
0
416
17
5
No
9 B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
45
3
11
6
09
5
Yes
7
0
1968
1
49
Y
es
9 C
leve
land
Cli
nic
4
37
9
3
04
6
Ves
7
0
1133
1
94
No
(+
3 11
m
10
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
41
6
82
0
66
Y
es
10
8
13
1
19
Y
es
11
Un
iver
sity
of
Chi
cago
Ho
spit
als
41
1
89
0
B2
Y
es
70
00
1 1
94
Y
es
12
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
41
0
10
4
00
4
Yes
7
0
752
10
8
Yes
13
u
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
B8
0
4
05
6
Yes
1
0
31
9
11
0
No
14
Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
3
83
1
11
1
54
Y
es
70
15
52
13
2
Yes
15
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
78
3
9
05
5
Ves
7
0
757
24
0
Yes
16
N
orth
Wes
tern
Mem
oria
l H
osp
ital
C
hica
go
37
5
51
0
73
Y
es
60
97
5 1
70
Y
es
17
Hen
ry F
ord
Ho
spit
al
Det
roit
3
75
1
2
05
6
Yes
6
5
19
45
1
82
Y
es
(+2
SD)
18
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
st
anfo
rd
Ca1
1f
36
1
68
0
83
Y
es
50
47
2 1
61
Y
es
19
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 3
64
3
6
05
6
Yes
7
0
328
19
8
Yes
2
0
Duk
e U
nive
rSit
y M
edic
al C
ente
r D
urha
m
NC
3
59
2
7
06
8
Yes
7
0
91
6
18
1
Yes
21
U
niv
ersi
ty H
osp
ital
D
enve
r 3
58
2
5
04
5
Yes
8
0
320
24
0
Yes
2
2
was
hing
ton
Ho
spit
al C
ente
r W
ashi
ngto
n
DC
3
57
2
0
07
6
Yas
6
0
1658
1
92
Y
es
23
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
35
4
16
0
65
Y
es
70
12
59
16
7
Yes
2
4
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 3
47
2
7
05
1
Yes
5
5
719
10
1
Yes
2
5
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
34
5
23
0
13
Y
es
70
86
6 1
61
Y
es
26
S
t
lou
is U
niv
ersi
ty H
osp
ital
3
43
0
7
04
0
Yes
1
0
637
14
1
Yes
2
7
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
3
43
1
1
06
4
Yes
1
0
1080
1
51
Y
es
28
U
niv
ersi
ty H
osp
ital
P
ort
lan
d
ore
3
42
2
8
048
Y
es
60
32
8 0
111
Yes
2
9
Un
iver
sity
of
Tex
as M
edic
al B
ranc
h H
osp
ital
s
Gal
vest
on
33
9
05
0
4B
Y
es
60
81
8 1
53
Y
es
30
G
ood
Sam
arit
an R
egio
nal
Med
ioal
Cen
ter
Pho
enix
3
38
1
0
01
7
Yes
7
0
58
0
10
7
Yes
31
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
Cha
pel
Hil
l 3
37
0
6
05
2
Yes
6
0
791
15
2
Yes
32
U
niv
ersi
ty o
f W
isco
nsin
Hos
pita
l an
d C
Hn
ics
Mad
ison
3
37
0
5
03
3
Yes
7
0
519
13
6
Yes
33
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al O
ak
Mio
h
33
7
06
0
80
Y
es
70
14
14
18
8
Yes
3
4
Flo
rid
a H
osp
ital
Med
ical
Cen
ter
Orl
ando
F
la
33
7
00
0
51
No
6
0
1698
1
67
Y
es
35
U
niv
ersi
ty o
f M
aryl
and
Med
ical
sys
tem
B
alti
mor
e 3
36
0
6
05
1
Ves
7
0
55
3
111
4 Y
es
36
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edic
al C
ente
r S
acra
men
to
33
4
06
0
59
Y
es
70
55
7 2
19
Y
es
37
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
33
3
05
0
50
Y
es
60
56
0 1
57
Y
es
38
Yal
emiddotN
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
33
2
38
1
03
Y
es
10
8
10
1
53
Y
es
39
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
9
00
0
38
Y
es
60
76
8 1
14
Y
es
40
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
3
29
0
0
04
9
Yes
5
5
656
13
5
Yes
41
A
lleg
heny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
32
8
00
0
66
Y
es
60
6
10
1
91
Y
es
42
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 3
27
6
4
16
7
Yes
7
0
1555
1
57
Y
es
43
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
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C
32
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32
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M
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Med
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ter
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a
32
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Med
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Yes
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cGaw
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ty
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Yes
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0
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16
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Yes
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8
Un
iver
sity
of
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a H
osp
ital
s an
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lin
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Cit
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32
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07
0
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6
85
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34
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49
M
edic
al C
ente
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are
Wil
min
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3
21
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0
08
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60
12
35
17
5
Ves
50
u
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
32
1
00
0
68
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70
77
3 1
51
Y
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- L
2001
K
idne
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se B
est
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spit
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Tec
hnol
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Dis
char
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Med
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Tra
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ital
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Mas
sach
use
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Gen
eral
Ho
spit
al
B
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00
0
27
6
09
5
Yes
5
0
1091
1
36
Y
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3 83
2
Bri
gham
and
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spit
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ton
95
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25
6
061
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74
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43
Y
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3 30
3
May
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lin
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Ro
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ter
M
inn
82
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18
5
06
3
Yes
5
0
1217
1
31
Y
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3 94
4
Cle
vel
and
Cli
nic
8
28
1
94
0
53
Y
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50
11
24
19
4
No
3 44
5
New
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k P
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Ho
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80
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12
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0
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3 11
1
6 Jo
hn
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77
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Yes
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Yes
3
41
7 UC
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edic
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Los
Ang
eles
7
26
1
53
0
60
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50
97
5 1
08
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3 54
8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
69
6
14
3
07
8
Yes
5
0
1108
1
81
Y
es
3 57
9
Bar
nes
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ish
Ho
spit
al
S
t
Lou
is
88
7
12
0
05
9
Yes
5
0
1863
1
49
Y
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3 76
10
U
niv
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ty H
osp
ital
D
enve
r 6
58
1
41
0
61
Yes
4
0
408
24
0
Yes
3
0 11
U
niv
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ty O
f M
ichi
gan
Med
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Cen
ter
A
nn A
rbor
5
89
8
8
05
4
Yes
5
0
922
17
9
Yes
3
60
12
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
iC
Nas
hv
ille
5
78
9
1
04
9
Yes
4
0
850
24
0
Yes
3
28
13
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
56
6
89
0
63
Y
es
40
52
8 1
61
Y
es
3 67
14
P
ark
lan
d M
emor
ial
Ho
spit
al
D
alla
s 56
1
73
0
31
Yes
5
0
660
19
8
Yes
3
39
15
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
41
6
6
06
2
Yes
5
0
1128
1
67
Y
es
3 80
16
U
niv
ersi
ty o
f C
ali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
53
4
74
0
45
Y
es
50
63
1 1
75
N
o 3
35
17
Ho
spit
al o
f th
e U
niv
ersi
ty O
f P
enn
sylv
ania
P
hil
adel
ph
ia
52
8
75
0
73
Y
es
50
96
2 1
61
Yes
3
44
18
Em
ory
Un
iver
sity
Ho
spit
al
A
tlan
ta
52
1
77
0
58
Y
es
45
78
4 0
93
N
o 3
48
19
un
ivers
ity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
51
6
78
0
55
Y
es
50
42
1 1
10
N
o 2
46
(+3
SO)
20
U
niv
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ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
47
3
56
0
93
Y
es
40
12
02
15
1
Yes
2
86
21
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
45
3
47
0
61
Yes
5
0
1013
1
58
Y
es
3 0
22
Hen
ry F
ord
Ho
spit
al
Detr
oit
4
47
2
1
05
8
Yes
5
0
1459
1
82
Y
es
3 76
2
3
Un
iver
sity
of
No
rth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
44
5
37
0
48
Y
es
40
10
33
15
2
Yes
3
16
24
F
airv
ieW
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iver
sity
Med
ical
Cen
ter
Min
neap
Oli
s 4
44
5
2
07
2
Yamp
s 5
0
690
15
6
No
3 24
2
5
Un
iver
sity
of
Chi
cago
Ho
spit
als
44
2
31
0
47
Y
es
50
75
8 1
94
Y
es
3 3
0
26
H
erm
ann
Ho
spit
al
Hou
ston
4
24
1
7
03
0
Yes
4
5
668
11
4
Yes
3
54
27
Ru
sh-P
resb
yte
rian
-St
L
uke
s
Med
ical
Cen
ter
C
hica
go
41
8
16
0
37
Y
es
50
12
73
11
4
No
3 49
2
8
New
Eng
land
Med
ical
Cen
ter
8
0st
on
4
16
4
2
07
9
Yes
5
0
330
24
2
Yes
2
30
2
9
Un
iver
sity
of
Cali
forn
ia
Dav
iS M
edic
al C
ente
r
Sac
ram
ento
4
16
2
2
05
5
Yes
5
0
681
27
9
Yes
3
40
30
Yal
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ew H
aven
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osp
ital
N
ew H
aven
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onn
4
12
3
8
09
9
Yes
5
0
943
15
3
Yes
3
52
(+2
SO)
31
Los
An
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ount
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SC
Med
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Cen
ter
40
9
04
0
08
Y
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45
21
3 1
67
Y
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3 43
32
S
hand
s H
osp
ital
et
the U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
40
6
34
0
74
Y
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45
69
9 1
57
Y
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2 3
0
33
St
L
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is U
niv
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ty H
osp
ital
3
99
1
2
041
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es
45
58
7 1
47
Y
es
3 43
3
4
Bos
ton
Med
ical
Cen
ter
39
4
15
0
44
Y
es
40
40
5 2
10
Y
es
3 36
35
U
niv
ersi
ty o
f T
exes
Med
ical
Bra
nch
Ho
spit
als
G
alv
esto
n
39
0
05
0
41
Yes
5
0
890
15
3
Yes
3
38
36
Un
iver
sity
Ho
spit
al
Po
rtla
nd
are
3
90
3
4
07
2
Yes
4
5
356
091
Y
es
3 18
37
M
eth
od
ist
Ho
spit
al
Hou
ston
3
89
3
3
10
0
Yes
4
6
796
13
3
No
3 69
38
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
88
0
6
06
0
Yes
5
0
935
17
0 Y
es
3 6
3
39
Fro
edte
rt M
emor
ial
Lu
ther
an H
osp
ital
M
ilw
auke
e 3
87
1
2
05
5
Yes
5
0
784
14
6
Yes
3
35
40
Un
iver
sity
Ho
spit
els
and
Cli
niC
S
Col
umbi
a
Mo
3
87
2
6
06
6
Yes
4
5
374
15
1
Yes
2
30
41
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
niC
S
Chi
cago
3
85
0
0
01
9
Yes
4
5
382
12
9
Yes
3
42
42
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
Ari
z
38
3
00
0
29
Y
es
45
37
6 1
72
Y
es
3 46
43
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
38
3
12
0
41
Y
es
00
81
4 1
68
N
o 91
44
W
illi
am B
eaum
ont
Ho
spit
el
Roy
al O
ak
Mic
h
38
3
03
0
74
Y
es
50
16
88
18
8
Yes
3
60
45
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
3
81
0
5
06
1
Yes
4
5
941
19
4
Yes
3
63
46
Un
iver
sity
01
Wis
con
sin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
7
22
0
82
Y
es
50
82
0 1
36
Y
es
3 32
4
7
Sax
ar C
ount
y H
osp
ital
Dis
tric
t
San
An
ton
io
37
7
16
0
64
Y
es
45
36
8 1
21
Y
es
3 51
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
WaS
hing
ton
D
C
37
7
05
0
43
Y
es
50
39
5 1
09
Y
es
3 53
49
U
niv
ersi
ty 0
1 V
irg
inie
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
3
77
1
4
06
4
Yes
5
0
930
22
7
No
3 34
50
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r
Dal
las
31
5
05
0
72
Y
es
45
97
6 1
22
Y
es
3 86
j r
l
~
2001
N
euro
logy
and
Neu
rosu
rger
y B
est
Ho
spit
al L
ist
Tec
hnol
ogy
Re p
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
so
ore
rate
M
embe
r (o
f 7)
D
isoh
arge
s to
bed
s C
ente
r
1 M
ayo
Cli
nic
R
oche
ster
M
inn
1
00
0
57
5
09
1
Yes
7
0
4763
1
31
Y
es
2 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
83
7
46
0
09
5
Yes
7
0
3705
1
38
Y
es
3 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
74
6
37
2
07
0
Yes
7
0
2641
1
42
Y
es
4 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
7
27
3
73
0
95
Y
as
70
40
78
13
2
Yes
5
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
51
6
24
1
10
0
Yes
6
0
1503
1
75
No
6 C
leve
land
Cli
nic
5
12
1
88
0
65
Y
es
70
33
38
19
4
No
7 B
arne
smiddotJe
wis
h H
osp
ital
S
t l
ou
is
38
9
92
0
81
Y
es
70
46
67
14
9
Yes
8
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
37
4
10
5
09
1
Yes
7
0
22
86
1
61
Y
es
(+3
SD)
9 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
32
4
70
1
02
Y
es
70
29
21
18
1
Yes
1
0
UCLA
Med
ioal
Cen
ter
lo
s A
ngel
es
32
2
64
0
80
Y
es
70
19
67
10
8
Yes
11
M
ount
S
inai
Med
ical
Cen
ter
Ne
w Y
ork
31
7
55
0
85
Y
es
70
23
83
15
7
Yes
12
M
etho
dist
Ho
spit
al
Hou
ston
3
15
6
2
08
6
Yes
6
0
3768
1
33
No
13
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
15
6
6
09
3
Yes
7
0
1925
1
43
Y
es
14
Un
iver
sity
of
Mic
higa
n M
edic
al C
arot
er
Ann
Arb
or
30
4
68
1
06
Y
es
70
17
02
17
9 Y
es
15
S
t J
ose
ph
s H
osp
ital
and
Med
ical
Cen
ter
Pho
enix
3
04
5
2
09
2
Yes
6
0
3336
1
27
Y
es
16
Los
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
29
9
04
0
29
Y
es
55
39
9 1
67
Y
es
17
H
enry
F
ord
Ho
spit
al
Det
roit
2
99
1
3
06
4
Yes
6
5
3299
1
82
Y
es
18
Den
ver
Hea
lth
and
Ho
spit
als
29
5
04
0
16
No
5
5
353
17
0
Yes
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
29
4
49
0
89
Y
es
50
19
06
16
1
Yes
2
0
Dan
amiddotF
arbe
r C
ence
r In
stit
ute
B
osto
n 2
94
0
3
00
0
No
85
6
22
7
No
21
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
29
3
15
0
46
Y
es
70
11
51
10
9
Yes
2
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
29
1
37
0
82
Y
es
70
21
86
13
4
Yes
(+
2 SD
) 2
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
28
8
13
0
36
V
es
60
33
6 2
68
No
2
4
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 2
88
1
8
07
0
Yes
7
0
3234
1
18
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
28
8
27
0
70
Y
es
60
15
98
15
7
Yes
2
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
87
2
1
07
0
Yes
6
0
1970
1
70
Y
es
27
u
niv
ersi
ty H
osp
ital
D
enve
r 2
87
3
3
07
3
Yes
6
0
613
24
0
Yes
2
8
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
28
6
08
0
19
Y
es
70
44
69
16
7
Yes
2
9
Un
iver
sity
of
Vir
gIn
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
28
5
34
0
83
Y
es
60
32
29
22
7
No
30
D
ooto
rs C
Onm
luni
ty H
osp
ital
la
nham
M
d
28
0
00
0
05
No
5
5
901
09
7
No
31
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
2
78
0
0
00
0
Yes
3
0
870
03
4
Ho
32
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 2
77
1
8
07
0
Yes
7
0
896
19
8
Yes
3
3
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
O
ak
Mic
h
27
6
00
0
82
V
es
70
48
44
18
8
Yes
3
4
St
L
uke
s H
osp
ital
N
ewbu
rgh
N
Y
27
5
00
0
02
No
5
0
82
6
08
0
No
35
B
osto
n M
edio
al C
ente
r 2
74
2
5
07
7
Ves
5
0
1255
2
10
Y
es
36
F
airv
ieW
-Uni
vers
ity
Med
ical
Cen
ter
Min
neap
olis
2
74
2
0
06
1
Ves
5
0
1685
1
56
No
37
U
nIv
ersi
ty M
edic
al C
ente
r T
ucso
n
Ari
z
27
4
00
0
50
Y
es
60
86
5 1
72
Y
es
38
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
73
0
0
06
6
Yes
6
0
3299
1
49
Y
es
39
Sc
hwab
Reh
abil
itat
ion
Ho
spit
al
Chi
cago
2
70
0
0
02
3
Yes
2
5
769
04
1 Y
es
40
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
68
0
0
04
9
Yes
5
0
498
21
0
Yes
41
S
t V
ince
nt H
ospI
tal
and
Hea
lth
Cen
ter
In
dia
nap
olb
2
66
0
0
07
0
Yes
6
0
32
89
1
37
Y
es
42
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
Chi
cago
2
65
0
6
05
4
Yes
7
0
1848
1
14
No
4
3
Bet
h Is
rael
Dea
oone
ss M
edio
al C
ente
r B
osto
n 2
65
1
4
08
5
Yes
6
0
2838
1
58
Y
es
44
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
2
64
0
0
00
6
No
35
12
64
03
8
No
45
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
2
63
1
8
08
8
Yes
7
0
1659
2
40
Y
es
46
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
nic
s C
hioa
go
26
2
13
0
62
Y
es
45
83
0 1
29
Y
es
47
H
arpe
r H
osp
ital
D
etro
it
26
1
04
0
55
Y
es
60
20
72
12
6
No
48
E
vans
ton
Nor
thw
este
rn H
ealt
h C
are
E
vans
ton
Il
l
28
1
09
0
75
Y
es
60
29
33
10
2
Yes
4
9
was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
2
59
0
4
07
7
Yes
6
0
2269
1
92
Y
es
50
Car
din
al H
ill
Reh
abil
itat
ion
Ho
spit
al
lex
ing
ton
K
y
25
8
00
0
02
No
0
5
1313
0
55
No
t
2001
O
rth
op
edio
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
GOTH
so
ore
R
N
$
Tra
uma
Ran
k H
osp
ital
IH
O
sco
re
rate
M
embe
r (o
f 5)
D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
49
2
05B
Y
es
50
77
52
13
1
Yes
2
Ho
spit
al f
or
Sp
ecia
l S
urg
ery
N
ew Y
ork
88
3
40
6
01
3
Yes
4
5
6837
1
57
Y
es
3 M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 7
13
3
20
1
01
Y
es
50
34
89
13
8
Yes
4
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
43
1
90
0
73
Y
es
50
16
28
14
2
Yes
5
Cle
vel
and
Cli
nic
5
19
1
73
0
63
Y
es
50
36
20
19
4
No
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
40
1
34
1
07
Y
es
50
28
63
18
1
Yes
7
Har
borv
iew
Med
ical
Cen
ter
S
eatt
le
37
2
101
1
05
Yes
3
5
820
23
3
Yes
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
37
0
75
0
74
Y
es
50
15
09
13
4
Yes
9
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
36
0
84
0
99
Y
es
50
17
57
10
8
Yes
(+
3 SO
) 10
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
2
68
0
56
Y
es
50
97
3 1
10
No
11
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
A
rbor
3
29
3
9
06
8
Yes
5
0
1586
1
79
Y
es
12
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
32
7
43
0
80
Y
es
50
26
80
14
3
Yes
13
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
32
6
48
0
92
Y
es
50
28
72
16
7
Yes
14
B
exar
Cou
nty
Ho
spit
al D
istr
ict
San
Ant
onio
3
24
3
9
04
8
Yes
4
0
645
12
1
Yes
15
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
3
49
0
87
Y
es
30
21
43
161
Y
es
16
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
35
0
67
Y
es
50
11
56
19
4
Yes
17
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
31
8
71
1
23
Y
es
50
58
7 1
98
Y
es
18
Un
iver
sity
Ho
spit
al
Den
ver
31
7
31
0
44
Y
es
40
63
3 2
40
Y
es
19
Bar
nes
middotJew
ish
Ho
spit
al
St
lo
uis
3
11
3
6
08
9
Yes
5
0
2911
1
49
Y
es
20
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f fl
ori
da
Gai
nes
vil
le
30
7
21
05
9
Yes
4
0
1781
1
57
Y
es
21
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
30
5
62
1
04
Y
es
40
92
7 1
75
No
(+
2 SO
) 22
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
03
1
6
05
9
Yes
5
0
1608
2
40
Y
es
23
Ho
spit
al o
f th
e U
niv
ersi
ty o
f p
enn
sylv
ania
P
hil
adel
ph
ia
30
1
45
1
04
Y
es
50
10
76
161
Y
es
24
U
niv
ersi
ty o
f A
labe
ma
Ho
spit
al a
t B
irm
ingh
am
29
9
22
0
73
Y
es
50
15
94
151
Y
es
25
Ho
spit
al f
or
Join
t D
isea
sesmiddot
Ort
ho
ped
ic I
nst
itu
te
New
Yor
k 2
97
4
0
02
5
No
30
21
10
09
3
No
26
SUl1
l1la
Hea
lth
sy
stem
A
kron
O
hio
29
5
05
0
49
Y
es
40
38
99
14
9
Yes
27
Y
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
Onn
2
93
1
2
061
Y
es
50
14
62
15
3
Yes
28
N
ew Y
ork
Pre
sby
teri
an H
osp
ital
2
92
4
5
12
2
Yes
5
0
2394
1
32
Y
es
29
Un
iver
sity
of
Ten
ness
ee M
edic
al C
ente
r
Mem
phis
2
92
4
2
05
4
No
46
90
1
50
No
30
U
niv
ersi
ty o
f W
isco
nsi
n H
osp
ital
and
Cli
nic
s
Mad
ison
2
89
1
1
061
Y
es
50
14
42
13
6
Yes
31
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
sacr
amen
to
28
6
24
0
87
Y
es
50
11
56
27
9
Yes
32
S
t
lou
is U
niv
ersi
ty H
osp
ital
2
83
0
4
04
8
Yes
5
0
819
14
7
Yes
33
R
ushmiddot
Pre
sby
teri
an
-St
lu
kes
Med
ical
Cen
ter
Chi
cago
28
1
25
0
79
Y
es
50
21
23
11
4
No
34
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Ill
28
0
00
0
46
Y
es
40
25
63
11
4
Yes
35
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
2
80
0
6
04
7
Yes
5
0
952
10
9
Yes
36
C
aro
lin
as M
edic
al C
ente
r
Ch
arlo
tte
N
C
28
0
23
1
03
Y
es
50
29
00
18
4
Yes
37
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
27
9
06
0
71
Yes
4
0
2274
1
58
Y
es
38
Coo
k C
ount
y H
osp
ital
C
hica
go
27 _
7 1
2
05
5
Yes
3
0
184
21
0
Yes
39
U
niv
ersi
ty o
f lo
uis
vil
le H
osp
ital
lo
uis
vil
le
Ky
2
76
0
5
04
2
Yes
4
0
317
19
0
Yes
40
A
lleg
hen
y G
ener
al H
osp
ital
P
itts
bu
rgh
2
76
0
0
06
4
Yes
4
0
2161
1
91
Yes
41
H
enry
For
d H
osp
ital
D
etro
it
27
6
00
0_
63
Yes
4
5
1834
1
82
Y
es
42
Un
iver
sity
of
Mia
mi
Jack
son
Mem
oria
l H
osp
ital
2
78
3
0
06
2
Yes
0
0
748
16
8
No
43
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 2
75
0
5
06
6
Yes
4
0
1518
1
52
Y
es
44
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
27
5
00
0
32
Y
es
40
87
1 1
72
Y
es
45
Mar
y H
itch
cock
Mem
oria
l H
osp
ital
le
ban
on
N
H
27
4
00
0
57
Y
es
40
14
30
19
4
Yes
46
B
apti
st M
emor
ial
Ho
spit
al
Mem
phis
2
74
4
5
11
2
No
50
29
14
09
3
Yes
47
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
2
73
1
2
08
6
Yes
4
0
2025
1
70
Yes
48
L
os A
ngel
es C
ou
nty
USC
Med
ical
Cen
ter
27
3
05
0
00
Y
es
35
23
6 1
Il7
Yes
49
M
edic
al C
ente
r o
f C
entr
al M
assa
chu
sett
s W
orc
este
r 2
73
0
0
06
0
Yes
4
5
1285
1
89
Y
es
60
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
middotSal
em
27
3
11
0
92
Y
es
50
21
20
1I
II
Yes
r-
-
2001
R
esp
irat
ory
Dis
ord
ers
Bes
t H
osp
ital
Lis
t Tec
hnol
ogy
Dis
char
ge
Rep
uta
tio
nal
M
ort
ali
ty
COTH
sc
ore
R
N
s T
raum
a p
lan
nin
g
Ran
k H
osp
Ital
IH
Q
sco
re
rate
M
embe
r (o
f 4
) D
isch
arg
es
to b
eds
Cen
ter
(of
3)
1 N
atio
nal
Jew
ish
Cen
ter
D
enve
r 1
00
0
501
0
22
N
o 3
0
121
37
5
No
3 2
May
o C
lin
ic
Ro
ches
ter
M
inn
8
S2
41
1
08
1
Yes
4
0
4391
1
31
Yes
3
3 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
63
3
2B0
0
95
Y
es
40
14
61
14
2
Yes
3
4 B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
54
6
21
2
08
9
Yes
4
0
5329
1
49
Y
es
3 5
Un
iver
sity
Ho
spit
al
Den
ver
45
7
151
0
83
Y
es
40
9
80
2
40
Y
es
3 6
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
43
2
15
0
09
0
Yes
4
0
1015
1
75
N
o 3
7 M
assa
chu
sett
s G
ener
al H
osp
Ital
B
osto
n 43
1
16
4
11
4
Yes
4
0
3306
1
38
V
es
3 8
Cle
vel
and
Cli
nic
4
20
1
24
0
77
Y
es
40
27
32
19
4
No
3 9
Bri
gham
and
WO
men
s H
osp
ital
B
osto
n 3
69
9
0
08
2
Yes
4
0
2526
1
43
V
es
3 10
U
CSIl
Med
ical
Cen
ter
S
an D
iego
3
68
9
1
08
0
Yes
4
0
1130
1
48
Y
es
3 11
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
4
12
0
09
8
Yes
4
0
720
11
0
110
2 12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbo
r 3
48
8
1
08
7
Yes
4
0
1927
1
79
Ves
3
(+3
SO)
13
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
II
C
33
7
96
1
12
Y
es
40
29
49
18
1
Yes
3
14
Bo
sto
n M
edic
al C
ente
r 3
25
3
8
05
7
Yes
4
0
1105
2
10
Y
es
3 15
H
osp
ital
of
the U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
32
3
96
1
15
Y
es
40
15
07
16
1
Ves
3
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
32
2
74
0
95
Y
es
40
16
20
161
Y
es
3 1
7
Un
ivers
ity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
05
6
0
09
7
Yes
4
0
2957
1
67
Y
es
3 18
UC
LA M
edic
al C
ente
r
Los
Ang
eles
2
97
4
1
07
5
Yes
4
0
1910
1
08
Y
es
3 19
V
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
onn
2
95
5
3
09
3
Ves
4
0
2355
1
53
Y
es
3 20
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
85
5
5
10
0
Yes
4
0
1432
1
94
Y
es
3 21
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
28
5
25
0
74
V
es
40
27
79
15
2
Yes
3
(+2
SO)
22
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
27
9
35
0
87
V
es
40
20
51
24
0
Yes
3
23
Los
A
ng
eles
Cou
nty-
USC
Med
ical
Cen
ter
27
5
04
0
18
Y
es
40
46
9 1
67
Y
es
3 24
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
Sac
ram
ento
2
73
1
2
06
7
Yes
4
0
1820
2
79
V
es
3 2
5
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
73
1
0
06
2
Yes
4
0
1475
1
47
Y
es
3 26
C
ook
Cou
nty
Ho
spit
al
C
hica
go
27
3
00
0
49
Y
es
40
11
45
21
0
Yes
3
27
San
Fra
nci
sco
Gen
eral
Ho
spit
al M
edio
al C
ente
r 2
70
5
6
08
7
Yes
2
0
899
11
0
No
3 28
H
enne
pin
Cou
nty
Med
ical
Cen
ter
M
inn
eap
oli
s 2
67
0
0
05
2
Yes
4
0
1959
1
05
Y
es
3 29
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
26
4
07
0
66
Y
es
40
17
63
15
7
Yes
3
30
Geo
r-ge
tow
n U
niv
ersi
ty H
osp
ital
w
ash
ing
ton
D
C
26
2
04
0
59
Y
es
40
99
3 1
09
Y
es
3 31
C
lar-
ian
Hea
lth
Part
ners
In
dia
nap
Oli
S
26
0
12
0
79
Y
es
40
42
95
16
7
Yes
3
32
Ru
sh-P
resb
yte
rian
-St
L
uk
es
Med
ical
Cen
ter
C
hica
go
25
4
28
0
82
Y
es
40
18
56
11
4
No
3 33
H
enry
Fo
rd H
osp
ital
D
etr
oit
2
54
1
4
08
5
Yes
4
0
3875
1
82
Y
es
3 34
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
2
53
2
2
08
3
Yes
4
0
2302
2
27
No
3
35
W
est
Jeff
ers
on
Med
ical
Cen
ter
M
arre
ro
La
2
52
0
0
05
3
No
40
14
94
11
3
Ves
3
36
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
251
0
0
07
1
Yes
4
0
6185
1
49
Y
es
3 37
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
iCS
M
adis
on
25
0
05
0
70
Y
es
40
14
28
13
6
Yes
3
38
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
50
0
4
07
2
Yes
4
0
1071
1
72
Y
es
3 39
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
sity
M
ayw
ood
Ill
2
49
1
8
08
6
Yes
4
0
1415
1
62
V
es
3 40
U
niv
ersi
ty o
f Il
lin
ois
Ho
spit
al a
nd C
11
nic
s
Chi
cago
2
49
0
5
06
6
Yes
3
5
779
12
9
Yes
3
41
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
46
0
0
06
3
Yes
3
5
1677
1
01
Yes
3
42
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
2
45
3
7
10
3
Yes
4
0
2116
1
51
Ves
2
43
Har
bo
rvie
w M
edic
al C
ente
r
Seett
le
24
4
24
0
89
Y
es
30
80
5 2
33
Y
es
3 44
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
2
44
2
3
09
2
Ves
4
0
1334
1
34
Y
es
3 45
T
rum
an M
adic
al C
ente
r-W
est
K
ansa
s C
ity
M
o
24
4
00
0
64
Y
es
35
99
1 1
14
Y
es
3 46
M
emor
ial
Med
ical
Cen
ter
S
avan
nah
G
a
24
2
00
0
71
Y
es
40
14
03
14
2
Yes
3
47
Tou
ro
Infi
rmar
y
lew
Orl
ean
s 24
1
00
0
65
V
es
40
14
07
06
5
Ves
3
48
St
Jo
sep
h H
osp
ital
D
enve
r 2
41
0
0
05
5
No
40
25
11
10
3
No
3 49
L
os A
ng
eles
Cou
nty-
Har
bor-
UC
LA
Med
ical
Cen
ter
24
0
13
0
10
No
4
0
420
16
5
Yes
2
50
Bay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
40
1
2
08
7
Ves
4
0
3026
1
22
V
es
3
-
J 1
2001
R
heum
atol
ogy
Bes
t H
osp
ital
lis
t
Hos
pita
lwid
e T
echn
olog
y D
isch
arge
R
epu
tati
on
al
mo
rtal
ity
CO
TH
sco
re
RN
s
plan
ning
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 5
) to
bed
s (o
f 3
)
May
o C
lin
ic
Roo
hest
er
Min
n
10
00
4
96
0
72
Y
es
50
1
31
3
2 Jo
hns
Hop
kins
Has
p ta
l 8
alti
mo
rs
85
9
38
0
08
2
Yes
5
0
14
2
3 3
Ho
spt
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 8
09
2
70
0
10
Y
es
45
1
57
3
4 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 7
17
2
54
0
81
Y
es
50
1
43
3
5 C
leve
land
Cli
nic
6
76
2
03
0
67
Y
es
50
1
94
3
6 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
66
4
22
1
09
3
Yes
5
0
1 3
8
3 7
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
66
2
21
2
08
3
Yes
5
0
10
8
3 B
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
64
1
20
8
09
6
Yes
5
0
15
1
2 9
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
5
68
1
34
0
93
Y
es
50
1
81
3
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co M
edic
al C
ente
r 5
58
1
23
0
85
Y
es
40
1
75
3
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
5
37
1
12
0
86
Y
es
30
1
61
3
12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
52
1
82
0
82
Y
es
50
1
79
3
(+3
SD)
13
B
arne
s-Je
wis
h H
osp
ital
S
t
lou
is
49
2
57
0
82
Y
es
50
1
49
3
14
H
osp
ital
fo
r Jo
int
Dis
ease
s-O
rtho
pedi
c In
stit
ute
N
ew Y
ork
48
9
59
0
55
No
3
0
09
3
3 1
5
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 4
86
7
8
10
5
Yes
5
0
11
8
3 1
6
los
Ang
eles
Cou
nty-
USC
Med
ical
can
ter
48
4
00
0
20
Y
es
35
1
S7
3
17
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
47
7
46
0
84
Y
es
50
1
67
3
la
St
lu
kes
Ho
spit
al
New
burg
h
NY
4
74
0
0
00
1
No
35
0
80
3
19
U
niv
ersi
ty H
osp
ital
D
enve
r 4
70
3
6
07
4
Yes
-4
0
24
0
3 2
0
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
46
9
32
0
77
Y
es
50
1
98
3
21
Doc
tors
Com
mun
ity H
osp
ital
L
anha
m
Md
4
69
0
0
00
7
No
35
0
97
2
(+2
SO)
22
Den
ver
Hea
lth
and
Ho
spit
als
48
1
00
0
21
No
4
0
17
0
2 2
3
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
46
6
53
1
02
Y
es
50
1
61
3
24
R
ehab
ilit
atio
n I
nst
itu
te o
f C
hica
go
46
3
00
0
03
Y
es
25
0
34
2
25
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
DC
4
62
0
9
05
3
Yes
5
0
10
9
3 2
6
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
4
58
0
0
00
9
No
25
0
38
3
27
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
45
4
39
0
92
Y
es
40
1
70
3
28
T
he
Inst
itu
te f
or
Reh
abil
itat
ion
and
Res
earc
h H
oust
on
45
3
00
0
13
No
1
5
06
9
3 2
9
Un
iver
sity
of
Chi
cago
Ho
spit
als
45
2
29
0
90
Y
es
50
1
94
3
30
C
ard
inal
Hil
l R
ehab
ilit
atio
n H
osp
ital
L
exin
gton
K
y
44
9
00
0
01
No
0
5
05
5
3 31
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
47
2
6
08
4
Yes
4
0
15
8
3 3
2
Reh
abil
itat
ion
In
stit
ute
of
Mic
higa
n
Det
roit
4
47
0
0
01
2
No
25
0
39
2
33
S
t
lou
is U
niv
ersi
ty H
osp
ital
4
44
0
4
07
1
Yes
5
0
14
7
3 3
4
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
44
4
05
0
66
Y
es
40
1
72
3
35
Coo
k C
ount
y H
osp
ital
C
hica
go
44
3
00
0
55
Y
es
30
2
10
)
36
Su
nnyv
iew
Ho
spit
al a
nd R
ehab
ilit
atio
n C
ente
r S
chen
ecta
dy
NY
4
42
0
0
00
7
No
10
0
43
2
37
B
osto
n M
edic
al C
ente
r 4
39
1
6
07
5
Yes
3
0
21
0
3 3
8
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
niC
S
Mad
ison
4
39
0
8
07
7
Yes
5
0
13
6
3 3
9
Hil
lsid
e R
ehab
ilit
atio
n H
osp
ital
W
arre
n
Ohi
o 4
38
0
0
01
2
No
15
0
30
2
40
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
4
36
1
4
08
6
Yes
5
0
13
4
3 41
U
niv
ersi
ty o
f M
aryl
and
Med
ical
Sys
tem
B
alti
mor
e 4
35
1
6
09
2
Yes
5
0
19
4
3 4
2
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hiO
4
35
0
0
06
8
Yes
4
0
14
9
3 4
3
UCSD
Med
ical
Cen
ter
San
Die
go
43
5
26
0
90
Y
es
30
1
48
3
44
R
ush
-pre
sby
teri
an-S
t
luk
es
Med
ical
can
ter
Chi
cago
4
34
0
0
07
0
Yes
5
0
11
4
3 4
5
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
43
4
15
0
92
Y
es
50
1
53
3 4
6
Hen
ry F
ord
Ho
spit
al
Det
roit
4
34
0
0
07
3
Yes
4
5
18
2
3 4
7
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
can
ter
S
acra
men
to
43
4
00
0
76
Y
es
50
2
19
3
48
H
enne
pin
coun
ty M
edic
al c
ante
r M
inne
apol
is
43
2
00
0
61
Y
es
35
1
05
3
49
W
est
Jeff
erso
n M
edic
al C
ente
r M
arre
ro
lao
43
2
00
0
55
No
4
0
11
3
3 5
0
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
43
2
09
0
87
Y
es
50
1
67
3
~
-
2001
U
rolo
gy B
est
Has
pi ta
l li
st
Tec
hnol
ogy
Rep
uta
tio
nal
M
Ort
alit
y CO
TH
sco
re
RN
s
Tra
uma
Ran
k H
osp
ital
IH
O so
ore
rate
M
embe
r (o
f 8
) D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
70
7
07
8
Yes
7
5
1231
1
42
Y
es
2 C
leve
land
Cli
nio
6
94
4
14
0
50
Y
es
80
1
61
8
19
4
No
3 M
ayo
Cli
nic
R
oche
ster
M
inn
6
80
3
92
0
50
Y
es
80
3
81
8
13
1
Yes
4
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
50
0
25
7
12
3
Yes
8
0
14
50
1
08
Y
es
5 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
4
41
1
79
0
79
Y
es
80
30
61
13
2
Yes
6
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
35
1
73
0
56
Y
es
70
11
61
21
2
No
1 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
13
1
49
0
81
Y
es
80
1
75
8
18
1
Yes
8 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
40
7
15
3
09
6
Yes
8
0
1401
1
38
Y
es
9 B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
iS
39
0
12
9
08
2
Yes
8
0
1778
1
49
Y
es
10
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
38
5
15
2
12
9
Yes
5
0
973
16
1
Yes
11
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
co M
edic
al C
ente
r 3
57
1
07
0
62
Y
es
70
78
3 1
75
No
(+
3 SO
) 1
2
Met
hodi
st H
osp
ital
H
oust
on
33
8
10
9
11
0
Yes
6
5
1381
1
33
No
1
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
33
0
10
8
11
1
Yes
6
0
69
0
26
8
No
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
32
0
60
0
78
Y
es
80
1
28
5
17
9
Yes
1
5
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
31
0
54
0
86
Y
es
80
14
97
16
7
Yes
1
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
07
3
7
04
8
Yas
7
0
95
9
17
0
Yes
1
7
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
30
0
31
0
55
Y
es
80
12
74
16
1
Yes
(+
2 SD
) 1
6
Van
der
bil
t U
niv
ersi
ty H
osp
ital
an
d C
11ni
c
Nas
hv
ille
2
92
5
6
11
5
Yes
7
0
83
3
24
0
Yes
1
9
Lah
ey H
itch
cock
Cli
nic
B
url
ing
ton
M
ass
2
91
2
7
05
4
Yes
7
0
886
15
2
Yes
2
0
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
28
7
51
1
09
Y
es
80
69
7 1
43
Y
as
21
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
28
8
41
0
65
Y
es
80
2
83
1
98
Y
es
22
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
seatt
le
27
9
27
0
24
Y
es
80
5
32
1
10
No
2
3
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
cen
ter
Ch
arlo
ttes
vil
le
27
7
28
0
51
Y
es
70
73
2 2
27
No
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddot S
alem
2
77
1
8
07
7
Yes
8
0
957
16
1
Yes
2
5
Shan
ds H
osp
ital
at
the
Un
iver
sity
of
Flo
rid
a
Gai
nes
vil
le
27
7
15
0
57
Y
es
65
90
5 1
57
Y
es
26
Car
oli
nas
Med
ical
Cen
ter
C
har
lott
e
N C
2
78
0
0
03
3
Yes
8
0
908
18
4
Yes
27
U
niv
ersl
ty o
f W
isco
nsin
Hos
pita
l an
d C
lin
ios
Mad
ison
2
74
0
5
04
5
Yes
8
0
1151
1
36
Y
es
28
Ne
w Y
ork
Un
iver
sity
Med
ioal
Cen
ter
27
3
16
0
66
Y
es
80
16
70
11
8
Yes
2
9
Hen
ry F
ord
Ho
spit
al
Det
roit
2
72
0
0
04
3
Yes
7
5
1079
1
82
Y
es
30
U
niv
ersi
ty H
osp
ital
D
enve
r 2
70
1
0
00
0
Yes
6
0
371
24
0
Y9$
31
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
67
1
4
06
9
Yes
7
0
1011
1
23
Y
es
32
Y
ale-
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
2
67
0
5
06
8
Yes
8
0
98
4
15
3
Yes
33
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
26
7
00
0
42
Y
es
60
9
17
1
92
Y
es
34
A
lban
y M
adic
al C
ente
r A
lban
y
NY
2
66
0
5
04
7
Yes
6
0
77
3
16
7
Yes
3
5
36
Lo
s A
ngel
es C
ount
ymiddotU
SC M
edic
al C
ente
r W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
26
5
26
4
14
0
0
00
0
06
2
Yes
Y
es
60
8
0
65
1
73
0
16
7
18
8
Yes
Y
es
37
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edio
al C
ente
r
Sao
ram
ento
2
64
1
0
05
1
Yes
8
0
412
27
9
Yes
3
8
Nor
th S
hore
Un
iver
sity
Ho
spit
al
Man
hass
et
NY
2
63
0
0
05
5
Yes
8
0
35
4
12
7
Yes
3
9
Sum
ma
Ilea
lth
Sys
tem
A
kron
O
hio
26
2
00
0
04
5
Yes
6
5
775
14
9
Yes
4
0
St
L
ouis
Un
iver
sity
Ho
spit
al
26
1
18
0
72
Y
es
75
4
25
1
47
Y
es
41
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
26
0
21
0
66
Y
es
70
1
12
9
09
3
No
42
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
25
9
00
0
26
Y
es
65
3
56
1
72
Y
es
43
U
niv
ersi
ty o
f L
ou
isv
ille
Ho
spit
al
Lo
uis
vil
le
Ky
2
58
0
8
00
0
Yes
6
0
28
1
90
Y
es
44
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
2
57
0
0
05
9
Yes
6
0
96
5
13
5
Yes
4
5
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
57
1
4
09
9
Yes
7
0
84B
1
62
Y
es
46
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
25
6
04
0
77
Y
es
75
83
3 1
94
Y
es
47
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
25
6
09
0
78
Y
es
60
80
1 1
52
Y
es
48
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
56
2
0
10
9
Yes
8
0
701
19
4
Yes
4
9
Bex
ar C
ount
y H
osp
ital
Dis
trio
t
San
Ant
onio
2
56
0
5
00
0
Yes
8
5
229
12
1
Yes
5
0
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
25
5
13
0
57
Y
es
80
34
9 1
09
Yes
~
l
i i
f
AppendixG
r bull Reputational Rankings for Special-Service Hospitals
i
I
I L
1~
r-
2001
E
yes
Rep
uta
tio
nal
Sco
re
Rep
uta
tio
nal
R
ank
Ho
spit
al
soo
re
Joh
ns
Hop
kins
Ho
spit
al
(Wilm
er
Eye
In
stit
ute
)
Bal
tim
ore
71
2
2 U
niv
ersi
ty o
f M
iam
i (B
asC
om
Pal
mer
Ey
e In
stit
ute
) 6
46
3
Wil
ls E
VQ
Hos
pita
l--
h
ilad
llip
hia
57
0
(+3
l
4 M
assa
chu
sett
s E
ye
and
Ear
In
firm
ary
B
osto
n 4
00
5
UCLA
Med
ioal
Cen
ter
(JII
IIIS
Ste
in E
ye
Inst
itu
te)
lo
s A
ngeJ
es
30
3
(+2
SO)
6 U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nio
s
Iow
a C
ity
1
93
7
USC
Un
iver
sity
Ho
spit
al
(Doh
eny
Eye
In
stit
ute
)
los
Ang
eles
1
03
8
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
B3
9
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
BO
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
66
11
M
ayo
Cli
nic
R
och
este
r
Min
n
63
12
N
ew Y
ork
Eye
an
d E
ar I
nfi
rmar
y
61
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
58
14
C
lev
elan
d C
lin
ic
54
16
M
eth
od
ist
Ho
spit
al
(Cul
len
Eye
Inst
itu
te)
H
oust
on
39
16
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
17
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
6
I
-~
r
middot
2001
P
edia
trio
s R
epu
tati
on
al S
core
Ran
k H
osp
ital
Ch
ild
ren
s H
osp
ital
Bos
ton
2 C
hil
dre
ns
Ho
spit
al o
f P
hil
adel
ph
ia
3 Jo
hns
Hop
kins
Ho
spit
al
BaU
iID
ore
4 C
hil
dre
ns
Ho
spit
al o
f P
itts
bu
rgh
5
Ch
ild
ren
s H
osp
ital
D
enve
r 6
Ch
ild
ren
s H
osp
ital
lo
s A
ngel
es
7 U
niv
H
osp
ital
s o
f C
lev
elan
d
(Rai
nbow
Bab
ies
amp C
hil
dre
ns
Hos
p J
8
Tex
llS C
hil
dre
ns
Ho
spit
al
Hou
ston
9
New
Yor
k P
resb
yte
rian
Ho
spit
al
(Bab
ies
amp C
hil
dre
ns
Ho
spit
al)
10
Ch
ild
ren
s H
osp
ital
Med
ical
Cen
ter
C
inci
nn
ati
11
Ch
ild
ren
s M
emor
ial
Ho
spit
al
Chi
cago
12
M
ayo
Cli
nic
R
och
este
r M
inn
13
U
niv
ersi
ty o
f C
a11
forn
ia
San
Fra
nci
sco
Med
ical
cen
ter
14
UCLA
(M
atte
I C
hild
ren
lS C
ente
r)
los
Ang
eles
15
lu
cil
le P
acka
rd C
hil
dre
ns
Ho
spit
al
Sta
nfo
rd
Cali
f
16
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
17
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
18
Ch
ild
ren
s H
osp
ital
and
Med
ical
Cen
ter
S
eatt
le
19
Ch
ild
ren
s N
atio
nal
Med
ical
Cen
ter
Was
hing
ton
D
C
20
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
21
Ch
ild
ren
s H
osp
ital
B
uff
alo
N
Y bull
22
Un
iver
sity
of
Mic
higa
n H
osp
ital
s
Ann
Arb
or
23
St
Ch
rist
op
her
s H
osp
ital
P
hil
adel
ph
ia
24
Met
ho
dis
t H
osp
ital
H
oust
on
Rep
uta
tio
nal
S
core
49
4
38
9
27
4
12
2
11
6
10
9
10
9
99
9
4
89
8
7
74
7
2
62
6
0
5S
4
9
48
4
3
39
3
7
37
3
6
32
(+3
SD)
(+2
SlY
j
i r-
2001
p
sych
iatr
y R
epu
tati
on
al S
oore
Rep
uta
tio
nal
R
ank
Ho
spit
al
Soo
re
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
31
8
2 N
ew Y
ork
pre
sby
teri
an H
osp
ital
25
2
3 C
F
M
enni
nger
Mem
oria
l H
osp
ital
T
opek
a
Kan
2
10
4
MoL
ean
Ho
spit
al
Bel
mon
t
Mas
s
20
6
5 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mor
e 19
9
+3
SOl
6 UC
LA N
euro
PIgt
iQh
atl
ic
Hos
rgt
1al
105
Ang
eles
~8~_
Il
ifJl
7
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
10
0
8 Y
ale-
New
Hav
en
Ho
spit
al
New
Hav
en
Con
n
92
9
May
o C
lin
iC
Ro
ches
ter
M
inn
8
8
10
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
6
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
52
12
S
hepp
ard
and
Eno
ch P
ratt
Ho
spit
al
Bal
tim
ore
52
13
U
niv
ersi
ty o
f C
ali
forn
ia
san
Fra
nci
sco
Med
ical
Cen
ter
46
14
U
nv
ars
ity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
4
0
e
15
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
7
16
Mou
nt S
inai
-NY
U M
edic
al C
ente
r
New
Yor
k 3
5
17
Cle
vel
and
Cli
nic
3
1
l r-shy
2001
R
ehab
ilit
atio
n R
epu
tati
on
al S
core
Rep
uta
tio
nal
R
ank
Ho
spit
al
Soo
re
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
6
37
2
The
In
stit
ute
fo
r R
ehab
ilit
atio
n a
nd
Res
earc
h
Hou
ston
3
74
3
Un
iver
sity
of
Was
hina
ton
Med
ioal
Cen
ter
$l
I1It
tle
32
9
___j+
3 S
O)
4 K
essl
er I
nst
itu
te f
or
Reh
abil
itat
ion
W
est
Ora
nge
N
J
23
8
5 M
ayo
Cli
nic
R
och
este
r
Min
n
20
3
6 C
raig
HQ
spit
al
Eng
lew
ood
c()l~
__
__
__
_
___2
00
(+
2 SO
l 7
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 1
40
8
Ohi
o st
ate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
11
1
9 T
hom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
10
7
10
Ran
oho
Los
AlII
igos
Med
ioal
Cen
ter
D
owne
y
Cali
f
10
0
11
Un
iver
sity
of
Mio
higa
n M
edio
al C
ente
r A
nn A
rbor
9
6
12
Sp
auld
ing
Reh
abil
itat
ion
Ho
spit
al
Bos
ton
69
13
N
atio
nal
Rs
hab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
8
6
14
Mou
nt
Sin
ai M
edic
al C
ente
r
New
Yor
k 6
7
15
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
9
16
Alb
ert
Ein
stei
n M
ed
Cen
ter
(Mos
s R
ehab
H
osp
)
Ph
ilad
elp
hia
5
6
17
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
39
18
S
heph
erd
Cen
ter
A
tlan
ta
39
1
9
Un
iver
sity
Ho
spit
al
Den
ver
31
2
0
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
31
L
AppendixH
The 2001 Honor Roll
Lj
l
r
t
The Honor Roll
To lend additional perspective we have constructed a measure called the Honor Roll to
indicate excellence across a broad range ofspecialties
To be listed on the Honor Roll a hospital has to rank at least 2 standard deviations
(SD s) above the mean in at least 6 ofthe 16 specialties A hospitals ranking in the Honor
Roll is based on points assigned as follows
bull For ranking between 2 and 3 standard deviations above the mean in a specialty a
hospital receives one point
bull For ranking at least 3 standard deviations above the mean a hospital receives two
points
We chose to use a standard deviation based criteria rather than simply adding up a
hospitals rankings in individual specialties for three reasons (1) the number ofoutstanding
hospitals varies from specialty to specialty (2) setting a threshhold is more informative because
it establishes a level ofalmost excellent and (3) it gives some measure ofthe distance
between hospitals which rankings do not
f
middot1
THE 2001 HONOR ROLL
16
Mayo Clinic Rochester Minn 27 13 1
Massachusetts General Hospital Boston 26 12 2
4 Cleveland Clinic 23 11 1
5 UCLA Medical Center Los Angeles 22 8 6
6 Duke University Medical Center Durham NC 20 8 4
7 Barnes-Jewish Hospital St Louis 18 6 6
7 University of Michigan Medical Center Ann Arbor 18 6 6
7 University of California San Francisco Medical Center 18 7 4
10 Stanford University Hospital Stanford Calif 17 6 5
11 Brigham and Womens Hospital Boston 16 6 4
12 University of Washington Medical Center Seattle 12 4 4
13 New York Presbyterian Hospital 12 5 2
14 Hospital of the University of Pennsylvania Philadelphia 11 3 5
15 University of Chicago Hospitals 9 1 7
16 University QfPittsburgh Medical Center 9 2 5 1 1
l
i
IL The Index ofHospital Quality
A Universe Defmition
We have implemented a two-stage approach to defining eligible hospitals for each of the
IHQ specialty lists
First eligible hospitals must be considered tertiary-care centers To be identified as a
tertiary-care hospital a hospital must meet at least one of the following criteria
bull COTH membership or
bull medical school affiliation or
bull a score of9 or higher on our hospital-wide high-technology index
(Appendix A)
Using these criteria we identified 1878 tertiary-care hospitals that were eligible for any of the
thirteen IHQ-based rankings Once the eligible hospitals were identified data for these hospitals
were drawn from the 1999 AHA Annual Survey As with any data collection effort the AHA
Annual Survey database is incomplete due to nonresponding hospitals Although it did not affect
the analysis this year we have a procedure to allow eligible hospitals that are nonresponders to
the current AHA Annual Survey to remain in our database First for all previously ranked
hospitals that are nonresponders to the current survey we average the two prior years ofdata and
substitute the result for the missing data Two-year non-responders that lack data both from the
current survey and from the previous two surveys are ranked without any structure data
Although nonresponding hospitals need to be treated separately for the IHQ analysis it is
unnecessary to do so for the four reputation-only lists
We then created separate analytic universes for each of the 13 IHQ-driven specialties
using criteria such as specialty-specific technology or facilities and a minimum number of
discharges across appropriate DRGs (Figure 1) However hospitals with a non-zero reputational
score were deemed eligible for ranking even if they had insufficient volume (discharges) in a
specialty
The flow chart in Figure 2 illustrates the eligibility process
6
Figure 1 1999 Universe Definition by Specialty
~pec~~ltyi bull Number ()fllospit~ Imiddotimiddotf~~ifji~t~~f~frl~~~~~~~~~fmiddot ~~ bull~~ bullbull ~ f~middot~~~~ ~ ~~)~~~~ ~~~ Imiddotmiddot~ lt IA~~~~~ri1j~(~~tl = ~-~ ~~~~~f~~-~)~~lt-)-_~- ~~ ~ ~ v~_~ ~_~~ ~~
Cancer minimum of 380 discharges for relevant DRGs or 935 non-zero reputation score
Digestive disorders minimum of734 discharges for relevant DRGs or non- 1394 zero reputation score
Ear nose and minimum of37 discharges for relevant DRGs or non- 1371 throat zero reputation score
Geriatrics score of 1 or more on the geriatrics service index and 1412 minimum of 5947 discharges for all DRGs or nonshy
zero reputation score
Gynecology minimum of 52 discharges for relevant DRGs or non- 1356 zero reputation score
have a cardiac catheterization lab or Heart offer open heart surgery or 853
offer angioplasty and minimum of 245 surgical discharges for relevant
DRGs or non-zero reputation score
Hormonal Minimum of3615 discharges for relev 944 disorders non-zero reputation score
Kidney disease Minimum of 185 discharges for relev 1389 non-zero reputation score
Neurology and Minimum of464 discharges for rete 1408 Neurosurgery non-zero reputation score Orthopedics Minimum of392 discharges for relevant DRGs or 1406
non-zero reputation score Respiratory Minimum of881 discharges for relevant DRGs or 1409
disorders non-zero reputation score Rheumatology Minimum of22 discharges for relevant DRGs or non- 1376
zero reputation score Urology Minimum of 133 discharges for relevant DRGs or 1370
non-zero reputation score
7
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B Composite Measure of Structure
The structural dimension defines the tools and environment available to care providers in
treating patients It represents the possibilities of care for a patient and physician Healthcare
research overwhelmingly supports the use of a measure of structure in assessing quality of care
However no prior research has revealed a single indicator of quality that summarizes all others
or that adequately represents the structure construct on its own Thus the structural component
must be represented by a composite variable comprising different measures that are specialtyshy
specific and are weighted relative to each other
For the 2001 index all structural elements other than volume are derived from the 1999
AHA Annual Survey of Hospitals database and are described below For specific mapping of
variables to the AHA data elements see Appendix B
COTH membership This dichotomous variable indicates membership in the Council of
Teaching Hospitals
Technology indices In 2001 we added medical and surgical intensive care beds to
the list of nephrology elements All other technology elements for all other specialties are
unchanged A complete list of the technologies considered for each specialty can be found in
AppendixA
Since the 1996 version of the index we have allowed our technology indices to reflect
the real cost of high-technology services While providing a service inside the hospital is
convenient for patients the cost may be unacceptable to some hospitals Many hospitals
provide access to technology services through the hospitals health system a local community
network or a contractual arrangement or joint venture with another provider in the
community We have taken this into account by giving hospitals that provide a service such as
ultrasound on-site one full point for that element hospitals that provide the service locally
through a formal arrangement receive a half-point A hospital receives no more than one point
for each element of the index
Volume The volume measure reflects the total number of medical or surgical (or both
when appropriate) discharges in the appropriate specialty-specific ORO groupings submitted for
HCF A reimbursement In the heart specialty surgical discharges indicates volume Data from
the three most recent years is pooled The ORO groupings are shown in Appendix C
9
RNs to beds The number of beds is defined by the AHA as beds set up and staffed at
the end of the reporting period Only nurses who have graduated with RN degrees from
approved schools of nursing and who are currently registered by their state are considered
Nurses must be full-time (35 hoursweek or more) and on staff Private-duty nurses nursing
staff whose salary is financed entirely by outside sources (eg an agency or a research grant)
and LPNs are not counted Registered nurses more appropriately classified in other
occupational categories (eg supervisory nurses facility administrators) also are not counted
Trauma In 1992 the annual US News survey of board-certified physicians ranked the
presence of an emergency room and a hospitals trauma provider level high on a list of hospital
quality indicators Physicians in nine specialties ranked trauma as one of the top five indicators
of quality The indications of these specialists and resultant high factor loadings supported the
inclusion of this data for heart hormonal disorders digestive disorders gynecology kidney
disease neurology and neurosurgery orthopedics ear nose and throat respiratory disorders and
urology
The trauma indicator is dichotomous and reflects two variables from the AHA database
whether the hospital has a certified trauma center in the hospital and the level of the trauma
center To receive credit for trauma services hospitals must provide either Level 1 or Level 2
trauma services in-hospital (as opposed to providing trauma services only as part of a health
system network or joint venture) Levell trauma service is defined as a regional resource
trauma center which is capable of providing total care for every aspect of injury and plays a
leadership role in trauma research and education4 Level 2 is defined by the AHA as a
community trauma center which is capable ofproviding trauma care to all but the most severely
injured patients who require highly specialized care4
Discharge planning The three elements of discharge planning are patient-education
services case management services and patient representative services TA service must be
provided in-hospital to receive credit
Service mix This indicator ranges from 0 to 10 points and comprises alcoholdrug abuse
or dependency inpatient care hospice home health services social work services reproductive
health services psychiatric education services womens health centerservices and psychiatric
consultationlliaison services Services must be provided within the hospital We do not award a
half-point for items in this measure
10
L
Geriatric services This indicator ranges from 0 to 7 points and comprises arthritis
treatment centers adult day care programs patient representative services geriatric services
meals on wheels assisted living and transportation to health facilities Again to receive credit
for a service it must be provided in-hospital
Gynecology services This indicator was introduced in 19975 It provides a means to
better rate the quality of services a hospital provides for its gynecological and obstetric patients
High factor loadings provide support to this variables inclusion With a range of 0 to 4 the
services included are obstetric care reproductive health care birthing rooms and womens
health center The half-point scheme used for the technology indices was not employed for this
indicator
Medicalsurgical intensive care beds This indicator is new in 2001 it surfaced as an
important factor for the nephrology specialty The AHA database provides the number of
medical and surgical intensive care beds per facility To be counted beds must be physically
located within the hospital and set up and staffed at the end of the reporting period
To combine these structural variables we weight the elements to create a flnal
composite measure Using factor analysis we force a one-factor solution and use the resultant
loadings as weight values for each variable in the composite structural measure The
relative weight assigned to each element varies from specialty to specialty and from one release
to the next within specialty Figure 3 provides the factor weights assigned to each element for
the 2001 release
11
F
Fig
ure
3 F
acto
r Lo
adin
g by
Spe
cial
ty
CO
TH
Imiddot
Tec
hnic
al
V
olum
e R
Ns
lBed
s D
is-
Goomiddot
Inde
xes
chan
ze
Can
cer
73
59
70
70
Dig
esti
ve d
isor
ders
69
52
60
63
Ear
nos
e a
nd th
roat
72
54
64
63
Ger
iatr
ics
35
81
Gyn
ecol
ogy
61
71
I H
eart
72
62
65
61
I
56
Hor
mon
al d
isor
ders
71
53
56
65
I
63
Kid
ney
dise
ase
63
66
62
57
I 54
Neu
rolo
gy a
nd n
euro
surg
ery
68
54
62
66
62
Ort
hope
dics
69
46
54
66
63
Res
pira
tory
dis
orde
rs
50
73
31
51
58
Rhe
umat
olog
y 45
82
Uro
logy
73
49
C Process
The process dimension of the quality equation is the sum or net effect of physicians
clinical decision-making Physicians clinical choices about the use of medication or diagnostic
tests admission to the hospital or one ofits units and length ofstay account for a large fraction
of the outcomes experienced by patients However measurements ofprocess on a national scale
are extremely difficult to obtain In order to measure process we rely on an alternative measure
to act as a proxy for process We contend that when a qualified expert identifies a hospital as
one of the best he or she is in essence endorsing the process choices made at that hospital
Thus we use the nomination of a hospital by a board-certified specialist as a measure off process In order to collect these nominations we conduct an annual survey of board-certified
f - physicians As in past releases we have pooled nominations for the past three years [1999-2001] I to arrive at the process measure i
Survey sample The sample for the 2001 survey consists of 2550 board-certified
physicians selected from the American Medical Associations (AMA) Physician Masterfile of
811000 physicians From within the Masterfile we selected a target population of 194916
board-certified physicians who met the eligibility requirements listed in Figure 4 Stratifying by
region and by specialty within region we selected a probability (random) sample of 150
t l physicians from each of 17 specialty areas for a total of 2550 physicians The final sample
r includes both non-federal and federal medical and osteopathic physicians residing in the 50
states and the District ofColumbia Figure 4 displays the list of specialties surveyed in 2001
f Eligibility requirements We defined a probability sample of physicians who could
properly represent the 17 specialty groupings delineated by us News amp World Report We
used two rules of eligibility one related to a mapping between the 17 specialties and the AMAs
list of 85 self-designated specialties and the second related to a mapping between these 85
specialties and the 23 member boards of the American Boards ofMedical Specialties (ABMS)
Under the first rule we linked each of the 17 specialties to one or more relevant AMA
specialties from the list of AMA self-designated practice specialty codes Physicians who
designated a primary specialty in one of the 17 specialties were preliminarily eligible for the
survey Under the second rule the physicians must also be certified by the corresponding
member board of the ABMS Figure 4 displays the correspondence between the specialty [ specified for US News amp World Report AMA self-designated specialty and the corresponding
member board
13
Figure 4 Physician Sample Mapping
us NEWS SPECIALTY
Cancer
r Digestive disorders
Ear nose and throat
Eyes
Geriatrics
i
Gynecology L
Heart
Hormonal disorders
Kidney disease
Neurology and Neurosurgery
-l ~
Orthopedics
Pediatrics
Psychiatry
Rehabilitation
Respiratory disorders
Rheumatology
Urology
I AMAKEY CODE
HEMl22 ON24
GEl
OTO48
OPW46
FPG38 IMG38
GYN21 OBG42
CD08 CDS08
END14 DW12
NEP
N36 NS
ORS85
PO55 ADUOI
P63
PW62
PUD
RHU174
Ul91
AMASELF-middot DESIGNATED
Hematology Oncology
Gastroenterology
Otolaryngology
Ophthalmology
Geriatrics
Gynecology Obstetrics amp gynecology
Cardiovascular diseases Cardiovascular surgery
Endocrinology Diabetes
Nephrology
Neurology Neurological surgery
Orthopedic surgery
Pediatrics Adolescent medicine
Psychiatry
Physical medicine amp rehabilitation
Pulmonary diseases
Rheumatology
Urological surgery
14
AMERICAN BOARD OF
Internal medicine Internal medicine
almedicine
Otolaryngology
Ophthalmology
Internal medicine
Obstetrics amp gynecology Obstetrics amp gynecology
Internal medicine Surgery
Internal medicine Internal medicine
Internal Medicine
Psychiatry amp neurology
Orthopedic surgery
Pediatrics Pediatrics
Psychiatry amp neurology
Physical medicine amp rehabilitation
Internal medicine
I Internal medicine
Urology
r -
l
r
to
f -
1 bull
Stratification To compensate for the widely varying number of eligible physicians
across the targeted specialties we used different probabilities of selection for each grouping and
used proportionate stratification across the four United States Census regions (West Northeast
South and North Central) Within each of the 17 strata we achieved a sample that was also
geographically representative of the spread ofphysicians across the country
2001 physician survey Sampled physicians were mailed a three-page questionnaire (see
Appendix D) a cover letter and a prepaid return envelope We also included a token incentive
in the form of a two-dollar bilL One week after the initial survey mailing a reminder postcard
was sent to the sampled physicians Two weeks following the reminder mailing we sent a
second mailing to nonrespondents including the questionnaire a cover letter and a business reply
envelope Three weeks after the second mailing we re-sent the questionnaire to nonrespondents
This third mailing was sent by Federal Express and included the questionnaire a cover letter and
a business reply envelope
2001 questionnaire redesign In consultation with Dr Donald Dillman of Washington
State University a noted questionnaire designer we revised the physical layout of the project
questionnaire (Appendix D) so that respondents could read and complete it more easily We
believe that the redesign had appreciable impact on this years response rate (below and Figure
5)
Response rate Of the 2550 physicians surveyed for this years report 1377 physicians
returned a useable questionnaire a response rate of 547 percent (Response rate is calculated as
the ratio of completed questionnaires to the total eligible in accordance with standard practice
any member of the sample found to be ineligible was removed from the denominator of the
equation for calculation purposes) Figure 5 shows response rates by specialty for the three years
used for the 2001 index
2001 experiments NORC conducted two experiments as part of the physician survey
for 2001 Briefly the experiments were 1) a Web version of the survey permitting direct onshy
line response for physicians and 2) a comparison of explicit citations of the Americas Best
Hospitals project for US News amp World Report and implicit references to the 12th Annual
15
Survey of Physicians conducted for US News amp World Report Citations appeared on both the
cover letters and questionnaire cover As with last years experimental launching of the Web
version this years version was used successfully by a small number of respondents We plan to
evaluate the cost-effectiveness ofthis strategy before using it again next year With regard to the
project citation experiment half of the physicians in each specialty were told explicitly that their
responses would be used to rank hospitals in Americas Best Hospitals issue of US News amp
World Report and the other half were told that they were participating in an annual survey of
physicians for US News amp World Report Our comparison of the explicit and implicit project
citations indicated no difference in response rates The difference in the number of survey
questionnaires returned by each group within each specialty ranged from 1 to 8 Figure 5 [
details the total number of surveys returned for each specialty
16
r
~
r-
lt
ance
r ig
esti
ve d
isor
ders
orm
onal
dis
orde
rs
idne
y di
seas
e
euro
logy
and
esp
irat
ory
diso
rder
s gy
Fig
ure
5 R
espo
nse
Rat
e b
y Y
ear
(150
sam
pled
phy
sici
ans
per
spe
cial
ty p
erye
ar)
n 70
71
82
75
84
70
62
68
62
78
r
Weighting Weighting was carried out in two steps First weights were assigned to
physicians that reflected the probabilities of selection within specialty groups and the overall
rates ofresponse within these groups Second the weights from the first step were poststratified
using the two-dimensional contingency table of specialty (17 categories) by census region
(Northeast Midwest South and West) To check the weights we ~nfinned that the sum across
the sample of the weights in each cell of the classifications (specialty x region) equaled the
population size
D Outcome
Many healthcare professionals have decried the use of mortality rates because of
limitations in the methods used to adjust for risk Nonetheless research strongly suggests a
positive correlation between a risk-adjusted mortality rate that is better than average and overall
quality8-17 Based on these findings we used adjusted mortality rate as the outcome measure for
our quality of care model All predicted mortality rates were provided by Solucient Inc of
Evanston Ill using the All Patient Refined Diagnosis Related Group (APR-DRG) method
designed by 3M Health Information Systems The APR-DRG adjusts expected deaths for
severity of illness by means of principle diagnosis and categories of secondary diagnoses A
detailed description of the full APR-DRG methodology is provided in Appendix E Solucient
applied this method to the pooled 1997 1998 and 1999 data set of reimbursement claims made to
HCF A by hospitals These complete data sets were the most current available
2001 DRG refmements We annually review the DRG-groupings for every specialty In 2001
we chose to conduct a thorough examination of the DRG groupings in heart and orthopedics
Because we anticipated likely changes as a result we conducted two independent reviews
Solucient conducted a review of each specialty and an independent consultant shy
a cardiologist and an orthopedic surgeon--conducted a review in his specialty Where the two
reviews agreed as they did in each of the two specialties we implemented the recommended
changes Revisions for each specialty are detailed below
18
Heart DRGs Three DRGs were added
109 = Coronary bypass wlo cardiac cath
124 =Circulatory disorders except AMI w cardiac cath and complex diag
125 =Circulatory disorders except AMI w cardiac cath and wlo complex diag
Orthopedic DRGs Two DRGs were deleted and six were added
DeletedDRGs
214 =Back amp neck procedures wI CC
215 =Back amp neck procedures wlo CC
AddedDRGs
496 =Combined anteriorlposterior spinal fusion
497 = Spinal fusion wI CC r 498 = Spinal fusion wlo CC 501 =Knee proc wI pdx ofinfection wi CC
502 =Knee proc wI pdx ofinfection wlo CC
503 =Knee proc wlo pdx ofinfection
As in previous years we used an all-cases mortality rate for four specialties (geriatrics
gynecology ear nose and throat and rheumatology) rather than a specialty-specific rate either
because the number of hospitals with sufficient discharges in the particular DRG-grouping was
too low or because the DRG groupings proved to be less robust than was desired Appendix C r -
lists the DRGs for each specialty
In 2000 we modified the construction of the outcome measure The IRQ is the final
score for each hospital in the specialty rankings It gives equal weight to process (represented by
reputation) outcome (mortality) and structure (volume technology and other elements of the
hospital environment) The numbers produced for each of these three measures however differ
greatly in magnitude and in range or variability Without correcting for that the final score
even when the three measures are weighted equally would be distorted
19
Pre-2000 solution For each specialty prior to 2000 the calculated mortality ratio for each
hospital was inverted--the ratio of actual to expected deaths was divided into 1 so that as with
other measures higher meant better For example a better-than-expected mortality ratio of 08
would produce an inverted result of 125 a worse-than-expected ratio of 12 would produce an
inverted result of 083 (The published rankings continued to display the ratio of actual to
expected deaths) Then the scores for reputation mortality and structure were standardized or
adjusted so that the degree ofvariability in each measure was the same
A difficulty with this approach was that inverting caused very low mortality ratios to
distort the outcome (Inverted a mortality ratio of 025 produces a score of 4 a ratio of 005
produces a score of 20 and a ratio of 001 produces a score of 100) If instead of being divided
into 1 the mortality ratio is subtracted from I-this could be called reverse scoring-such extremes r
are eliminated Using reverse scoring a mortality ratio of 025 produces a score of 075 a ratio
of 005 produces a score of 095 and a ratio of 001 produces a mortality score of 99 This
maintains the magnitudes of the differences and avoids extreme values Accordingly the new
rankingsreflect reverse scoring in mortality To dampen the effect of year-to-year fluctuations
mortality scores will be averaged over three years
Finally scores at the extremes in mortality and in certain structural measures were
trimmed to eliminate the influence ofvery wide variation Figure 6 gives the percentile at which
each of the mortality distributions was trimmed
Lj Figure 6 Percentile at Which Each Mortality Distribution Was Trimmed
Specialty
Cancer
Digestive disorders
Ear nose and throat
Geriatrics
Gynecology
Heart
Hormonal disorders l ~
Percentile
95
99
95
99
99
95
95
Specialty Percentile
Kidney disease 99
Neurology and neurosurgery 99
Orthopedics 95
Respiratory disorders 99
Rheumatology 99
Urology 90
20
l
A second round of standardizing also was added in 2000 after trimming extremes
Previously this second standardization was not perfonned resulting in trimmed measures having
less influence on the final score than other measures did Restandardizing restores the balance so
that trimmed and untrimmed measures have the same influence
Phase-in The changes described affect the final scores so they are phased in over two
years For 2000 each hospitalts final score averaged pre-2000 and current methodologies As
before the top hospital in each specialty received a score of 100 with other hospitals scaled
down from that figure
In 2001 the phase-in is complete with the 2001 mortality ratios fully reflecting the
revised methodology
J
--
21
E Calculation of the Index
i
The calculation of the IRQ for each hospital (other than in specialties ranked solely on
reputation) considers equally the three dimensions of quality of care structure process and
outcome Although all three measures represent a specific aspect of quality a single score not
only provides an easier-to-use result but yields a more accurate portrayal of overall quality than
would the three aspects individually
Therefore in computing the final scores for a particular specialty the reputational score
mortality scores and the collective set of structural indicators receive arithmetically equivalent
importance
The total fonnula for calculation of the specialty-specific IHQs is
where
IHQi = Index for Hospital Quality for specialty i
Sl-n = Structural indicators (STRUCTURE)
F = Factor loading
P = Nomination score (PROCESS)
M = Standardized mortality ratio (OUTCOME)
The general fonnula for deriving the index scores for tertiary-level hospitals is the same
as it began in 1993 Each of the three components--structure process and outcomes--is
considered equally in determining the final overall score For presentation purposes we
standardized raw scores then equated the raw IRQ scores as computed above to a 100-point
scale where the top hospital in each specialty received a score of 100
The mean and standard deviation of each of the 17 specialties are listed in Figure 7
Note that for the four reputation-only rankings mean and standard deviation of the reputational
score are presented This data further illustrates that the spread of IRQ scores produces a very
small number of hospitals two and three standard deviations above the mean Horizontal lines
in each of the 17 specialty lists in Appendices F and G indicate the cutoff points of two and
three standard deviations above the mean
22
We could not calculate scores for hospitals that provide care in eyes pediatrics
psychiatry or rehabilitation because data for robust and meaningful structural and outcomes
measures are not available for these specialties Thus as shown in Appendix G we rank
hospitals in these specialties solely by reputation Although the four reputation-only specialties
are ranked without the Index of Hospital Quality standard deviations of the reputational scores
are still useful in identifying truly superior hospitals (in terms of statistically relevant nomination
scores)
Figure 7 Mean and Standard Deviations ofIHQ and Reputational Scores
Mean Standard deviation 1 SD above Z SDs above 3 SDs above the mean the mean the mean
~- IHQScore
Cancer 2390 652 3042 3694 4346
Digestive disorders 1514 538 2052 2590 3128
Ear nose and throat 2064 647 2711 3358 4005
Geriatrics 2049 588 2637 3225 3813 Gynecology 1857 598 2455 3053 3651
Heart 2079 674 2753 3427 4101 Hormonal disorders 2545 574 3119 3693 4267 Kidney disease 2600 758 3358 4116 4874
Neurology and 1781 562 2343 2905 3467 neurosurgery Orthopedicsmiddot 1960 539 2499 3038 3577I Respiratory disorders 1665 569 I 2234 2805 3372 Rheumatology 3768 454 4222 4676 5130 Urology 1930 502 2432 2934 3436
Reputational Score
lEyes 455 1272 1727 2999 4271 [pediatrics 299 659 958 1617 2276 psychiatry 252 524 776 1300 1824 Rehabilitation 287 777 1064 1841 2618
23
III Directions for Future Releases
The US News Index has since its inception used the most rigorous methodology
available to define measure and combine the components of quality incorporated in its
construction Over the next few years we plan to subject each of the components (process
outcome and structure) to a searching re-examination We are aware that the skewed
distribution of the reputation scores can appear to give an inappropriate advantage to hospitals
that obtain a high percentage ofnominations and we will continue to examine the way in which
the reputation scores are used to define the process score We intend to test and evaluate
different transformations of the raw scores to see whether a transformation would produce a
bull i superior measure With regard to outcome the refinement of definitions of non-fatal outcomesshy
particularly in some specialties-suggests incorporating some of these measures into outcome
scores We will continue to refine and develop our measures of technology for the structural
component Finally we will re-examine the way in which the three components are combined
into the IHQ There may be ways to maintain the principle of equal weight for the three
components while improving the method ofcombining them
We will also examine the possibility of extending the evaluation of the four specialties
that are currently ranked only on reputation to incorporate appropriate structure and outcome
measures
As in years past we welcome input from users of the index in charting new directions
Readers and users are encouraged to contact the authors with suggestions and questions
j bull
24
l
lmiddot
References 1 Donabedian A Evaluating the quality of medical care The Milbank Memorial Fund Quarterly
1966 44166-203
2 Donabedian A Promoting quality through evaluating the process of patient care Med Care 1968 6181
3 Hill CA Winfrey KL Rudolph BA Best Hospitals A description of the methodology for the index ofhospital quality Inquiry 1997 34(1)80-90
4 American Hospital Association 1996 Annual Survey of Hospitals Data Base Documentation Manual
5 Ehrlich RH Hill CA Winfrey KL 1997 Survey oBest Hospitals Chicago NORC 1997
6 Hill CA Winfrey KL1995 Survey on Best Hospitals Chicago NORC 1995
7 Palella FJ Jr Delaney KM Moorman AC Loveless MO Fuhrer J Satten GA Aschman DJ Holmberg SD Declining Morbidity and Mortality Among Patients With Advanced Human Immunodeficiency Virus Infection N Engl J Med 1998 338853-860
8 United States Department of Health and Human Services Medicare hospital mortality information HCFA publication 01-002 Report prepared by Otis R Bowen and William L Roper Washington DCUSGPO 1987
9 Blumberg MS Comments on HCFA hospital death rate statistical outliers HSR Health Services Research 1987 21715-40
10 Dubois RW Brook RH Rogers WH Adjusted hospital death rates a potential screen or the quality ofmedical care MPH 1987 771162-6
11 Gillis KD Hixson JS Efficacy of statistical outlier analysis for monitoring quality of care Journal oBusiness and Economic Statistics 1991 9241-52
12 Green J Wintfield N Sharkey P Passman LJ The importance of severity of illness in assessing hospital mortality JAMA 1990 263241-6
13 Green J Passman LJ Wintfield N Analyzing hospital mortality the consequences ofdiversity in patient mix JAMA 1991 2651849-53
14 Greenfield S Aronow HU ElashoffRM Watanabe D Flaws in mortality data the hazards of ignoring comorbid disease JAMA 1988 2602253-7
15 Rosen HM Green BA The HCFA excess mortality lists a methodological critique Hospital and Health Services Administration 1987 2119-24
16 Flood AB Scott WR Conceptual and methodological issues in measuring the quality of care in hospitals In Hospital structure and performance Baltimore Johns Hopkins University Press 1987
17 Iezzoni LI Ash AS Coffinan GA Moskowitz MA Predicting in-hospital mortality a comparison of severity measurement approaches Med Care 1992 30347-59
25
Appendix A
Technology Indices by Specialty t
1
All Hospital Index
17 elements (used to define eligible hospitals)
r
Cancer
7 Elements
AnRioplasty Cardiac Catheterization Lab
Cardiac Intensive Care Beds
Computed Tomography Scanner
Diagnostic Radioisotope Facility
Diagnostic Mammography Services
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
MedicaVSurgical Intensive Care
Neonatal Intensive Care Beds
Open Heart Surgery
Pediatric Intensive Care Beds
Positron Emission Tomography Scanner
ReprQductive Health
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraphy Scanner Magnetic Resonance Imaging
Oncology Services
Pediatric Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
I Digestive disorders
8 Elements Computed Tomography Scanner Diagnostic Radioisotope Facility
Extracorporeal Shock Wave Lithiotripter
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound i
X-ray Radiation Therapy
Ear Nose and Throat
5 Elements Comouted Tomorrraohv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
X-ray Radiation Therapy
Heart
9 Elements Angioplasty Cardiac Catheterization Lab
Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Open Heart Surgery
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
j
Hormonal disorders
7 Elements
Geriatrics
8 Elements
Gynecology
8 Elements
Computed TomoRraphv Scanner Diagnostic Radioisotope Facility
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Cardiac Catheterization Lab Cardiac Intensive Care
Computed Tomography Scanner
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed TomoRraDhv Scanner Diagnostic Mammography Services
Magnetic Resonance Imaging
Neonatal Intensive Care
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Kidney disease
5 Elements
Neurology and f Neurosurgery t j
7 Elements
t
l
Orthopedics
5 Elements I t
Respiratory disorders 4 Elements
Extracorporeal Shock Wave Lithiotripter Ultrasound
Computed Tomography Scanner
Diagnostic Radioisotope FacUity
Transplant Services
Computed Tomography Scanner Diagnostic Radioisotope FacUity
Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
X-ray Radiation Therapy
Computed Tomolraphv Scanner Magnetic Resonance Imaging
Positron Emissions Tomography Scanner
Single Photon Emissions Computed Tomography
Ultrasound
Computed Tomographv Scanner Diagnostic Radioisotope FacUity
Radiation Therapy
Ultrasound
Rheumatology
5 Elements Computed TomoJraphv Scanner Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
Urology
8 Elements Extracorporeal Shock Wave Lithiotripter X-ray Radiation Therapy
Computed Tomography Scanner
Diagnostic Radioisotope Facility
i Magnetic Resonance Imaging
Positron Emission Tomography Scanner
Single Photon Emission Computed Tomography
Ultrasound
(
i
AppendixB
Structural Variable Map
f
L
r
t bull
r
tJ
L
The following variables used to construct structural elements of the 2001 IHQ were taken from the 1999 Annual Survey of Hospitals Data Base published by the American Hospital Association
ALL HOSP~TAL ~NDBX - used to define hospital eligibility 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ~GIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICBDHOS=l half point if CICBDSYS CICBDNET or CICBDVEN=l 1 point if CTS CNHOS=1 half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if MSICHOS=l half point if MSICSYS MSICNET or MSICVEN=l 1 point if NICBDHOS=l half point if NICBDSYS NICBDNET or NICBDVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PEDBDHOS=l half point if PEDBDSYS PEDBDNET or PEDBDVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if REPROHOS=l half point if REPROSYS REPRONET or REPROVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Cancer Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if ONCOLHOS=l half point if ONCOLSYS ONCOLNET or ONCOLVEN=l 1 point if PEDICHOS=l half point if PEDICSYS PEDICNET or PEDICVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
Digestive Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Ear I Nose and Throat Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRIVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l
1
Heart Technology Index 1 point if ANGIOHOS=l half point if ANGIOSYS ANGIONET or ANGIOVEN=l 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNETor CICVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if OHSRGHOS=l half point if OHSRGSYS OHSRGNET or OHSRGVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Hormonal Disorders Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRlHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Geriatrics Technology Index 1 point if CCLABHOS=l half point if CCLABSYS CCLABNET or CCLABVEN=l 1 point if CICHOS=l half point if CICSYS CICNET or ClCVEN=l 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETROS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Gynecology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MAMMSHOS=l half point if MAMMSSYS MAMMSNET or MAMMSVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if NICHOS=l half point if NICSYS NICNET or NlCVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTROS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Kidney Disease Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=lhalf point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if TPLNTHOS=l half point if TPLNTSYS TPLNTNET or TPLNTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Neurology and Neurosurgery Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Orthopedics TeChn610gy ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Respiratory Disorders Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Rheumatology Technology ~ndex 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if MRIHOS=l half point if MRISYS MRlNET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
Urology Technology Index 1 point if CTSCNHOS=l half point if CTSCNSYS CTSCNNET or CTSCNVEN=l 1 point if DRADFHOS=l half point if DRADFSYS DRADFNET or DRADFVEN=l 1 point if ESWLHOS=l half point if ESWLSYS ESWLNET or ESWLVEN=l 1 point if MRIHOS=l half point if MRISYS MRINET or MRlVEN=l 1 point if PETHOS=l half point if PETSYS PETNET or PETVEN=l 1 point if RADTHHOS=l half point if RADTHSYS RADTHNET or RADTHVEN=l 1 point if SPECTHOS=l half point if SPECTSYS SPECTNET or SPECTVEN=l 1 point if ULTSNHOS=l half point if ULTSNSYS ULTSNNET or ULTSNVEN=l
r
I
Discharge Planning COTH ] point if CMNGTHOS=] Yes if MAPP8=1 ] point if PATEDHOS=] 1 point if PATRPHOS=l RN I s to Beds
Full-time Registered Nurses Geriatric Services (FTRNTF) divided by Total Hospital 1 point if ADULTHOS=l Beds (HOSPBD) ] point if ARTHCHOS=l 1 point if ASSTLHOS=l Trauma ] point if GERSVHOS=l Yes if TRAUML90=] or 2 and 1 point if MEALSHOS=l TRAUMHOS=l 1 point if PATRPHOS=l 1 point if TPORTHOS=l
Gynecology Services 1 point if BROOMHOS=l 1 point if OBLEV=2 or 3 and OBHOS=] 1 point if REPROHOS=l
l ~
1 point if WOMHCHOS=l r ~
Service Mix ] point if ALCHHOS=l ] point if COUTRHOS=l 1 point if HOMEHHOS=l ] point if HOSPCHOS=l ] point if PSYEDHOS=] 1 point if PSYLSHOS=] 1 point if REPROHOS=l ] point if SOCWKHOS=] ] point if WOMHCHOS=]
l
i
1
[ l
AppendixC
Diagnosis-Related Group (DRG) Groupings l by Specialty
r 1
DRG10 DRGll DRG64 DRG82 DRGl72 DRG173 DRG199 DRG203 DRG239
DRG257 DRG258 DRG259 DRG260 DRG274
r 1 DRG275 DRG338 DRG344 DRG346 DRG347 DRG354 DRG355 DRG357 DRG366 DRG367 DRG400 DRG401 DRG402 DRG403 DRG404 DRG405 DRG409 DRG410 DRG411 DRG412 DRG413 DRG414
r 1 DRG473 DRG492
1
U
I 1
LJ
Cancer
NERVOUS SYSTEM NEOPLASMS W CC NERVOUS SYSTEM NEOPLASMS WIO CC EAR NOSE MOUTH amp TIIROAT MALIGNANCY RESPIRATORY NEOPLASMS DIGESTIVE MALIGNANCY W CC DIGESTIVE MALIGNANCY WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS PAlHOLOGICAL FRACTURES amp MUSCULOSKELETAL amp CONN TISS MALIGNANCY TOTAL MASTECTOMY FOR MALIGNANCY W CC TOTAL MASTECTOMY FOR MALIGNANCY WIO CC SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC SUBTOTAL MASTECTOMY FOR MALIGNANCY WIO CC MALIGNANT BREAST DISORDERS W CC MALIGNANT BREAST DISORDERS WIO CC TESTES PROCEDURES FOR MALIGNANCY OTHER MALE REPRODUCTIVE SYSTEM OR PROCEDURES FOR MALIGNANCY MALIGNANCY MALE REPRODUCTIVE SYSTEM W CC MALIGNANCY MALE REPRODUCTIVE SYSTEM WIO CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG W CC UTERINEADNEXA PROC FOR NON-OVARIANADNEXAL MALIG WIO CC UTERINE amp ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY MALIGNANCY FEMALE REPRODUCTIVE SYSTEM W CC_ MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WIO CC LYMPHOMA amp LEUKEMIA W MAJOR OR PROCEDURE LYMPHOMA amp NONmiddotACUTE LEUKEMIA W OTHER OR PROC W CC LYMPHOMA amp NON-ACUTE LEUKEMIA W OTHER OR PROC WIO CC LYMPHOMA amp NON-ACUTE LEUKEMIA W CC LYMPHOMA amp NON-ACUTE LEUKEMIA WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGE 0-17 RADIOlHERAPY CHEMOTHERAPY WIO ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS HISTORY OF MALIGNANCY WIO ENDOSCOPY HISTORY OF MALIGNANCY W ENDOSCOPY OlHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WIO CC ACUTE LEUKEMIA WIO MAJOR OR PROCEDURE AGEgt17 CHEMOTHERAPY W ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS
DRG146 DRG147 DRG148 DRG149 DRG150 DRG151 DRG152 DRG153 DRG154 DRG155 DRG156 DRG170
l i DRG171 DRG174 DRG175
L DRG176 DRG177 DRG178 DRG179 DRG180 DRG181 DRG182 DRG183 DRG184 DRG188
l DRG189 DRG190 DRG191
i J DRG192 DRG193 DRG194 DRG195 DRG196 DRG197
t
LeJ DRG198 DRG200 DRG201 DRG202 DRG204 DRG205 DRG206 DRG207 DRG208 DRG493 DRG494
Digestive Disorders
RECTAL RESECTION W CC RECTAL RESECTION WIO CC MAJOR SMALL amp LARGE BOWEL PROCEDURES W CC MAJOR SMALL amp LARGE BOWEL PROCEDURES WIO CC PERITONEAL ADHESIOLYSIS W CC PERITONEAL ADHESIOLYSIS WIO CC MINOR SMALL amp LARGE BOWEL PROCEDURES W CC MINOR SMALL amp LARGE BOWEL PROCEDURES WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE gt17 W CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGEgt17 WIO CC STOMACH ESOPHAGEAL amp DUODENAL PROCEDURES AGE 0-17 OTHER DIGESTIVE SYSTEM OR PROCEDURES W CC OTHER DIGESTIVE SYSTEM OR PROCEDURES WO CC G HEMORRHAGE W CC GJ HEMORRHAGE WIO CC COMPLICATED PEPTIC ULCER UNCOMPLICATED PEPTIC ULCER W CC UNCOMPLICATED PEPTIC ULCER WIO CC INFLAMMATORY BOWEL DISEASE GI OBSTRUCTION W CC GI OBSTRUCTIONWO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 W CC ESOPHAGmS GASTROENT amp MISC DIGEST DISORDERS AGEgt17 WIO CC ESOPHAGITIS GASTROENT amp MISC DIGEST DISORDERS AGE 0-17 OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 W CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGEgt17 WIO CC OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0-17 PANCREAS LIVER amp SHUNT PROCEDURES W CC PANCREAS LIVER amp SHUNT PROCEDURES W 10 CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE W CC BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO CDE WIO CC CHOLECYSTECTOMY W CDE W CC CHOLECYSTECTOMY W CDE WIO CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE W CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO CDE WIO CC HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY OTHER HEPATOBILIARY OR PANCREAS OR PROCEDURES CIRRHOSIS amp ALCOHOLIC HEPATITIS DISORDERS OF PANCREAS EXCEPT MALIGNANCY DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEP A W CC DISORDERS OF LIVER EXCEPT MALIGCIRRALC HEPA WIO CC DISORDERS OF THE BILIARY TRACT W CC DISORDERS OF THE BILIARY TRACT WO CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE W CC LAPAROSCOPIC CHOLECYSTECTOMY WIO CDE WO CC
DRG49 DRG50 DRG51 DRG55 DRG57 DRG58 DRG61 DRG62 DRG63 DRG65 DRG66 DRG67
DRG68
DRG69 DRG70 DRG71 DRG72 DRG73 DRG74
DRG353 DRG356 DRG358 DRG359 DRG360 DRG361 DRG362 DRG363 DRG364 DRG365 DRG368 DRG369
Ear Nose and Throat
MAJOR HEAD amp NECK PROCEDURES SIALOADENECTOMY SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY MISCELLANEOUS EAR NOSE MOUTH amp TIiROAT PROCEDURES TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGEgt17 TampA PROC EXCEPT TONSILLECTOMY amplOR ADENOIDECTOMY ONLY AGE 0-17 MYRINGOTOMY W TUBE INSERTION AGE gt17 MYRINGOTOMY W TUBE INSERTION AGE 0-17 OTHER EAR NOSE MOUTH amp TIiROAT OR PROCEDURES DYSEQUILIBRIUM EPISTAXIS EPIGLOTTITIS
OTITIS MEDIA amp URI AGEgt17 W CC OTITIS MEDIA amp URI AGEgt17 WIO CC OTITIS MEDIA amp URI AGE 0-17 LARYNGOTRACHEITIS NASAL TRAUMA amp DEFORMITY OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE gt17 OTHER EAR NOSE MOUTH amp TIiROAT DIAGNOSES AGE 0-17
Geriatrics ALL CASES
Gynecology
PELVIC EVISCERATION RADICAL HYSTERECTOMY amp RADICAL VULVECTOMY FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY W CC UTERINE amp ADNEXA PROC FOR NON-MALIGNANCY WIO CC VAGINA CERVIX amp VULVA PROCEDURES LAP AROSCOPY amp INCISIONAL TUBAL INTERRUPTION ENDOSCOPIC TUBAL INTERRUPTION DampC CONIZATION amp RADIO-IMPLANT FOR MALIGNANCY DampC CONIZATION EXCEPT FOR MALIGNANCY OrnER FEMALE REPRODUCTIVE SYSTEM OR PROCEDURES INFECTIONS FEMALE REPRODUCTIVE SYSTEM MENSTRUAL amp OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
DRG103 DRGl04 DRG105 DRG106 DRG107 DRG108 DRG109
DRG1l0 DRG1l1 DRG112 DRG115 DRG1l6 DRG117 DRG118 DRG121 DRG122 DRG123 DRG124 DRG125 DRG126 DRG127 DRG128 DRG129 DRG130 DRG131 DRG132 DRG133 DRG135 DRG136 DRG137 DRG138 DRG139 DRG140 DRG141middot DRG142 DRG 144 DRG145
r i
f ~
Heart
HEART TRANSPLANT CARDIAC VALVE PROCEDURES W CARDIAC CATH CARDIAC VALVE PROCEDURES WIO CARDIAC CATH CORONARY BYPASS W CARDIAC CATH CORONARY BYPASS WIO CARDIAC CATH OTHER CARDIOTHORACIC PROCEDURES CORONARY BYPASS WIO CARDIAC CATH
MAJOR CARDIOVASCULAR PROCEDURES W CC MAJOR CARDIOVASCULAR PROCEDURES WIO CC PERCUTANEOUS CARDIOVASCULAR PROCEDURES PERM CARDIAC PACEMAKER IMPLANT W AMI HEART FAILURE OR SHOCK OTH PERM CARDIAC PACEMAKER IMPLANT OR AICD LEAD OR GENERATOR PRO
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT CARDIAC PACEMAKER DEVICE REPLACEMENT CIRCULATORY DISORDERS W AMI amp CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI WIO CV COMP DISCH ALIVE CIRCULATORY DISORDERS W AMI EXPIRED CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH AND CMPLX DIAG CIRCULATORY DISORDERS EXCEPT AMI WCARD CATH WIO CMPLX DIAG ACUTE amp SUBACUTE ENDOCARDmS HEART FAILURE amp SHOCK DEEP VEIN THROMBOPHLEBITIS CARDIAC ARREST UNEXPLAINED PERIPHERAL VASCULAR DISORDERS W CC PERIPHERAL VASCULAR DISORDERS WIO CC ATHEROSCLEROSIS W CC ATHEROSCLEROSIS WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 W CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGEgt17 WIO CC CARDIAC CONGENITAL amp VALVULAR DISORDERS AGE 0-17 CARDIAC ARRHYTIIMIA amp CONDUCTION DISORDERS W CC CARDIAC ARRHYTHMIA amp CONDUCTION DISORDERS WIO CC ANGINA PECTORIS SYNCOPE amp COLLAPSE W CC SYNCOPE amp COLLAPSE WIO CC OTHER CIRCULATORY SYSTEM DIAGNOSES W CC OTHER CIRCULATORY SYSTEM DIAGNOSES WIO CC
1
DRG286 DRG287 DRG288 DRG289 DRG290 DRG292 DRG293 DRG294 DRG295 DRG296 DRG297
t DRG298 DRG299
DRG300 DRG301
~- --j
DRG316 DRG317 DRG320 DRG321 DRG322 DRG325 DRG326 DRG327 DRG 331 DRG332 DRG333
f
Hormonal Disorders
ADRENAL amp PITUITARY PROCEDURES SKIN GRAFTS amp WOUND DEBRID FOR ENDOC NUTRlT amp METAB DISORDERS OR PROCEDURES FOR OBESITY P ARA1HYROID PROCEDURES 1HYROIDPROCEDURES OrnER ENDOCRINE NUTRIT amp METAB OR PROC W CC 01HER ENDOCRINE NUTRIT amp METAB OR PROC WIO CC DIABETES AGE gt35 DIABETES AGE 0-35 NUTRlTIONAL amp MISC METABOLIC DISORDERS AGEgt17 W CC NUTRITIONAL amp MISC METABOLIC DISORDERS AGE gt17 WIO CC NUTRlTIONAL amp MISC METABOLIC DISORDERS AGE 0-17 INBORN ERRORS OF METABOLISM ENDOCRINE DISORDERS W CC ENDOCRINE DISORDERS WIO CC
Kidney Disease
RENAL FAILURE ADMIT FOR RENAL DISEASE KIDNEY amp URINARY TRACT INFECTIONS AGE gt17 W CC KIDNEY amp URINARY TRACT INFECTIONS AGEgt17 WIO CC KIDNEY amp URINARY TRACT INFECTIONS AGE 0-17 KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 W CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMSgt17 WIO CC KIDNEY amp URINARY TRACT SIGNS amp SYMPTOMS AGE 0-17 01HERKIDNEY amp URINARY TRACT DIAGNOSES AGE gt17 W CC 01HER KIDNEY amp URINARY TRACT DIAGNOSESgt 17 WIO CC 01HER KIDNEY amp URINARY TRACT DIAGNOSES AGE 0-17
Neurology and Neurosurgery
DRGl CRANIOTOMY AGE gt17 EXCEPT FOR TRAUMA DRG2 CRANIOTOMY FOR TRAUMA AGEgt17 DRG3 CRANIOTOMY AGE 0-17 DRG4 SPINAL PROCEDURES DRG5 EXTRACRANIAL VASCULAR PROCEDURES DRG6 CARPAL TUNNEL RELEASE DRG7 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC W CC DRG8 PERIPH amp CRANIAL NERVE amp OTHER NERV SYST PROC WIO CC DRG9 SPINAL DISORDERS amp INJURIES DRG12 DEGENERATIVE NERVOUS SYSTEM DISORDERS
j DRG13 MULTIPLE SCLEROSIS amp CEREBELLAR ATAXIA DRG14 SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA DRG15 TRANSIENT ISCHEMIC ArrACK amp PRECEREBRAL OCCLUSIONS DRG16 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC DRG17 NONSPECIFIC CEREBROVASCULAR DISORDERS WIO CC DRG18 CRANIAL amp PERIPHERAL NERVE DISORDERS W CC DRG19 CRANIAL amp PERIPHERAL NERVE DISORDERS WIO CC DRG20 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGmS DRG21 VIRAL MENlNGITIS DRG22 HYPERTENSIVE ENCEPHALOPATHY DRG23 NONTRAUMATICSTUPORampCOMA DRG24 SEIZURE amp HEADACHE AGEgt17 W CC DRG25 SEIZURE amp HEADACHE AGEgt17 WIO CC DRG26 SEIZURE amp HEADACHE AGE 0-17 DRG27 TRAUMATIC STUPOR amp COMA COMA gt1 HR DRG28 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGEgt17 W CC DRG29 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE gt17 WIO CC
imiddot DRG30 TRAUMATIC STUPOR amp COMA COMA lt1 HR AGE 0-17 DRG31 CONCUSSION AGEgt17 W CC DRG32 CONCUSSION AGEgt17 WIO CC DRG33 CONCUSSION AGE 0-17 DRG34 OTHER DISORDERS OF NERVOUS SYSTEM W CC DRG35 OTHER DISORDERS OF NERVOUS SYSTEM WIO CC
(
DRG209 DRG210 DRG211 DRG212 DRG213 DRG216 DRG217 DRG218 DRG219 DRG220 DRG221 DRG222 DRG223 DRG224 DRG225 DRG226 DRG227 DRG228 DRG229 DRG230 DRG231 DRG232 DRG233 DRG234 DRG235
j DRG236 DRG237 DRG238 DRG240 DRG241 DRG471 DRG485
DRG491 DRG496 DRG497 DRG498
f DRG501 DRG502 DRG503
Orthopedics
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 W CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGEgt17 WIO CC HIP amp FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0-17 AMPUTATION FOR MUSCULOSKELETAL SYSTEM amp CONN TISSUE DISORDERS BIOPSIES OF MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE WND DEBRID amp SKN GRFT EXCEPT HANDFOR MUSCSKELET amp CONN TISS DIS LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 W CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGEgt17 WIO CC LOWER EXTREM amp HUMER PROC EXCEPT HIPFOOTFEMUR AGE 0-17 KNEE PROCEDURES W CC KNEE PROCEDURES WO CC MAJOR SHOULDERIELBOW PROC OR OTHER UPPER EXTREMITY PROC W CC SHOULDERELBOW OR FOREARM PROCEXC MAJOR JOINT PROC WIO CC FOOT PROCEDURES SOFT TISSUE PROCEDURES W CC SOFT TISSUE PROCEDURES WIO CC MAJOR THUMB OR JOINT PROCOR OTH HAND OR WRIST PROC W CC HAND OR WRIST PROC EXCEPT MAJOR JOINT PROC WIO CC LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES OF HIP amp FEMUR LOCAL EXCISION amp REMOVAL OF INT FIX DEVICES EXCEPT HIP amp FEMUR ARTHROSCOPY OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC W CC OTHER MUSCULOSKELET SYS amp CONN TISS OR PROC WIO CC FRACTURES OF FEMUR FRACTURES OF HIP amp PELVIS SPRAINS STRAINS amp DISLOCATIONS OF HIP PELVIS amp THIGH OSTEOMYELmS CONNECTIVE TISSUE DISORDERS W CC CONNECTIVE TISSUE DISORDERS WIO CC BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY LIMB REATTACHMENT HIP AND FEMUR PROC FOR MULT SIGNIFICANT
MAJOR JOINT amp LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY COMBINED ANTERIORIPOSTERIOR SPINAL FUSION SPINAL FUSION WI CC SPINAL FUSION WIO CC KNEE PROC WI PDX OF INFECTION WI CC KNEE PROC WI PDX OF INFECTION WOCC KNEE PROC WOPDX OF INFECTION WI CC
~ t L ~
l
DRG76 DRG77 DRG78 DRG79 DRG80 DRG81 DRG85 DRG86 DRG87 DRG88 DRG89 DRG90 DRG91 DRG92 DRG93 DRG94 DRG95 DRG96 DRG97 DRG98 DRG99 DRG100 DRG101 DRG102 DRG475
DRG242 DRG244 DRG245 DRG246 DRG247 DRG256
i_J
Respiratory Disorders
OTHER RESP SYSTEM OR PROCEDURES W CC OTHER RESP SYSTEM OR PROCEDURES WO CC PULMONARYEMBOUSM RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 W CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGEgt17 WO CC RESPIRATORY INFECTIONS amp INFLAMMATIONS AGE 0-17 PLEURAL EFFUSION W CC PLEURAL EFFUSION WO CC PULMONARY EDEMA amp RESPIRATORY F AlLURE CHRONIC OBSTRUCTIVE PULMONARY DISEASE SIMPLE PNEUMONIA amp PLEURISY AGEgt17 W CC SIMPLE PNEUMONIA amp PLEURISY AGEgt17 WO CC SIMPLE PNEUMONIA amp PLEURISY AGE 0-17 INTERSTITIAL LUNG DISEASE W CC INTERSTITIAL LUNG DISEASE W 10 CC PNEUMOTIIORAX W CC PNEUMOTIIORAX WO CC BRONCHmS amp ASTIIMA AGEgt17 W CC BRONCHmS amp ASTIIMA AGEgt17 WO CC BRONCIDTIS amp ASTIIMA AGE 0-17 RESPIRATORY SIGNS amp SYMPTOMS W CC RESPIRATORY SIGNS amp SYMPTOMS WO CC OTHER RESPIRATORY SYSTEM DIAGNOSES W CC OTHER RESPIRATORY SYSTEM DIAGNOSES WO CC RESPIRATORY SYSTEM DIAGNOSIS WITII VENTILATOR SUPPORT
Rheumatology
SEPTIC ARTHRITIS BONE DISEASES amp SPECIFIC ARTHROPATIIIES W CC BONE DISEASES amp SPECIFIC ARTHROPATIDES WO CC NON-SPECIFIC ARTHROPATHIES SIGNS amp SYMPTOMS OF MUSCULOSKELETAL SYSTEM amp CONN TISSUE OTIIER MUSCULOSKELETAL SYSTEM amp CONNECTIVE TISSUE DIAGNOSES
DRG302 DRG303 DRG304 DRG305 DRG306 DRG307 DRG308 DRG309 DRG31O DRG311 DRG312 DRG313 DRG314
DRG315 DRG323 DRG324 DRG328 DRG329 DRG330 DRG334 DRG335 DRG336 DRG337 DRG339 DRG340 DRG341 DRG342 DRG343 DRG348 DRG349 DRG350 DRG351 DRG352
Urology
KIDNEY TRANSPLANT KIDNEYURETER amp MAJOR BLADDER PROCEDURES FOR NEOPLASM KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL W CC KIDNEYURETER amp MAJOR BLADDER PROC FOR NON-NEOPL WIO CC PROSTATECTOMY W CC PROSTATECTOMY WIO CC MINOR BLADDER PROCEDURES W CC MINOR BLADDER PROCEDURES WIO CC TRANSURETHRAL PROCEDURES W CC TRANSURETHRAL PROCEDURES WIO CC URETHRAL PROCEDURES AGE gt17 W CC URETHRAL PROCEDURES AGEgt17 WIO CC URETHRAL PROCEDURES AGE 0-17 OTHER KIDNEY amp URINARY TRACT OR PROCEDURES URINARY STONES W CC amplOR ESW LTIHOTRIPSY URINARY STONES WIO CC URETHRAL STRICTURE AGEgt17 W CC URETHRAL STRICTURE AGE gt17 WIO CC URETHRAL STRICTURE AGE 0-17 MAJOR MALE PELVIC PROCEDURES W CC MAJOR MALE PELVIC PROCEDURES WIO CC TRANSURETHRAL PROSTATECTOMY W CC TRANSURETHRAL PROSTATECTOMY WIO CC TESTES PROCEDURES NON-MALIGNANCY AGEgt17 TESTES PROCEDURES NON-MALIGNANCY AGE 0-17 PENIS PROCEDURES CIRCUMCISION AGEgt17 CIRCUMCISION AGE 0-17 BENIGN PROSTATIC HYPERTROPHY W CC BENIGN PROSTATIC HYPERTROPHY WIO CC INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM STERILIZATION MALE OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES
AppendixD
f 2001 Sample Physician Questionnaire
( Americas Best Hospitals)
This survey of physicians judgments provides the
basis for the reputation component of the annual
ranking of hospitals for U S News amp World Report
c
Conducted by the National Opinion Research Center at the University of Ctlicago 1155 East 60th Street Chicago IL 60637
( THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with rehabilitation regardless of location or expense (weve provided space for both hospital andlor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
l L Answers to these questions will help Have your patients been helped ormiddot
us to understand the impact of the hindered by the information they have Internet on medica practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions
D Neith~imiddoto Yes
D BothONo D Does notapply
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
D Helped
D Hindered
D Neither
D Both
D I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D A day or two a week
l D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical L company web sites
DYes D No
D Does not apply
Do you ever access medical association web sites
DYes D No
ri D Does not apply L
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet isbullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes D No
Do you allow your patients to communicate with you via electronic mail
DYes o No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes D No
D Does not apply
Thank you again for your participation
r I
l~
National Opinion Research Center at the University of Chicago 1155 East 60th Street Chicago IL 60637
Jbullbullbull
(12th Annual Survey of PhysiciansJ Direct input from physicians is
crucial in evaluating hospital quality_ f
Conducted by the National Opinion Research Center at the University of Chicago 1155 East 60th Street Chica9o IL 60637
l J
(THE NATIONS BEST HOSPITALS)
Please list in the spaces below the five hospitals (andor affiliated medical schools) in the United States that you believe provide the best care for patients with the most serious or difficult medical problems associated with cancer regardless of location or expense (weve provided space for both hospital andor affiliated medical school in hopes that will make it easier to provide your answer)
Five hospitals that provide the best careaffiliated medical schools City State
a
b
c
d
e
( THE INTERNET AND MEDICAL PRACTICE)
Answers to these questions will help Have your patients been helped or us to understand the Impact of the hindered by the information they have Internet on medical practices obtained from the Internet following your
suggestion Have you ever suggested to your D Helpedpatients that they go to the Internet for D Hinderedinformation about their conditions o NeitherOmiddotYes o BothD No o Does not apply
-Continued
Have your patients been helped or hindered by the information they have obtained from the Internet by themselves
HelpedD HinderedD NeitherD BothD
0 I dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to patients
How often do you use the Internet
D Nearly every day
D Aday or two a week
D Several times a month
D Less than once a month
D Never
Do you ever access pharmaceutical company web sites
DYes
D No
D Does not apply
Do you ever access medical association web sites
DYes
D No
D Does not apply
What other medical sites if any do you sometimes access
Do you think that the quality of information on the Internet is bullbull
D Very good
D Good
D Neither good nor bad
D Bad
D Very bad
D Dont know
In the area of medical information on the Internet what one development if any has proven most beneficial to physicians
Do youdoes your office have an electronic mail address
DYes
D No
Do you allow your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Do you encourage your patients to communicate with you via electronic mail
DYes
D No
D Does not apply
Thank you again for your participation
r
r
1 National Opinion Research Center at th~ University of Chicagobull 0 __ bull bull
1155 East 60th Street Chicago IL 60637
AppendixE
Predicted Mortality APR-DRG Methodology
r
shyi
Introduction to DRGs
The All Patient Refined Diagnosis Related Groups (APR-DRGs) were developed by 3M Health
Information Systems (3M-HIS) in conjunction with the National Association of Childrens Hospitals and
Related Institutions (NACHRI) APR-DRGs expand the basic diagnosis-related group (DRG) structure to
address patient severity of illness risk ofmorta1ity and resource intensity The APR-DRG Version 140
uses the Health Care Financing Administration (HCFA) Version 140 DRG methodology Because APRshy
DRGs are based on DRGs and All Patient DRGs (AP-DRGs) a brief explanation of both structures will
be useful
Current HCFA DRG Structure
Created from Adjacent Diagnosis Related Groups (ADGs) which combine patients into groups
with common characteristics DRGs were developed by Yale University in the 1970s to relate a
hospitals case mix index to the resource demands and associated costs experienced by the hospital
ADGs were created by subdividing an MDC1 into two groups based on the presence or absence of
an operating room procedure Surgical patients identified as those having an operating room procedure
were then classified by type ofprocedure to form surgical ADGs Patients with multiple procedures were
assigned to the highest surgical class Medical patients were divided into smaller groups based on their
principal diagnosis to form medical ADGs
DRGs use ADGs as a base and then further classify patients into selected disease and procedure
categories based on whether or not they have substantial comorbidities or complications (CC)
Approximately 3000 diagnosis codes have been designated by HCFA as substantial CCs (defined by a
list of additional diagnosis codes that a panel of physicians felt would increase the length of stay by at
least one day for 75 percent of the patients) This list covers a broad range of disease conditions and no
differentiation in severity or complexity level was made among the additional diagnoses The patients
age and discharge status were sometimes used in the definition ofDRGs
r
1 Major Diagnostic Categories (MDCs) are broad medical and surgical categories one step hierarchically higher than DRGs (several DRGs roll-up into an MDC) MDCs are divided by body systems such as nervous ear nose and throat and respiratory
Current AP-DRG Structure
In 1987 the New York State Department of Health entered into an agreement with 3M-HIS to
evaluate the applicability of DRGs to a non-Medicare population with a specific focus on neonates and
patients with Human Immunodeficiency Virus (HIV) infections The DRG definitions developed by this
relationship are referred to as the AP-DRGs
The AP-DRGs are modeled after the HCF A DRGs and attempt to improve the DRGs in an effort
to more accurately predict a hospitals resource demands and associated costs for all acute care patients
In the creation ofAP-DRGs the modifications made to the DRG structure can be summarized as follows
bull Except for neonates who die or are transferred within the first few days of life AP-DRGs define six ranges ofbirth weight that represent distinct demands on hospital resources Within each birth weight range neonates are then subdivided based on the presence of a significant operating room procedure and then further subdivided based on presence ofmultiple major minor or other problems
bull Assignment to neonatal MDC is based on age Specifically the AP-DRGs assign a patient to the neonatal MDC when the age of the patient is less than 29 days at admission regardless of the principal diagnosis
bull MDC 25 was created to account for the highly specialized treatment of multiple trauma patients Patients assigned to MDC 25 have at least two significant trauma diagnoses from different body sites
bull MDC 20 for alcohol and substance abuse was restructured to differentiate patients based on the substance being abused
bull Across all MDCs patient with a tracheostomy were put into either of two tracheostomy AP-DRGs tracheostomy performed for therapeutic reasons and tracheostomy representing long-term ventilation
bull All liver bone marrow heart kidney and lung transplant patients were assigned to an AP-DRG independent of the MDC ofthe principal diagnosis
bull For several MDCs a single major comorbidity and complication (CC) AP-DRG was formed across all surgical patients within an MDC and a single major CC AP-DRG was formed across all medical patients within an MDC
I I The AP-DRGs introduced changes to the HCF A DRGs in an attempt tomiddot depart from using the
LJ principal diagnosis as the initial variable for assignment The AP-DRGs were designed to more
accurately group patients into like groups that provide an operational means of defining and measuring a
hospitals case mix complexity
r
All Patient Refined DRGs
APR-DRG Objectives
The primary objective of the RCF A DRG and AP-DRG patient classification systems was to
relate the type ofpatients treated to the hospital resources they consumed This limited focus on resource
intensity does not allow providers to classify patients into other groups for meaningful analysis The
APR-DRG patient classification system goes beyond traditional resource intensity measures and was
designed with the ability to address the following needs
bull Compare hospitals across a wide range ofresource and outcome measures
bull Evaluate differences in inpatient mortality rates
bull Implement and support critical pathways
bull Identify continuous quality improvement initiatives
bull Support internal management and planning systems
bull Manage capitated payment arrangements
To meet these needs the APR-DRG system classifies patients according to severity of illness risk
of mortality and resource intensity Therefore in the APR-DRG classification system a patient is
assigned three distinct descriptors base APR-DRG severity of illness subclass and risk of mortality
subclass
Severity of illness can be defined as the extent of physiologic decompensation or organ system
loss of function experienced by the patient In contrast risk of mortality is defined as the patients
likelihood ofdying
For analyses such as evaluating resource intensity or patient care outcomes the base APR-DRGs
in conjunction with the severity of illness subclass is used For evaluating patient mortality the base
APR-DRGs in conjunction with the risk ofmortality subclass is used
Development of the APR-DRGs
The AP-DRGs were used as the base DRGs in the development of the APR-DRGs because they
were representative of the entire inpatient population and accounted for populations not included in DRGs
at the time of development Several consolidations additions and modifications were made to the APshy
DRGs to form the list of APR-DRGs used in the severity of illness and risk of mortality subclass
assignments
The following list summarizes the revisions made to the AP-DRGs in the creation ofthe APR-DRGs
bull All age CC and major CC splits were consolidated
bull Splits based on discharge status or death were consolidated
bull Definitions based on the presence or absence ofa complicated principal diagnosis were consolidated
bull Additional APR-DRGs were created for pediatric patients
bull APR-DRGs for newborns were completely restructured to create medical and surgical hierarchies within each birth weight range
bull Low volume APR-DRGs were consolidated into other related APR-DRGs
bull APR-DRGs that could be explained by the severity of illness subclasses were consolidated into one APR-DRG
bull Due to risk ofmortality subclasses several APR-DRGs were split to account for significant differences in mortality between patient groups
APR-DRG Severity oflllness Subclass Assignment
With the exception of neonatal patients after a patient has been given an APR-DRG code a
Severity of Illness Subclass is assigned based on the level of the secondary diagnoses presence of certain
non-OR procedures and the interaction among secondary diagnoses age APR-DRG and principal
diagnosis Neonatal patients have their own hierarchical method for determining severity of illness and
will be discussed later The four severity ofillness subclasses are
t l
~~~~~i~~ 1 Minor (Includes non CC)
2 Moderate
3 Major
i L 4 Extreme
The severity of illness subclass is used in conjunction with the patients base APR-DRG for
analysis such as evaluating resource intensity or patient care outcomes A patients severity of illness
subclass should not be used with their DRG because several DRGs may form one APR-DRG Therefore
since severity of illness subclasses correspond to the APR-DRG number and not the DRG it is important
to use the APR-DRG number to accurately interpret data
The process for assigning a patient a severity of illness subclass is a three phase process and is
summarized as follows
Phase
bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further analysis
bull Remaining secondary diagnoses are assigned one of four distinct Standard Severity of lllness Levels Figure 1 presents examples of secondary diagnoses in each severity ofillness leveL
Figure 1 Examples of Secondary Diagnoses by Severity of Illness Level
Minor Benign hypertension acute bronchitis lumbago
Moderate Chronic renal failure viral pneumonia diverticulitis
Major Diabetic ketoacidosis chronic heart failure acute cholecystitis
Extreme Septicemia acute myocardial infarction cerebral vascular accident
bull The Standard Severity of Illness Level is modified for some secondary diagnoses based on age APRshyDRG and presence of non-OR procedures Figure 2 displays an example of modifications to the standard severity ofillness level based on the APR-DRG
Bronchitis and asthma Minor
Chronic renal failure Moderate Diabetes Major LJ
Cardiomegaly Moderate Chronic heart failure Minor
Uncomplicated Minor Vaginal delivery Moderate LJ diabetes
f
f
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Severity of Illness Level is retained This prevents double counting clinically similar diagnoses
bull The Base Severity of Illness Subclass of the patient is set to the highest Standard Severity of lllness Level ofany of the secondary diagnoses
bull Patients with a Base Severity of Illness Subclass of major (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Standard Severity of Illness Level Figure 3 displays the requirements for keeping a severity of illness subclass ofmajor or extreme
Major
Extreme Two or more secondary diagnoses that are extreme or one secondary diagnosis that is extreme and at least two second dia oses that are maor
Phase III bull A minimum Severity of Illness Subclass is established based on the patients principal diagnosis This
accounts for patients assigned to codes that contain both the underlying disease and an associated manifestation of the disease (ie diabetes with hyperosmolar coma) but is only assigned to the APRshyDRG that accounts for the underlying disease
bull A minimum Severity of Illness Subclass is established based on combinations of principal diagnosis and age for specific APR-DRGs
bull A minimum Severity of Illness Subclass is established for some APR-DRGs with certain APR-DRG and non-OR procedure combinations as well as principal diagnosis and non-OR procedure combinations
bull A minimum Severity of Illness Subclass is established based on the presence of certain combinations ofsecondary diagnoses Figure 4 shows the combination of secondary diagnoses necessary to increase the severity of illness subclass to a minimum severity of illness level For example a type 1 combination would be a major bacterial infection with pleural effusion If a diagnosis from both of these categories is present plus at least one other secondary diagnosis that is at least a major severity of illness level then the minimum patient severity of illness subclass will be extreme
Figure 4 Minimum Severity of Illness Requirements
maor second dia osis 2 At least one additional Major
moderate secondary dia osis
3 Specified combinations of At least one additional Major a moderate and a minor moderate secondary cate 0 dia osis
4 Specified combinations of At least two additional Moderate r--1 Two minor cate ories minor second i Ii 5 Specified combinations of
Two moderate cate ories None Major
bull The final patient Severity of Illness Subclass is selected based on the maximum of the Phase II Base Patient Severity of Illness Subclass and the Phase III minimum Severity of Illness Subclass
Both medical and surgical patients are assigned a severity of illness level of 1-4 based on the
assignment process outlined previously
f
r-
I
l
r f
~
l
r 1
APR-DRG Risk of Mortality Subclass Assignment
Similar to the Severity ofIllness Subclass assignment the Risk ofMortality Subclass assignment
is based on the level ofthe secondary diagnoses and the interaction among secondary diagnoses age
APR-DRG and principal diagnosis In general the patients Risk ofMortality Level and Subclass will be
lower than the Severity ofIllness Level and Subclass respectively Neonatal patients have their own
hierarchical method for determining risk ofmortality and will be discussed later The four severity of
illness subclasses are
~~~~~~~G~~pound~) bull~~~~~~~~S~rs~~2bullbullmiddott~ 1 Minor (includes non CC)
2 Moderate
3 Major
4 Extreme
The risk ofmortality subclass is used in conjunction with the patients base APR-DRG for
evaluating patient mortality Like the severity of illness subclass a patients risk ofmortality subclass
should not be used with their DRG because several DRGs may form one APR-DRG Therefore since
risk ofmortality subclasses correspond to the APR-DRG number and not the DRG it is important to use
the APR-DRG number to accurately interpret data
The process for assigning a patient a risk ofmortality subclass is a three phase process and is
summarized as follows
Phase I bull Secondary diagnoses that are closely related to the principal diagnosis are eliminated from further
analysis
bull Remaining secondary diagnoses are assigned one of four distinct Risk ofMortality Levels
bull The Risk ofMortality Level is modified for some secondary diagnosis based on the patients age and APR-DRG
Phase II
bull All secondary diagnoses that are closely related to other secondary diagnoses are eliminated from further analysis and the secondary diagnosis with the highest Risk ofMortality Level is retained This prevents double counting clinically-similar diagnoses
bull The Base Risk ofMortality Subclass of the patient is set to the highest Risk ofMortality Level ofany of the secondary diagnoses
bull Patients with a Base Risk ofMortality Subclass ofmajor (3) or extreme (4) will be reduced to the next lower subclass unless the patient has multiple secondary diagnoses with a high Risk ofMortality Level
Phase III
bull A minimum Risk ofMortality Subclass is established based on the patients principal diagnosis This accounts for specific APR-DRGs that have a principal diagnosis indicative of a higher risk ofmortality relative to the other principal diagnoses in the APR-DRG r
i
l ~ bull A minimum Risk ofMortality Subclass is established based on the presence ofcertain combinations of secondary diagnoses
bull The final patient Risk ofMortality Subclass is selected based on the maximum ofthe Phase II Base l
Risk ofMortality Subclass and the Phase III minimum Risk ofMortality Subclass
J
r
AppendixF
f Index of Hospital Quality (lHQ) Scores by Specialty
i
i L
F-~
f laquo
2001
C
ance
r B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
con
sc
ore
R
N s
R
ank
Ho
spit
al
10
0
sco
re
rate
M
embe
r (o
f 7
) D
isch
arg
es
to b
eds
Mem
oria
l S
loan
-Ket
teri
ng
can
cer
Cen
ter
N
ew Y
ork
10
00
7
18
0
93
Y
es
60
51
67
21
2
2 U
niv
ersi
ty 0
1 T
exas
M
D
A
nder
son
Cen
cer
Cen
ter
H
oust
on
98
2
68
5
07
7
Yes
5
0
5103
2
68
3
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
78
3
59
0
69
Y
es
70
15
78
14
2
4 D
ana-
farb
er C
ance
r In
stit
ute
B
osto
n 6
37
3
88
0
81
No
60
21
8 2
27
5
May
o C
lin
ic
Ro
ches
ter
M
inn
5
81
2
50
0
60
Y
es
70
37
11
13
1
(+3
SO)
6 UC
LA M
edic
al C
ente
r
los
Ang
eles
41
0
79
0
56
Y
es
70
12
19
10
8 7
Un
iver
sity
01
Chi
cago
Ho
spit
als
40
6
65
0
66
Y
es
70
14
69
19
4
8 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
401
7
1
07
5
Yes
7
0
3494
1
81
9
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
40
0
91
0
82
Y
es
60
18
44
16
1
10
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
38
5
10
7
09
2
Yes
4
0
1105
1
61
11
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r
Ann
Arb
or
38
4
31
0
42
Y
es
70
16
56
17
9
12
Un
iver
sity
01
was
hing
ton
Med
ical
Cen
ter
S
eatt
le
38
3
79
0
66
Y
es
60
92
6 1
10
13
M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 3
80
8
8
09
5
Yes
7
0
2022
1
38
14
C
lari
an H
ealt
h P
art
ners
In
dia
nap
oli
s 3
78
5
2
07
5
Yes
7
0
2149
1
67
15
U
niv
ersi
ty o
f P
ittS
bu
rgh
Med
ical
Cen
ter
37
4
26
0
56
Y
es
65
23
10
16
7
(+2
SO)
16
Cle
vel
and
Cli
nic
3
62
3
1
07
4
Yes
7
0
2018
1
94
17
R
osw
ell
Par
k C
ance
r In
stit
ute
B
uff
alo
36
1
55
0
85
Y
es
50
16
76
28
7
18
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
35
5
37
0
73
Y
es
60
14
15
14
3
19
Un
iver
sity
of
Ken
tuck
y H
osp
ital
le
xin
gto
n
351
0
5
05
6
Yes
7
0
1047
2
20
20
fo
x C
hase
can
cer
Cen
ter
P
hil
adel
ph
ia
35
0
56
0
83
Y
es
50
10
46
15
8
21
H
lee M
off
itt
can
oer
Cen
ter
T
ampa
F
la
35
0
15
0
65
Y
es
60
16
44
16
8lt
22
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
Cen
ter
Ch
arl
ott
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ille
3
49
0
5
061
Y
es
60
13
48
22
7
23
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
34
8
17
0
67
Y
es
70
99
9 2
40
24
S
hand
s H
osp
ital
at
the
Un
iver
sity
of
flo
rid
a
Gei
nes
vil
le
34
7
14
0
46
Y
es
60
10
23
15
7
25
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
34
6
00
0
57
Y
es
60
12
22
191
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
34
4
17
0
67
Y
es
80
16
15
151
27
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
34
3
15
0
66
Y
es
55
14
14
15
8
28
Un
iver
sity
Ho
spit
al o
f A
rkan
sas
li
ttle
Roc
k 3
43
0
5
06
3
Yes
5
5
1287
2
54
29
U
niv
ersi
ty H
osp
ital
D
enve
r 3
42
2
7
05
7
Yes
5
0
431
24
0
30
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
34
2
23
0
49
Y
es
60
44
8 1
72
lt
31
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
34
2
00
0
61
Y
es
70
15
55
15
3
32
Art
hu
r G
Ja
mes
Can
cer
Ho
spit
al
Col
umbu
s
Ohi
o 3
41
0
0
04
8
Yes
5
5
2147
1
56
33
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
34
0
19
0
69
Y
es
70
11
42
13
6
34
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
33
9
00
0
50
Y
es
55
14
81
14
9
35
New
Yor
k P
resb
yte
rian
HO
spit
al
33
7
34
0
86
Y
es
70
31
03
13
2
36
Un
iver
sity
of
cali
forn
ia
San
Fra
nci
soo
Med
ical
Cen
ter
33
5
30
0
71
Yes
6
0
573
17
5
37
fG
M
cGaw
Ho
spit
al a
t lo
yo
la U
niv
ersi
ty
May
woo
d
Ill
3
33
1
6
07
0
Yes
6
0
1023
1
62
38
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
33
3
00
0
62
Y
es
60
12
79
15
2
39
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
-Sal
em
33
3
19
0
84
Y
es
70
20
21
181
40
fa
irv
iew
-Un
iver
sity
Med
ical
Cen
ter
M
inn
eap
oli
s 3
32
0
4
06
2
Yes
5
0
1248
1
56
41
G
reat
er B
alti
mo
re M
edic
al C
ente
r B
alti
mo
re
33
2
00
0
58
Y
es
35
12
39
20
0
42
Un
iver
sity
Ho
spit
als
of
Cle
vel
and
3
30
0
0
06
4
YampS
70
19
71
12
1
43
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
lo
we
Cit
y
32
9
04
0
70
Y
es
70
13
05
13
4
44
St
Jo
hn
S H
osp
ital
S
pri
ng
fiel
d
Ill
3
29
0
0
05
5
Yes
6
0
996
13
3
45
Hen
ry F
ord
Ho
spit
al
Detr
oit
3
27
0
0
07
6
Yes
6
5
1473
1
92
46
B
arn
es-J
ewis
h H
osp
ital
S
t
lou
is
32
6
05
0
74
Y
es
85
27
56
14
9
47
luth
era
n G
ener
al H
ealt
hSys
tem
P
ark
Rid
ge
Ill
3
26
0
0
06
2
Ves
6
0
1420
1
14
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
3
24
0
5
05
0
Yes
7
0
776
10
9
49
Coo
k C
ount
y H
osp
ital
C
hica
go
32
3
04
0
49
Y
es
50
49
1 2
10
50
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
32
2
09
0
90
Y
es
50
13
24
19
2
1
2001
D
iges
tiv
e D
iso
rder
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N
s
Tra
uma
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 8
) D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
59
8
05
9
Yes
8
0
7660
1
31
Yes
2
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
6
82
3
50
0
63
Y
es
75
31
28
14
2
Yes
3
Cle
vel
and
Cli
nic
6
27
3
05
0
57
Y
es
80
44
75
19
4 N
o 4
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
58
9
29
9
08
7
Yes
8
0
4403
1
38
Y
es
5 M
ount
Sin
ai
Med
ical
Cen
ter
N
ew Y
ork
49
5
23
2
09
8
Yes
8
0
5220
1
57
Y
es
6 UC
LA M
edic
al C
ente
r
Los
A
ngel
es
44
5
18
5
081
Y
es
80
25
40
10
8
Yes
7
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
39
7
14
3
09
0
Yes
8
0
3787
1
81
Yes
8
un
ivers
ity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
37
9
13
2
07
0
Yes
7
0
1596
1
75
N
o 9
Un
iver
sity
of
Chi
oago
Ho
spit
als
37
0
131
0
93
Y
es
80
19
84
19
4
Yes
(+
3 SO
) 10
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
30
6
57
0
61
Y
es
80
91
3 1
98
Y
es
11
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 2
99
5
2
07
5
Yes
8
0
4048
1
67
Y
es
12
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
2
95
7
7
09
9
Yes
8
0
2348
1
61
Yes
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
29
2
47
0
72
Y
es
80
56
89
14
9
Yes
14
U
niv
ersi
ty o
f M
iohi
gan
Med
ical
Cen
ter
Ann
Arb
or
291
3
8
06
8
Yes
8_
0 28
16
17
9
Yes
15
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 2
90
4
9
07
4
Yes
8
0
2636
1
43
Y
es
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
28
0
50
0
74
Y
es
50
20
34
161
Y
es
17
Cla
rian
Hea
lth
part
ners
In
dia
nap
oli
s 2
78
5
2
09
2
Yes
8
0
5286
1
67
Y
es
18
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
27
6
45
0
84
Y
es
80
28
28
15
3
Yes
19
B
eth
Isra
el
Dea
cone
ss M
edio
al C
ente
r
Bos
ton
21
4
34
0
73
Y
es
70
45
27
15
8
Yes
20
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
27
1
30
0
45
Y
es
80
99
2 1
09
Y
es
21
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
N
ew Y
ork
26
5
16
0
49
Y
es
70
26
18
21
2
No
22
New
Yor
k P
resb
yte
rian
Ho
spit
al
26
2
52
1
01
Yes
8
0
4884
1
32
Yes
23
U
niv
ers
ttv o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
26
0
20
0
65
Y
es
80
21
84
13
6 Y
es
(+2
SOI
24
Med
ical
Un
iver
sity
of
Sou
th C
aro
lin
a C
har
lest
on
2
58
6
9
12
0
Yes
7
0
2202
2
09
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
25
1 2
2
07
5
Yes
6
5
2472
1
57
Y
es
26
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
oak
M
ich
2
50
0
8
07
0
Yes
8
0
5809
1
88
Y
es
27
8ay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
49
2
6
07
8
Yes
6
0
4673
1
22
y
es
28
All
egh
eny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
24
8
00
0
60
Y
es
70
26
48
191
Y
es
29
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
42
1
4
06
9
Yes
7
5
1677
1
47
Y
es
30
Los
A
ngel
es C
ount
y-U
Sc
Med
ical
Cen
ter
24
2
08
0
37
Y
es
60
39
5 1
67
Y
es
31
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
24
0
18
0
79
Y
es
70
18
25
24
0
Yes
32
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
24
0
39
0
78
y
es
80
11
34
11
0
No
33
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Il
l
23
8
00
0
59
Y
es
60
31
21
11
4
Yes
34
U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
oer
Cen
ter
H
oust
on
23
7
33
0
80
Y
es
60
13
61
26
8
No
35
Lah
ey H
itch
coo
k C
lin
io
Bu
rlin
gto
n
Mas
s
23
6
00
0
67
Y
es
70
26
77
15
2
Yes
36
C
edar
s-S
inai
Med
ical
Cen
ter
L
os A
ngel
es
23
4
27
0
94
Y
es
80
47
95
10
6
Yes
37
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
Sit
y
May
woo
d
Ill
2
34
0
0
06
6
Yes
7
0
2180
1
62
Y
es
38
Mar
y H
itch
coo
k M
emor
ial
Ho
sp
ital
le
ban
on
N
H
23
4
04
0
68
Y
es
70
15
58
19
4
Yes
39
U
niv
ersi
ty o
f C
ali
forn
ie
Dav
is M
edio
al C
ente
r
Sac
ram
ento
2
33
0
0
06
8
Yes
8
0
1751
2
79
Y
es
40
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
iCS
Io
wa
Cit
y
23
3
13
0
77
Y
es
80
19
31
13
4
Yes
41
N
ew E
ngla
nd M
edic
al C
ente
r
Bos
ton
23
3
20
0
82
Y
es
10
11
88
24
2
Yes
42
F
roed
tert
Mem
oria
l L
uth
eran
Ho
spit
al
Mil
wau
kee
23
2
00
0
63
Y
es
70
19
29
14
6
Yes
43
T
hom
as J
eff
ers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
32
0
8
07
6
Yes
1
0
3206
1
23
Y
es
44
Tem
ple
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
30
1
7
01
0
Yes
7
5
1450
1
46
N
o 45
G
reat
er B
alti
mo
re M
edic
al C
ente
r
Bal
tim
ore
2
30
1
2
071
Y
es
SO
24
95
20
0
No
46
Hen
ry F
ord
Ho
spit
al
Detr
oit
2
29
0
8
08
6
Yes
7
5
3475
1
82
Y
es
47
Un
iver
sity
Of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pal
Hil
l 2
29
1
0
081
Y
es
60
29
86
15
2
Yes
48
O
chsn
er F
ou
nd
atio
n H
osp
1ta
l
New
Orl
ean
s 2
28
1
5
07
4
Yes
6
5
2465
1
40
N
o 49
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
F
la
22
S
00
0
62
14
0 7
0
5778
1
67
Y
es
SO
Un
iVer
sity
Ho
spit
al
Den
ver
22
7
11
0
81
Yes
6
0
1151
2
40
Y
es
L r
middotmiddot
2001
E
ar
Nos
e
and
Thr
oat
Bes
t H
osp
ital
Lis
t
Hos
pita
lwid
e T
echn
olog
y R
eput
atio
nal
mo
rtal
ity
C
OTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
sc
ore
rate
M
embe
r (o
f 5)
D
isch
arge
s to
bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
40
2
08
2
Ves
5
0
26
4
14
2
Yes
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
8S
4
32
4
08
6
Yes
5
0
219
13
4
Ves
3
Mas
saoh
uset
ts E
ye
and
Ear
In
firm
ary
B
osto
n 7
66
2
71
0
11
No
3
0
26
8
18
7
Ves
4
May
o C
lin
io
Roo
hest
er
Min
n
68
2
21
0
07
2
Ves
5
0
502
13
1
Ves
5
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
6
39
1
90
0
82
Y
es
50
28
3 1
79
Y
es
6 U
niv
ersi
ty o
f P
itts
bUrg
h M
edic
al C
ente
r 6
23
1
85
0
84
V
es
50
36
3 1
67
Y
es
7 UC
LA M
edic
al C
ente
r
los
Ang
eles
6
21
1
89
0
83
Y
es
50
2
88
1
08
Y
es
8 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
cano
er C
ente
r H
oust
on
51
6
14
7
08
9
Ves
4
0
124
26
8
No
9 H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
5
05
1
36
1
02
Y
es
50
26
7 1
61
Y
es
10
Cle
vela
nd C
lin
ic
49
5
10
6
06
7
Yes
5
0
23
6
19
4
No
11
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nio
N
ashv
ille
4
64
9
3
09
4
Yes
5
0
28
4
24
0
Yes
12
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
caU
f
46
1
10
8
08
6
Yes
3
0
13
4
16
1
Yes
1
3
Bar
nesmiddot
Jew
ish
Ho
spit
al
St
lo
uis
4
68
9
0
08
2
Yes
5
0
39B
1
49
Y
es
14
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
42
6
10
1
0middot8
7 Y
es
50
8
6
11
0
No
15
M
etho
dist
Ho
spit
al
Hou
ston
4
09
1
02
1
07
Y
es
40
2
30
1
33
No
(+
3 SO
l 16
M
emor
ial
Slo
anmiddotK
ette
rin
g e
ence
r C
ente
r
New
Vor
k 3
91
5
4
07
9
Yes
5
0
24
9
21
2
No
17
Mou
nt S
lnai
Med
ioal
Cen
ter
New
Vor
k 3
86
7
8
11
1
Yes
5
0
31
2
15
7
Yes
18
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
37
9
45
0
79
Y
es
50
16
6 1
57
Y
es
19
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
oo M
edio
al C
ente
r 3
78
6
3
08
5
Ves
4
0
131
17
5
No
20
Duk
e U
niv
ersi
ty M
edio
al C
ente
r D
urha
m
NC
3
50
4
3
09
3
Yes
5
0
15
3
18
1
Ves
21
U
niv
ersi
ty o
f W
isoo
nsin
Ho
spit
al a
nd C
lin
ios
Med
ison
3
40
1
9
07
7
Yes
5
0
23
2
13
6
Yes
22
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
enoe
s C
ente
r C
har
lott
esv
ille
3
39
3
0
08
1
Ves
4
0
195
22
7
No
23
un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 3
37
2
2
07
9
Ves
4
0
18
9
15
2
Yes
(+
2 SO
l 2
4
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
33
4
26
0
77
V
es
50
4
4
19
8
Ves
2
5
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty O
f F
lori
da
Gai
nes
vil
le
33
3
18
0
76
V
es
40
16
7 1
57
Y
es
26
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middot Sal
em
33
1
26
0
92
Y
es
50
2
43
1
61
Y
es
27
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
33
0
29
0
76
Y
es
35
11
2 1
01
V
es
28
H
enry
For
d H
osp
ital
D
etro
it
32
9
05
0
73
Y
es
45
2
14
1
82
V
es
29
st
lo
uis
Un
iver
sity
Ho
spit
al
32
5
12
0
71
Y
es
50
1
13
1
47
Y
es
30
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
w
ashi
ngto
n
DC
3
24
1
7
05
3
Ves
5
0
89
1
0
9middot
Yes
31
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hioa
go
32
3
26
0
92
V
es
40
18
4 1
70
ve
s 32
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
C
hica
go
32
3
20
0
70
V
es
50
14
5 1
14
No
3
3
Fai
rvie
w-U
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
32
3
23
0
79
Y
es
30
3
57
1
56
No
3
4
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
25
0
90
Y
es
50
1
00
1
94
Y
es
35
Un
iver
sity
Ho
spit
al
Den
ver
31
7
15
0
74
Y
es
40
52
2
40
Y
es
36
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
3
17
1
9
08
5
Yes
4
0
19
9
12
3
Yes
3
7
Sum
ma
Hea
lth
syst
em
Akr
on
Ohi
o 3
16
0
0
06
9
Ves
4
0
28
7
14
9
Yes
3
8
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
sa
cram
ento
3
15
0
5
07
6
Ves
5
0
14
3
27
9
Ves
3
9
lOS
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
31
2
13
0
20
Y
es
35
42
1
67
Y
es
40
Val
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
31
2
16
0
92
Y
es
50
2
43
1
53
V
es
41
Un
iver
sity
of
Tex
as M
edio
al B
rano
h H
osp
ital
s
Gal
vest
on
31
1
27
0
91
Yes
4
0
118
15
3
Yes
4
2
Lut
hera
n G
ener
al H
ealt
hsys
tem
P
ark
Rid
ge
Ill
3
09
0
0
07
0
Yes
4
0
212
11
4
Yes
4
3
Un
iver
sity
of
Illi
no
is
Ho
spit
al a
nd C
lin
iCs
Chi
cago
3
06
1
2
06
6
Yes
2
5
87
1
29
Y
es
44
lah
ey H
itoh
oook
Cli
nic
B
url
ing
ton
M
ass
3
05
0
5
07
6
Yes
4
0
138
15
2
Yes
4
5
Art
hur
G
Jam
es C
anoe
I H
osp
ital
C
olum
bus
O
hio
30
4
00
0
57
V
es
40
13
1 1
56
Y
es
46
w
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
30
3
05
0
86
Y
es
40
2
16
1
92
V
es
47
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 3
02
0
4
08
7
Yes
5
0
35
5
16
7
Ves
4
8
wil
liam
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
3
02
0
0
08
5
Yes
5
0
29
6
18
8
Yes
4
9
New
Vor
k Ey
e an
d E
ar
Infi
rmar
y
New
Yor
k 3
02
1
7
00
0
No
35
50
2
63
Y
es
50
F
G
McG
aw H
osp
ital
at
lOll
ola
Un
iver
sity
M
ayw
ood
Il
l
30
0
10
0
87
Y
es
40
16
6 1
62
Y
es
L L
2001
G
eria
tric
s B
est
Ho
spit
al L
ist
Hos
ptta
lwid
e T
echn
olog
y D
isch
arge
S
erv
ice
Ger
iatr
ic
Rep
utat
iona
l m
ort
alit
y
COTH
sc
ore
R
N
s
plan
ning
m
ix
serv
ices
R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (o
f 8
) to
bed
s (o
f 3
) (o
f 1
0)
(of
7)
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
10
00
3
97
0
83
Y
es
80
1
08
3
6 5
2 JO
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
89
5
33
6
08
2
Yes
8
0
14
2
3 9
4 3
Mou
nt
Sin
ai M
edic
al C
ente
r N
ew Y
ork
73
3
27
6
11
1
Yes
8
0
15
7
3 8
4 4
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
6
11
1
98
0
93
Y
es
80
1
81
3
7 3
5 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
59
4
18
5
09
3
Yes
8
0
13
8
3 8
4 6
May
o C
11ni
c
Roo
hest
er
Min
n
51
1
11
2
07
2
Yes
8
0
13
1
3 1
0
8 7
St
L
ouis
Un
iver
sity
Ho
spit
al
45
2
95
0
71
Y
es
80
1
47
3
4 3
8 Y
alemiddot
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
4
33
1
00
0
92
Y
es
80
1
53
3
1 3
9 C
leve
land
lt1
1nio
4
28
7
0
06
7
Yes
8
0
19
4
3 8
4 10
U
niv
ersi
ty o
f M
ichI
gan
Med
ical
Cen
ter
Ann
Arb
or
42
2
79
0
82
Y
es
80
1
79
3
9 4
11
Bet
h Is
rael
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
11
7
7
08
4
Yes
7
0
15
8
3 9
4 (+
3 SO
) 12
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
68
7
3
08
7
Yes
7
0
11
0
2 6
2 1
3
Un
iver
sity
01
Chi
cago
Ho
spit
als
35
4
50
0
90
Y
es
80
1
94
3
8 4
14
B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
33
6
32
0
82
Y
es
80
1
49
3
9 4
15
U
niv
ersi
ty H
osp
ital
D
enve
r 3
34
2
5
07
4
Yes
7
0
24
0
3 8
5 16
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
28
3
0
08
1
Yes
8
0
14
3
3 7
4 17
R
ush
middotPre
sby
teri
anmiddotS
t L
uke
s M
edic
al C
ente
r C
hica
go
32
5
14
0
70
Y
es
80
1
14
3
9 5
19
u
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nois
co l
led
ical
Cen
ter
32
5
36
0
85
Y
es
70
1
75
3
6 4
(+2
SO)
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
0
34
0
86
Y
es
60
1
61
3
9 3
20
Ho
spit
al o
f th
e U
niv
ersi
ty o
f pe
nnsy
lvan
ia
Ph
ilad
elp
hia
3
16
4
4
10
2
Yes
8
0
16
1
I 8
3 21
U
niv
ersi
ty H
osp
ital
s o
f C
leve
land
3
13
2
5
07
9
Yes
8
0
12
1
2 8
4 2
2
Par
klan
d ll
emor
ial
Ho
spit
al
Dal
las
31
3
1S
0
77
Y
es
80
1
98
3
7 4
23
N
orth
Car
oli
na
Bap
tist
Ho
spit
al
Win
ston
middotSai
em
31
1
20
0
92
Y
es
80
1
61
3
10
6
24
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
30
8
05
0
53
Y
es
70
1
09
3
8 4
25
U
niv
ersi
ty o
f Il
lin
Ois
Ho
spit
al a
nd C
lin
ios
C
hioa
go
30
7
11
0
66
Y
es
55
1
29
3
7 4
26
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 3
04
4
1
10
5
Yes
8
0
11
8
3 1
4 2
7
Fai
rvie
wmiddotu
niv
ersi
ty M
edic
al C
ente
r M
inne
apol
is
30
4
14
0
19
Y
es
60
1
56
3
9 5
28
Sos
ton
Med
ioal
Cen
ter
30
4
16
0
75
Y
es
60
2
10
3
7 4
29
Fra
nci
s S
cott
Key
Med
ical
Cen
ter
Bal
tim
ore
30
4
18
0
80
Y
es
70
0
79
3
8 5
30
S
parr
ow H
osp
ital
and
Hea
lth
Sys
tem
L
anS
ing
M
ich
3
04
0
0
06
5
No
70
1
13
3
10
6
31
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
02
0
8
08
4
Yes
8
0
16
7
3 9
7 3
2
Los
Ang
eles
cou
ntymiddot
uSC
lle
dica
l C
ente
r 3
01
0
3
02
0
Yes
6
5
16
7
3 8
3 3
3
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
98
2
3
09
2
Yes
7
0
17
0
3 9
4 3
4
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
29
7
03
0
68
Y
es
70
1
49
3 9
3 3
5
Coo
k C
ount
y H
osp
ital
C
hica
go
28
6
00
0
55
Y
es
60
2
10
3
7 4
36
U
niv
ersi
ty o
f C
onne
ctic
ut H
ealt
h C
ente
r
Far
min
gton
2
94
4
6
10
0
Yes
6
0
26
0
3 3
2 3
7
Ho
spit
al f
or
Sp
ecia
l S
urge
ry
New
Yor
k 2
91
0
0
01
0
Yes
6
0
15
1
3 5
4 3
8
Un
iver
sity
Med
ioal
Cen
ter
Tuc
son
A
riz
2
90
0
0
06
6
Yes
7
0
17
2
3 7
3 3
9
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
28
9
07
0
79
Y
es
70
1
52
3
10
3
40
Thom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
28
9
13
0
85
Y
es
70
1
23
3
9 4
41
Hen
nepi
n C
ount
y M
edic
al C
ente
r
Min
neap
olis
2
89
0
0
06
1
Yes
6
5
10
5
3 7
3 4
2
St
L
uk
es
Ho
spit
al
Ch
este
rfie
ld
Mo
2
88
0
0
06
7
No
70
1
06
3
8 8
43
Aug
usta
Hea
lth
Car
e
Fis
her
svil
le
Va
2
87
0
0
06
5
No
50
1
35
3
8 5
44
John
D
Arc
hbol
d M
emor
ial
Ho
spit
al
Tho
maS
Vil
le
Ga
2
86
0
0
06
3
No
70
0
93
3
7 4
45
F
G
McG
aw H
osp
ital
at
Loy
ola
un
iver
sity
M
ayw
ood
Il
l
28
5
14
0
87
Y
es
70
1
62
3
9 3
46
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
Cen
ter
Sac
ralll
ampnt
o 2
84
0
4
07
6
Yes
8
0
27
9
3 6
4 4
7
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
28
4
00
0
70
Y
es
70
1
14
3
7 4
49
Hen
ry F
ord
Ho
spit
al
Det
roit
2
83
0
4
07
3
Yes
7
5
18
2
3 4
4 4
9
Un
iver
sity
of
Vir
gin
ia H
ealt
h Sc
ienc
amps
Cen
ter
Ch
arlo
ttes
vil
le
282
0
3
08
1
Yes
7
0
22
7
3 9
4 50
S
t
Jose
ph H
osp
ital
D
enve
r 2
80
0
0
06
3
No
70
1
03
3
6 3
2001
G
ynec
olog
y B
est
Ho
spit
al L
ist
Hos
p1ta
lwid
e T
echn
olog
y G
ynec
olog
y R
eput
atio
nal
mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
serv
ices
R
ank
Ho
spit
al
IHQ
sc
ore
ra
te
Mem
ber
(of
8)
Dis
char
ges
to b
eds
Cen
ter
(of
4)
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
32
5
0B
2
Yes
8
0
24
0
14
2
Yes
4
2 M
ayo
Cli
nic
R
oche
ster
M
inn
7
53
2
10
0
72
Y
es
80
13
40
13
1
Yes
3
3 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 6
70
1
77
0
81
Y
es
80
4
83
1
43
Y
es
4 4
UCLA
Med
ical
Cen
ter
L
os A
ngel
es
58
3
14
2
08
3
Yes
8
0
310
10
8
Yes
4
5 U
niv
ersi
ty o
f T
exas
M
D
A
nder
son
Can
cer
Cen
ter
Hou
ston
5
72
1
59
0
89
Y
es
60
2
34
2
68
No
0
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
49
9
10
9
09
3
Yes
8
0
512
18
1
Yes
4
7 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
49
8
11
0
09
3
Yes
8
0
418
13
8
Yes
4
8 P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 4
89
1
01
0
77
Y
es
80
9
4
19
8
Yes
3
11 Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
4
37
1
00
1
15
Y
es
80
56
0 1
32
Y
es
4 1
0
Un
iver
sity
of
Nor
th C
arol
ina
Ho
spit
als
Cha
pel
Hil
l 4
06
6
1
07
9
Yes
7
0
34
3
15
2
Yes
4
11
Mem
oria
l S
loan
-Ket
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
03
7
4
07
9
Yes
7
0
179
21
2
No
1 1
2
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
3
87
6
7
08
6
Yes
5
0
274
16
1
Yes
2
13
M
agee
-Wom
ens
Ho
spit
al
Pit
tsb
urg
h
38
4
50
0
67
Y
es
65
55
1 1
53
No
3
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
38
3
52
0
82
Y
es
80
3
90
1
79
Y
es
3 15
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
36
5
52
0
92
Y
es
70
29
1 1
70
Y
es
4 (+
3 SD
) 1
6
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
36
3
50
0
92
Y
es
80
34
6 1
53
Y
es
4 17
C
leve
land
Cli
nic
3
59
3
7
06
7
Yes
7
0
711
19
4
No
3 18
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsyl
vani
a
Ph
ilad
elp
hia
3
54
5
5
10
2
Yes
8
0
222
16
1
Yes
4
19
Un
iver
sity
of
Chi
cago
Ho
spit
als
35
1
43
0
90
Y
es
80
2
33
1
94
Y
es
4 2
0
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
34
3
50
0
85
Y
es
70
51
1
75
No
3
21
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
niC
N
ash
vil
le
33
B
35
0
84
Y
es
B_O
30
2 2
40
Y
es
3 2
2
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
2
12
0
S3
Y
es
80
16
9 1
09
Y
es
4 2
3
Los
Ang
eles
Cou
nty-
uSC
Med
ical
Cen
ter
31
7
12
0
20
Y
es
65
4
0
16
7
Yes
4
24
Bar
nes-
Jew
ish
Ho
spit
al
St
L
ouis
3
16
2
3
08
2
Yes
7
5
62
3
14
9
Yes
4
25
R
ush
-Pre
sby
teri
an-S
t
Luk
es
Med
ical
Cen
ter
Chi
oago
3
15
2
2
07
0
Yes
8
0
30
3
114
No
3
26
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irmin
gham
3
14
3
1
09
6
Yes
8
0
411
15
1
Yes
4
(+2
SO)
27
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
97
1
9
08
5
Yes
7
0
33
7
12
3
Yes
4
28
U
niv
ersi
ty M
edic
al C
ente
r T
uoso
n A
riz
2
95
0
8
06
6
Yes
7
0
150
17
2
Yes
3
29
U
niv
ersi
ty H
osp
ital
D
enve
r 2
92
1
3
07
4
Ves
6
0
90
2
40
Y
es
4 3
0
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 2
92
3
2
11
1
Yes
8
0
317
15
7
Yes
4
31
Art
hur
G
Jam
es C
ance
r H
osp
ital
C
olum
bus
O
hio
29
1
00
0
57
Y
es
70
1
73
1
56
Y
es
3 32
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
90
0
0
05
5
Yes
6
0
69
21
0
Yes
4
33
U
niv
ersi
ty o
f C
alif
orn
ia
Irv
ine
Med
ical
Cen
ter
Ora
nge
2B
9
30
0
82
Y
es
60
69
1
05
Y
es
1 3
4
Un
iver
sity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
28
8
24
0
87
Y
es
80
2
07
1
10
No
4
35
S
tbull
Jose
ph H
osp
ital
D
enve
r 2
88
0
8
05
3
No
70
2
89
1
03
No
4
36
C
edar
smiddotS
inai
Med
ical
Cen
ter
Lo
s A
ngel
es
29
4
29
1
07
Y
es
BO
S
02
10
6
Yes
4
37
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
83
0
0
06
8
Yes
6
5
37
6
14
9
Yes
4
38
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r D
alla
s 2
8S
1
6
08
8
Yes
6
5
559
12
2
Yes
4
39
M
ary
Hit
chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
28
2
12
0
86
V
es
70
2
34
1
94
Y
es
4 4
0
emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
28
1
38
0
90
Y
es
80
2
09
0
93
No
0
41
Wom
en a
nd
Infa
nts
Ho
spit
al O
f R
hode
Is
lan
d
Pro
vide
nce
28
1
04
0
29
Y
es
50
5
19
0
63
No
4
42
B
eth
Isra
el
Oea
cone
ss M
edic
al C
ente
r B
osto
n 2
80
1
2
08
4
Yes
7
0
286
15
8
Yes
3
43
C
lari
an H
ealt
h P
artn
ers
In
dia
nap
oli
s 2
79
1
1
08
7
Yes
8
0
55
8
16
7
Yes
3
44
Ohi
o S
tate
un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
77
1
0
07
6
Yes
6
5
157
10
1
Yes
4
45
W
illi
am
Bea
umon
t H
osp
ital
R
oyal
Oak
M
ich
2
75
0
4
08
5
Yes
9
0
59
5
18
9
Yes
4
46
L
uthe
ran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
27
4
00
0
70
Y
es
70
2
60
1
14
Y
es
4 4
7
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nic
s
Mad
ison
2
12
1
2
07
7
Yes
7
0
20
7
13
6
Yes
1
48
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
27
1
05
0
76
Y
es
70
2
62
1
57
Y
es
2 4
9
Gre
ater
Bal
tim
ore
Med
ical
Cen
ter
Bal
tim
ore
27
0
00
0
69
Y
es
55
46
0 2
00
No
4
50
FG
M
oGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
70
1
0
08
7
Yes
7
0
186
16
2
Yes
4
rmiddot--
I
i L
L
2001
H
eart
Bes
t H
osp
ital
Lis
t
Ran
k H
osp
ital
1 C
leve
land
Cli
nic
2
May
o C
11ni
o
Roc
hest
er
Min
n
3 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
4 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
5 B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
7
Tex
as H
eart
In
stit
ute
-St
Luk
es
Epi
scop
al H
osp
ital
H
oust
on
B
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
9 Em
ory
un
iver
sity
Ho
spit
al
Atl
anta
1
0
Bet
h Is
rael
Dea
oone
ss M
edic
al C
tlnt
er
Bos
ton
11
B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
is
12
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
13
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
1
4
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
1
5
Lah
ey H
itch
oock
Cli
nic
B
url
ing
ton
M
ass
1
6
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
1
7
Orl
ando
Reg
iona
l M
edic
al C
ente
r O
rlan
do
Fla
18
Hen
ry F
ord
Ho
spit
al
Det
roit
1
9
Thom
as
Jeff
erso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
20
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
21
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
2
2
Bos
ton
Med
ical
Cen
ter
2
3
St
Lou
is U
niv
ersi
ty H
osp
ital
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddotS
alem
2
5
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
6
Un
iver
sity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
2
7
Mou
nt
Sin
ai M
edic
al C
ente
r
New
Yor
k
28
N
ew Y
ork
pre
sby
teri
an H
osp
ital
2
9
UCLA
Med
ioal
Cen
ter
Los
Ang
eles
3
0
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
nio
s
Mad
ison
31
L
uthe
ran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
F
lori
da
Ho
spit
al M
edic
al C
ente
r O
rlan
do
Fla
33
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
4
Un
iver
sity
of
Was
hing
ton
Mad
ical
Cen
ter
Sea
ttle
3
5
Ru
sh-P
resb
yte
rian
middotSt
L
uke
s M
edic
al C
ente
r C
hica
go
36
S
t
Lu
ke
s H
osp
ital
B
ethl
ehem
P
a
37
S
enta
ra N
orfo
lk G
ener
al H
osp
ital
N
orfo
lk
Va
3
8
St
Vin
cent
Ho
spit
al a
nd H
ealt
h C
ente
r
Ind
ian
apo
lis
3
9
How
ard
Un
iver
sity
Ho
spit
al
Was
hing
ton
4
0
Ced
ars-
Sin
ai M
edic
al C
ente
r
LOS
Ang
eles
41
S
inai
Ho
spit
al o
f B
alti
mor
e
42
S
pect
rum
Hea
lth
Gra
nd R
apid
s
Mio
h
43
N
orth
Sho
re U
niv
ersi
ty H
osp
ital
M
anha
sset
N
V
44
Was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
45
M
ary
Hit
chco
ck M
emor
ial
Ho
spit
al
Leb
anon
N
H
46
Geo
rget
own
Un
iver
sity
Ho
spit
al
waS
hing
ton
D
C
47
M
edic
al C
ente
r o
f D
elaw
are
Wilm
ingt
on
48
C
hri
st H
osp
ital
C
inci
nn
ati
4
9
St
Tho
mas
Ho
spit
al
Nas
hv
illa
5
0
Lan
kena
u H
osp
ital
W
ynne
woo
d
Ill
Tec
hnol
ogy
R
epu
tati
on
al
Mo
rtal
ity
CO
TH
sco
re
Su
rgic
al
RN
s
Tra
uma
IH
Q
sco
re
rate
M
embe
r (o
f 9
) vo
lum
e to
bed
s C
tlnt
er
10
00
6
42
0
65
Y
es
90
9
07
30
00
0
19
4
No
90
9
55
5
01
2
Yes
9
0
82
78
00
00
1
31
Y
es
63
4
31
6
08
2
Yes
9
0
52
05
00
00
1
38
Y
es
58
1
29
1
09
1
Yes
9
0
34
79
00
00
1
42
Y
es
57
1
26
2
08
5
Yes
9
0
43
21
00
00
1
43
Y
es
53
4
21
3
08
1
Yes
9
0
58
92
00
00
1
81
Y
as
45
3
19
3
09
4
Yes
B
O
60
27
00
00
1
33
No
4
32
1
56
0
91
Y
es
70
3
00
60
00
0
16
1
Yes
(+
3 SO
) 3
15
1
14
0
91
Y
es
90
4
66
90
00
0
09
3
No
35
9
87
0
94
Y
es
80
5
60
80
00
0
15
8
Yes
3
55
5
0
08
0
Yes
9
0
39
87
00
00
1
49
Y
es
(+2
SO)
34
2
37
0
84
Y
es
90
8
66
70
00
0
18
8
Yes
3
34
6
8
09
9
Yes
9
0
51
54
00
00
1
51
Y
es
32
8
61
0
83
Y
es
80
9
82
00
00
1
75
No
3
18
0
6
07
0
Yes
8
0
29
03
00
00
1
52
Y
es
31
8
13
0
66
Y
es
90
1
37
00
00
1
98
Y
es
31
4
00
0
70
Y
es
90
2
81
60
00
0
12
8
Yes
3
12
0
0
07
2
Yes
8
5
18
58
00
00
1
82
Y
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30
7
21
0
90
Y
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80
1
82
90
00
0
12
3
Yes
3
05
0
0
07
2
Yes
8
0
22
46
00
00
1
49
Y
es
30
5
28
0
94
Y
es
90
4
71
80
00
0
16
7
Yes
3
03
1
0
07
6
Yes
7
0
17
60
00
00
2
10
Y
es
30
2
08
0
76
V
es
90
1
15
30
00
0
14
7
Yes
3
02
0
3
08
3
Yes
9
0
39
93
00
00
1
61
Y
es
30
1
06
0
74
Y
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80
1
09
30
00
0
17
2
Yes
3
00
1
7
09
1
Yes
9
0
26
91
00
00
1
79
Y
es
29
8
47
1
06
Y
es
90
4
25
30
00
0
15
7
Yes
2
91
6
1
11
1
Yes
9
0
57
76
00
00
1
32
Y
es
29
5
37
0
92
Y
es
90
1
50
40
00
0
10
8
Yes
2
95
0
0
07
6
Ves
9
0
15
10
00
00
1
36
Y
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29
3
00
0
72
Y
es
80
1
70
90
00
0
11
4
Yes
2
93
0
3
07
5
No
80
1
09
16
00
00
1
61
Y
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29
3
14
0
89
Y
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90
1
73
80
00
0
24
0
Yes
2
92
1
07
1
16
Y
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80
1
20
80
00
0
11
0
No
29
2
14
0
76
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1
41
50
00
0
11
4
No
29
1
00
0
76
Y
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80
3
29
80
00
0
08
7
Yes
2
91
0
0
08
2
Yes
8
0
55
75
00
00
1
51
Y
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28
9
06
0
84
Y
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80
8
04
80
00
0
13
7
Yes
2
89
0
0
06
5
Yes
9
0
25
60
00
0
11
0
Yes
2
89
3
5
09
9
Yes
9
0
39
64
00
00
1
06
Y
es
28
9
00
0
76
Y
es
80
2
03
30
00
0
12
1
Yes
2
89
0
0
07
9
Yes
8
0
28
37
00
00
1
06
Y
es
28
9
06
0
87
Y
es
90
4
71
00
00
0
12
7
Yes
2
88
0
0
08
6
Yes
8
0
89
54
00
00
1
92
Y
es
28
7
00
0
84
Y
es
80
2
44
50
00
0
19
4
YeS
2
86
0
0
06
0
Yes
8
0
79
90
00
0
10
9
Yes
2
85
0
0
08
7
Yes
8
0
40
88
00
00
1
15
Y
es
28
4
00
0
70
N
o 8
5
45
27
00
00
1
59
N
o 2
83
0
6
07
6
No
80
8
15
10
00
0
19
9
No
28
3
00
0
71
No
8
0
31
45
00
00
1
10
N
o
2001
H
oroo
nal
Dis
ord
ers
Bes
t H
osp
ital
lis
t
Tec
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
RN
s
T
raum
a R
ank
Ho
spit
al
IHQ
sco
re
rate
M
embe
r (O
f 7
) D
isch
arge
s to
bed
s C
ente
r
May
o C
lin
ic
Roc
hest
er
Min
n
10
00
6
12
0
66
Y
es
70
14
59
13
1
Yes
2
Mas
sach
uset
ts G
ener
al H
OSp
tal
B
osto
n 9
89
5
27
0
91
Y
es
70
l1
B3
13
B
Yes
3
John
s H
opki
ns H
osp
ital
B
alti
mor
e 5
96
2
52
0
64
Y
es
70
B
07
14
2
Yes
4
Bri
gham
and
Wom
en s
H
osp
ital
B
osto
n 5
36
2
05
0
72
Y
es
70
6
17
1
43
Y
es
I
Bet
h Is
rael
Dee
cone
ss M
edic
al C
ente
r B
osto
n 4
55
1
13
0
62
Y
es
60
11
46
15
8
Ves
6
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
45
4
11
5
04
9
Yes
6
0
1029
2
27
No
7
Un
iver
sity
of
Cal
ifo
rnia
Se
n F
ranc
isco
Med
ical
Cen
ter
45
3
14
5
07
2
Yes
6
0
416
17
5
No
9 B
arne
smiddotJe
wis
h H
osp
ital
S
t
Lou
is
45
3
11
6
09
5
Yes
7
0
1968
1
49
Y
es
9 C
leve
land
Cli
nic
4
37
9
3
04
6
Ves
7
0
1133
1
94
No
(+
3 11
m
10
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
41
6
82
0
66
Y
es
10
8
13
1
19
Y
es
11
Un
iver
sity
of
Chi
cago
Ho
spit
als
41
1
89
0
B2
Y
es
70
00
1 1
94
Y
es
12
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
41
0
10
4
00
4
Yes
7
0
752
10
8
Yes
13
u
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
Sea
ttle
3
B8
0
4
05
6
Yes
1
0
31
9
11
0
No
14
Ne
w Y
ork
Pre
sby
teri
an H
osp
ital
3
83
1
11
1
54
Y
es
70
15
52
13
2
Yes
15
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
78
3
9
05
5
Ves
7
0
757
24
0
Yes
16
N
orth
Wes
tern
Mem
oria
l H
osp
ital
C
hica
go
37
5
51
0
73
Y
es
60
97
5 1
70
Y
es
17
Hen
ry F
ord
Ho
spit
al
Det
roit
3
75
1
2
05
6
Yes
6
5
19
45
1
82
Y
es
(+2
SD)
18
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
st
anfo
rd
Ca1
1f
36
1
68
0
83
Y
es
50
47
2 1
61
Y
es
19
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 3
64
3
6
05
6
Yes
7
0
328
19
8
Yes
2
0
Duk
e U
nive
rSit
y M
edic
al C
ente
r D
urha
m
NC
3
59
2
7
06
8
Yes
7
0
91
6
18
1
Yes
21
U
niv
ersi
ty H
osp
ital
D
enve
r 3
58
2
5
04
5
Yes
8
0
320
24
0
Yes
2
2
was
hing
ton
Ho
spit
al C
ente
r W
ashi
ngto
n
DC
3
57
2
0
07
6
Yas
6
0
1658
1
92
Y
es
23
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
35
4
16
0
65
Y
es
70
12
59
16
7
Yes
2
4
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 3
47
2
7
05
1
Yes
5
5
719
10
1
Yes
2
5
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
34
5
23
0
13
Y
es
70
86
6 1
61
Y
es
26
S
t
lou
is U
niv
ersi
ty H
osp
ital
3
43
0
7
04
0
Yes
1
0
637
14
1
Yes
2
7
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
3
43
1
1
06
4
Yes
1
0
1080
1
51
Y
es
28
U
niv
ersi
ty H
osp
ital
P
ort
lan
d
ore
3
42
2
8
048
Y
es
60
32
8 0
111
Yes
2
9
Un
iver
sity
of
Tex
as M
edic
al B
ranc
h H
osp
ital
s
Gal
vest
on
33
9
05
0
4B
Y
es
60
81
8 1
53
Y
es
30
G
ood
Sam
arit
an R
egio
nal
Med
ioal
Cen
ter
Pho
enix
3
38
1
0
01
7
Yes
7
0
58
0
10
7
Yes
31
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
Cha
pel
Hil
l 3
37
0
6
05
2
Yes
6
0
791
15
2
Yes
32
U
niv
ersi
ty o
f W
isco
nsin
Hos
pita
l an
d C
Hn
ics
Mad
ison
3
37
0
5
03
3
Yes
7
0
519
13
6
Yes
33
W
illi
am B
eaum
ont
Ho
spit
al
Roy
al O
ak
Mio
h
33
7
06
0
80
Y
es
70
14
14
18
8
Yes
3
4
Flo
rid
a H
osp
ital
Med
ical
Cen
ter
Orl
ando
F
la
33
7
00
0
51
No
6
0
1698
1
67
Y
es
35
U
niv
ersi
ty o
f M
aryl
and
Med
ical
sys
tem
B
alti
mor
e 3
36
0
6
05
1
Ves
7
0
55
3
111
4 Y
es
36
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edic
al C
ente
r S
acra
men
to
33
4
06
0
59
Y
es
70
55
7 2
19
Y
es
37
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
33
3
05
0
50
Y
es
60
56
0 1
57
Y
es
38
Yal
emiddotN
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
33
2
38
1
03
Y
es
10
8
10
1
53
Y
es
39
luth
eran
Gen
eral
Hea
lths
yste
m
Par
k R
idge
Il
l
32
9
00
0
38
Y
es
60
76
8 1
14
Y
es
40
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
3
29
0
0
04
9
Yes
5
5
656
13
5
Yes
41
A
lleg
heny
Gen
eral
Ho
spit
al
Pit
tsb
urg
h
32
8
00
0
66
Y
es
60
6
10
1
91
Y
es
42
Mou
nt S
inai
Med
ical
Cen
ter
New
Yor
k 3
27
6
4
16
7
Yes
7
0
1555
1
57
Y
es
43
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
32
6
05
0
20
Y
es
70
32
9 1
09
Y
es
44
M
emor
ial
Med
ical
Cen
ter
Sav
anna
h G
a
32
6
00
0
48
Y
es
60
5
52
1
42
V
es
45
Med
ical
Col
lege
of
Geo
rgia
Ho
spit
al a
nd C
lin
iC
Aug
usta
3
23
0
0
03
1
Yes
5
0
381
15
0
Yes
46
S
t L
uk
es
Med
ioal
Cen
ter
Milw
auke
e W
is
32
3
00
0
62
Y
es
60
13
70
08
6
Yes
4
1
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
trd
ty
May
woo
d
Ill
3
23
1
0
07
1
Yes
6
0
64
3
16
2
Yes
4
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
32
3
07
0
68
Y
es
70
6
85
1
34
Y
es
49
M
edic
al C
ente
r o
f D
elaw
are
Wil
min
gton
3
21
0
0
08
1
ves
60
12
35
17
5
Ves
50
u
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
32
1
00
0
68
Y
es
70
77
3 1
51
Y
es
- L
2001
K
idne
y D
isea
se B
est
Ho
spit
al l
ist
Tec
hnol
ogy
Dis
char
ge
Med
ical
l R
epu
tati
on
al
Mo
rtal
ity
CO
TH
sco
re
RN
s
Tra
uma
pla
nn
ing
S
urg
ical
Ran
k H
osp
ital
IH
Q
sco
re
rate
M
embe
r (o
f 5
) D
isch
arg
es
to
beds
C
ente
r (o
f 3
) B
eds
Mas
sach
use
tts
Gen
eral
Ho
spit
al
B
osto
n 1
00
0
27
6
09
5
Yes
5
0
1091
1
36
Y
es
3 83
2
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
95
6
25
6
061
Y
es
50
74
2 1
43
Y
es
3 30
3
May
o C
lin
iC
Ro
ches
ter
M
inn
82
B
18
5
06
3
Yes
5
0
1217
1
31
Y
es
3 94
4
Cle
vel
and
Cli
nic
8
28
1
94
0
53
Y
es
50
11
24
19
4
No
3 44
5
New
Yor
k P
resb
yte
rian
Ho
spit
al
80
6
19
6
12
2
Yes
5
0
1617
1
32
Y
es
3 11
1
6 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
77
3
17
4
05
4
Yes
4
5
811
14
2
Yes
3
41
7 UC
LA M
edic
al C
ente
r
Los
Ang
eles
7
26
1
53
0
60
Y
es
50
97
5 1
08
Y
es
3 54
8
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
69
6
14
3
07
8
Yes
5
0
1108
1
81
Y
es
3 57
9
Bar
nes
-Jew
ish
Ho
spit
al
S
t
Lou
is
88
7
12
0
05
9
Yes
5
0
1863
1
49
Y
es
3 76
10
U
niv
ersi
ty H
osp
ital
D
enve
r 6
58
1
41
0
61
Yes
4
0
408
24
0
Yes
3
0 11
U
niv
ersi
ty O
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbor
5
89
8
8
05
4
Yes
5
0
922
17
9
Yes
3
60
12
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
iC
Nas
hv
ille
5
78
9
1
04
9
Yes
4
0
850
24
0
Yes
3
28
13
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
56
6
89
0
63
Y
es
40
52
8 1
61
Y
es
3 67
14
P
ark
lan
d M
emor
ial
Ho
spit
al
D
alla
s 56
1
73
0
31
Yes
5
0
660
19
8
Yes
3
39
15
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
41
6
6
06
2
Yes
5
0
1128
1
67
Y
es
3 80
16
U
niv
ersi
ty o
f C
ali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
53
4
74
0
45
Y
es
50
63
1 1
75
N
o 3
35
17
Ho
spit
al o
f th
e U
niv
ersi
ty O
f P
enn
sylv
ania
P
hil
adel
ph
ia
52
8
75
0
73
Y
es
50
96
2 1
61
Yes
3
44
18
Em
ory
Un
iver
sity
Ho
spit
al
A
tlan
ta
52
1
77
0
58
Y
es
45
78
4 0
93
N
o 3
48
19
un
ivers
ity
of
Was
hing
ton
Med
ical
Cen
ter
S
eatt
le
51
6
78
0
55
Y
es
50
42
1 1
10
N
o 2
46
(+3
SO)
20
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
al a
t B
irm
ingh
am
47
3
56
0
93
Y
es
40
12
02
15
1
Yes
2
86
21
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
45
3
47
0
61
Yes
5
0
1013
1
58
Y
es
3 0
22
Hen
ry F
ord
Ho
spit
al
Detr
oit
4
47
2
1
05
8
Yes
5
0
1459
1
82
Y
es
3 76
2
3
Un
iver
sity
of
No
rth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
44
5
37
0
48
Y
es
40
10
33
15
2
Yes
3
16
24
F
airv
ieW
-Un
iver
sity
Med
ical
Cen
ter
Min
neap
Oli
s 4
44
5
2
07
2
Yamp
s 5
0
690
15
6
No
3 24
2
5
Un
iver
sity
of
Chi
cago
Ho
spit
als
44
2
31
0
47
Y
es
50
75
8 1
94
Y
es
3 3
0
26
H
erm
ann
Ho
spit
al
Hou
ston
4
24
1
7
03
0
Yes
4
5
668
11
4
Yes
3
54
27
Ru
sh-P
resb
yte
rian
-St
L
uke
s
Med
ical
Cen
ter
C
hica
go
41
8
16
0
37
Y
es
50
12
73
11
4
No
3 49
2
8
New
Eng
land
Med
ical
Cen
ter
8
0st
on
4
16
4
2
07
9
Yes
5
0
330
24
2
Yes
2
30
2
9
Un
iver
sity
of
Cali
forn
ia
Dav
iS M
edic
al C
ente
r
Sac
ram
ento
4
16
2
2
05
5
Yes
5
0
681
27
9
Yes
3
40
30
Yal
e-N
ew H
aven
H
osp
ital
N
ew H
aven
C
onn
4
12
3
8
09
9
Yes
5
0
943
15
3
Yes
3
52
(+2
SO)
31
Los
An
gel
es C
ount
y-U
SC
Med
ical
Cen
ter
40
9
04
0
08
Y
es
45
21
3 1
67
Y
es
3 43
32
S
hand
s H
osp
ital
et
the U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
40
6
34
0
74
Y
es
45
69
9 1
57
Y
es
2 3
0
33
St
L
ou
is U
niv
ersi
ty H
osp
ital
3
99
1
2
041
Y
es
45
58
7 1
47
Y
es
3 43
3
4
Bos
ton
Med
ical
Cen
ter
39
4
15
0
44
Y
es
40
40
5 2
10
Y
es
3 36
35
U
niv
ersi
ty o
f T
exes
Med
ical
Bra
nch
Ho
spit
als
G
alv
esto
n
39
0
05
0
41
Yes
5
0
890
15
3
Yes
3
38
36
Un
iver
sity
Ho
spit
al
Po
rtla
nd
are
3
90
3
4
07
2
Yes
4
5
356
091
Y
es
3 18
37
M
eth
od
ist
Ho
spit
al
Hou
ston
3
89
3
3
10
0
Yes
4
6
796
13
3
No
3 69
38
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
88
0
6
06
0
Yes
5
0
935
17
0 Y
es
3 6
3
39
Fro
edte
rt M
emor
ial
Lu
ther
an H
osp
ital
M
ilw
auke
e 3
87
1
2
05
5
Yes
5
0
784
14
6
Yes
3
35
40
Un
iver
sity
Ho
spit
els
and
Cli
niC
S
Col
umbi
a
Mo
3
87
2
6
06
6
Yes
4
5
374
15
1
Yes
2
30
41
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
niC
S
Chi
cago
3
85
0
0
01
9
Yes
4
5
382
12
9
Yes
3
42
42
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
Ari
z
38
3
00
0
29
Y
es
45
37
6 1
72
Y
es
3 46
43
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
38
3
12
0
41
Y
es
00
81
4 1
68
N
o 91
44
W
illi
am B
eaum
ont
Ho
spit
el
Roy
al O
ak
Mic
h
38
3
03
0
74
Y
es
50
16
88
18
8
Yes
3
60
45
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
3
81
0
5
06
1
Yes
4
5
941
19
4
Yes
3
63
46
Un
iver
sity
01
Wis
con
sin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
7
22
0
82
Y
es
50
82
0 1
36
Y
es
3 32
4
7
Sax
ar C
ount
y H
osp
ital
Dis
tric
t
San
An
ton
io
37
7
16
0
64
Y
es
45
36
8 1
21
Y
es
3 51
48
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
WaS
hing
ton
D
C
37
7
05
0
43
Y
es
50
39
5 1
09
Y
es
3 53
49
U
niv
ersi
ty 0
1 V
irg
inie
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
3
77
1
4
06
4
Yes
5
0
930
22
7
No
3 34
50
B
aylo
r U
niv
ersi
ty M
edic
al C
ente
r
Dal
las
31
5
05
0
72
Y
es
45
97
6 1
22
Y
es
3 86
j r
l
~
2001
N
euro
logy
and
Neu
rosu
rger
y B
est
Ho
spit
al L
ist
Tec
hnol
ogy
Re p
uta
tio
nal
M
ort
alit
y
COTH
sc
ore
R
N s
T
raum
a R
ank
Ho
spit
al
IHQ
so
ore
rate
M
embe
r (o
f 7)
D
isoh
arge
s to
bed
s C
ente
r
1 M
ayo
Cli
nic
R
oche
ster
M
inn
1
00
0
57
5
09
1
Yes
7
0
4763
1
31
Y
es
2 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
83
7
46
0
09
5
Yes
7
0
3705
1
38
Y
es
3 Jo
hns
Hop
kins
Ho
spit
al
Bal
tim
ore
74
6
37
2
07
0
Yes
7
0
2641
1
42
Y
es
4 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
7
27
3
73
0
95
Y
as
70
40
78
13
2
Yes
5
Un
iver
sity
of
Cal
ifo
rnia
Sa
n F
ranc
isco
Med
ical
Cen
ter
51
6
24
1
10
0
Yes
6
0
1503
1
75
No
6 C
leve
land
Cli
nic
5
12
1
88
0
65
Y
es
70
33
38
19
4
No
7 B
arne
smiddotJe
wis
h H
osp
ital
S
t l
ou
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38
9
92
0
81
Y
es
70
46
67
14
9
Yes
8
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
37
4
10
5
09
1
Yes
7
0
22
86
1
61
Y
es
(+3
SD)
9 D
uke
Un
iver
sity
Med
ical
Cen
ter
Dur
ham
N
C
32
4
70
1
02
Y
es
70
29
21
18
1
Yes
1
0
UCLA
Med
ioal
Cen
ter
lo
s A
ngel
es
32
2
64
0
80
Y
es
70
19
67
10
8
Yes
11
M
ount
S
inai
Med
ical
Cen
ter
Ne
w Y
ork
31
7
55
0
85
Y
es
70
23
83
15
7
Yes
12
M
etho
dist
Ho
spit
al
Hou
ston
3
15
6
2
08
6
Yes
6
0
3768
1
33
No
13
B
righ
am a
nd W
omen
s H
osp
ital
B
osto
n 3
15
6
6
09
3
Yes
7
0
1925
1
43
Y
es
14
Un
iver
sity
of
Mic
higa
n M
edic
al C
arot
er
Ann
Arb
or
30
4
68
1
06
Y
es
70
17
02
17
9 Y
es
15
S
t J
ose
ph
s H
osp
ital
and
Med
ical
Cen
ter
Pho
enix
3
04
5
2
09
2
Yes
6
0
3336
1
27
Y
es
16
Los
Ang
eles
Cou
nty-
USC
Med
ical
Cen
ter
29
9
04
0
29
Y
es
55
39
9 1
67
Y
es
17
H
enry
F
ord
Ho
spit
al
Det
roit
2
99
1
3
06
4
Yes
6
5
3299
1
82
Y
es
18
Den
ver
Hea
lth
and
Ho
spit
als
29
5
04
0
16
No
5
5
353
17
0
Yes
19
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
29
4
49
0
89
Y
es
50
19
06
16
1
Yes
2
0
Dan
amiddotF
arbe
r C
ence
r In
stit
ute
B
osto
n 2
94
0
3
00
0
No
85
6
22
7
No
21
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
29
3
15
0
46
Y
es
70
11
51
10
9
Yes
2
2
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ios
Io
wa
Cit
y
29
1
37
0
82
Y
es
70
21
86
13
4
Yes
(+
2 SD
) 2
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
28
8
13
0
36
V
es
60
33
6 2
68
No
2
4
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 2
88
1
8
07
0
Yes
7
0
3234
1
18
Y
es
25
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f F
lori
da
Gai
nes
vil
le
28
8
27
0
70
Y
es
60
15
98
15
7
Yes
2
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
oago
2
87
2
1
07
0
Yes
6
0
1970
1
70
Y
es
27
u
niv
ersi
ty H
osp
ital
D
enve
r 2
87
3
3
07
3
Yes
6
0
613
24
0
Yes
2
8
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
28
6
08
0
19
Y
es
70
44
69
16
7
Yes
2
9
Un
iver
sity
of
Vir
gIn
ia H
ealt
h S
oien
ces
Cen
ter
Ch
arlo
ttes
vil
le
28
5
34
0
83
Y
es
60
32
29
22
7
No
30
D
ooto
rs C
Onm
luni
ty H
osp
ital
la
nham
M
d
28
0
00
0
05
No
5
5
901
09
7
No
31
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
2
78
0
0
00
0
Yes
3
0
870
03
4
Ho
32
P
arkl
and
Mem
oria
l H
osp
ital
D
alla
s 2
77
1
8
07
0
Yes
7
0
896
19
8
Yes
3
3
Wil
liam
Bea
umon
t H
osp
ital
R
oyal
O
ak
Mic
h
27
6
00
0
82
V
es
70
48
44
18
8
Yes
3
4
St
L
uke
s H
osp
ital
N
ewbu
rgh
N
Y
27
5
00
0
02
No
5
0
82
6
08
0
No
35
B
osto
n M
edio
al C
ente
r 2
74
2
5
07
7
Ves
5
0
1255
2
10
Y
es
36
F
airv
ieW
-Uni
vers
ity
Med
ical
Cen
ter
Min
neap
olis
2
74
2
0
06
1
Ves
5
0
1685
1
56
No
37
U
nIv
ersi
ty M
edic
al C
ente
r T
ucso
n
Ari
z
27
4
00
0
50
Y
es
60
86
5 1
72
Y
es
38
Su
mm
a H
ealt
h S
yste
m
Akr
on
Ohi
o 2
73
0
0
06
6
Yes
6
0
3299
1
49
Y
es
39
Sc
hwab
Reh
abil
itat
ion
Ho
spit
al
Chi
cago
2
70
0
0
02
3
Yes
2
5
769
04
1 Y
es
40
C
ook
Cou
nty
Ho
spit
al
Chi
cago
2
68
0
0
04
9
Yes
5
0
498
21
0
Yes
41
S
t V
ince
nt H
ospI
tal
and
Hea
lth
Cen
ter
In
dia
nap
olb
2
66
0
0
07
0
Yes
6
0
32
89
1
37
Y
es
42
R
ush
middotPre
sby
teri
anmiddotS
t
luk
es
Med
ical
Cen
ter
Chi
cago
2
65
0
6
05
4
Yes
7
0
1848
1
14
No
4
3
Bet
h Is
rael
Dea
oone
ss M
edio
al C
ente
r B
osto
n 2
65
1
4
08
5
Yes
6
0
2838
1
58
Y
es
44
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
2
64
0
0
00
6
No
35
12
64
03
8
No
45
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
2
63
1
8
08
8
Yes
7
0
1659
2
40
Y
es
46
Un
iver
sity
of
Illi
no
is H
osp
ital
and
Cli
nic
s C
hioa
go
26
2
13
0
62
Y
es
45
83
0 1
29
Y
es
47
H
arpe
r H
osp
ital
D
etro
it
26
1
04
0
55
Y
es
60
20
72
12
6
No
48
E
vans
ton
Nor
thw
este
rn H
ealt
h C
are
E
vans
ton
Il
l
28
1
09
0
75
Y
es
60
29
33
10
2
Yes
4
9
was
hing
ton
Ho
spit
al C
ente
r w
ashi
ngto
n
DC
2
59
0
4
07
7
Yes
6
0
2269
1
92
Y
es
50
Car
din
al H
ill
Reh
abil
itat
ion
Ho
spit
al
lex
ing
ton
K
y
25
8
00
0
02
No
0
5
1313
0
55
No
t
2001
O
rth
op
edio
s B
est
Ho
spit
al L
ist
Teo
hnol
ogy
Rep
uta
tio
nal
M
ort
alit
y
GOTH
so
ore
R
N
$
Tra
uma
Ran
k H
osp
ital
IH
O
sco
re
rate
M
embe
r (o
f 5)
D
isch
arg
es
to
beds
C
ente
r
May
o C
lin
ic
Ro
ches
ter
M
inn
1
00
0
49
2
05B
Y
es
50
77
52
13
1
Yes
2
Ho
spit
al f
or
Sp
ecia
l S
urg
ery
N
ew Y
ork
88
3
40
6
01
3
Yes
4
5
6837
1
57
Y
es
3 M
assa
chu
sett
s G
ener
al H
osp
ital
B
osto
n 7
13
3
20
1
01
Y
es
50
34
89
13
8
Yes
4
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
43
1
90
0
73
Y
es
50
16
28
14
2
Yes
5
Cle
vel
and
Cli
nic
5
19
1
73
0
63
Y
es
50
36
20
19
4
No
6 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
40
1
34
1
07
Y
es
50
28
63
18
1
Yes
7
Har
borv
iew
Med
ical
Cen
ter
S
eatt
le
37
2
101
1
05
Yes
3
5
820
23
3
Yes
8
Un
iver
sity
of
Iow
a H
osp
ital
s an
d C
lin
ics
Io
wa
Cit
y
37
0
75
0
74
Y
es
50
15
09
13
4
Yes
9
UCLA
Med
ical
Cen
ter
lo
s A
ngel
es
36
0
84
0
99
Y
es
50
17
57
10
8
Yes
(+
3 SO
) 10
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
2
68
0
56
Y
es
50
97
3 1
10
No
11
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
A
rbor
3
29
3
9
06
8
Yes
5
0
1586
1
79
Y
es
12
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
32
7
43
0
80
Y
es
50
26
80
14
3
Yes
13
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
32
6
48
0
92
Y
es
50
28
72
16
7
Yes
14
B
exar
Cou
nty
Ho
spit
al D
istr
ict
San
Ant
onio
3
24
3
9
04
8
Yes
4
0
645
12
1
Yes
15
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cali
f
32
3
49
0
87
Y
es
30
21
43
161
Y
es
16
Un
iver
sity
of
Chi
cago
Ho
spit
als
31
9
35
0
67
Y
es
50
11
56
19
4
Yes
17
P
ark
lan
d M
emor
ial
Ho
spit
al
Dal
las
31
8
71
1
23
Y
es
50
58
7 1
98
Y
es
18
Un
iver
sity
Ho
spit
al
Den
ver
31
7
31
0
44
Y
es
40
63
3 2
40
Y
es
19
Bar
nes
middotJew
ish
Ho
spit
al
St
lo
uis
3
11
3
6
08
9
Yes
5
0
2911
1
49
Y
es
20
Sha
nds
Ho
spit
al a
t th
e U
niv
ersi
ty o
f fl
ori
da
Gai
nes
vil
le
30
7
21
05
9
Yes
4
0
1781
1
57
Y
es
21
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
30
5
62
1
04
Y
es
40
92
7 1
75
No
(+
2 SO
) 22
V
and
erb
ilt
Un
iver
sity
Ho
spit
al a
nd C
lin
ic
Nas
hv
ille
3
03
1
6
05
9
Yes
5
0
1608
2
40
Y
es
23
Ho
spit
al o
f th
e U
niv
ersi
ty o
f p
enn
sylv
ania
P
hil
adel
ph
ia
30
1
45
1
04
Y
es
50
10
76
161
Y
es
24
U
niv
ersi
ty o
f A
labe
ma
Ho
spit
al a
t B
irm
ingh
am
29
9
22
0
73
Y
es
50
15
94
151
Y
es
25
Ho
spit
al f
or
Join
t D
isea
sesmiddot
Ort
ho
ped
ic I
nst
itu
te
New
Yor
k 2
97
4
0
02
5
No
30
21
10
09
3
No
26
SUl1
l1la
Hea
lth
sy
stem
A
kron
O
hio
29
5
05
0
49
Y
es
40
38
99
14
9
Yes
27
Y
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
Onn
2
93
1
2
061
Y
es
50
14
62
15
3
Yes
28
N
ew Y
ork
Pre
sby
teri
an H
osp
ital
2
92
4
5
12
2
Yes
5
0
2394
1
32
Y
es
29
Un
iver
sity
of
Ten
ness
ee M
edic
al C
ente
r
Mem
phis
2
92
4
2
05
4
No
46
90
1
50
No
30
U
niv
ersi
ty o
f W
isco
nsi
n H
osp
ital
and
Cli
nic
s
Mad
ison
2
89
1
1
061
Y
es
50
14
42
13
6
Yes
31
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
sacr
amen
to
28
6
24
0
87
Y
es
50
11
56
27
9
Yes
32
S
t
lou
is U
niv
ersi
ty H
osp
ital
2
83
0
4
04
8
Yes
5
0
819
14
7
Yes
33
R
ushmiddot
Pre
sby
teri
an
-St
lu
kes
Med
ical
Cen
ter
Chi
cago
28
1
25
0
79
Y
es
50
21
23
11
4
No
34
Lu
ther
an G
ener
al H
ealt
hsy
stem
P
ark
Rid
ge
Ill
28
0
00
0
46
Y
es
40
25
63
11
4
Yes
35
G
eorg
etow
n U
niv
ersi
ty H
osp
ital
W
ashi
ngto
n
DC
2
80
0
6
04
7
Yes
5
0
952
10
9
Yes
36
C
aro
lin
as M
edic
al C
ente
r
Ch
arlo
tte
N
C
28
0
23
1
03
Y
es
50
29
00
18
4
Yes
37
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r
Bos
ton
27
9
06
0
71
Yes
4
0
2274
1
58
Y
es
38
Coo
k C
ount
y H
osp
ital
C
hica
go
27 _
7 1
2
05
5
Yes
3
0
184
21
0
Yes
39
U
niv
ersi
ty o
f lo
uis
vil
le H
osp
ital
lo
uis
vil
le
Ky
2
76
0
5
04
2
Yes
4
0
317
19
0
Yes
40
A
lleg
hen
y G
ener
al H
osp
ital
P
itts
bu
rgh
2
76
0
0
06
4
Yes
4
0
2161
1
91
Yes
41
H
enry
For
d H
osp
ital
D
etro
it
27
6
00
0_
63
Yes
4
5
1834
1
82
Y
es
42
Un
iver
sity
of
Mia
mi
Jack
son
Mem
oria
l H
osp
ital
2
78
3
0
06
2
Yes
0
0
748
16
8
No
43
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s
Cha
pel
Hil
l 2
75
0
5
06
6
Yes
4
0
1518
1
52
Y
es
44
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
27
5
00
0
32
Y
es
40
87
1 1
72
Y
es
45
Mar
y H
itch
cock
Mem
oria
l H
osp
ital
le
ban
on
N
H
27
4
00
0
57
Y
es
40
14
30
19
4
Yes
46
B
apti
st M
emor
ial
Ho
spit
al
Mem
phis
2
74
4
5
11
2
No
50
29
14
09
3
Yes
47
N
ort
hw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
2
73
1
2
08
6
Yes
4
0
2025
1
70
Yes
48
L
os A
ngel
es C
ou
nty
USC
Med
ical
Cen
ter
27
3
05
0
00
Y
es
35
23
6 1
Il7
Yes
49
M
edic
al C
ente
r o
f C
entr
al M
assa
chu
sett
s W
orc
este
r 2
73
0
0
06
0
Yes
4
5
1285
1
89
Y
es
60
Nor
th C
aro
lin
a B
ap
tist
Ho
spit
al
Win
ston
middotSal
em
27
3
11
0
92
Y
es
50
21
20
1I
II
Yes
r-
-
2001
R
esp
irat
ory
Dis
ord
ers
Bes
t H
osp
ital
Lis
t Tec
hnol
ogy
Dis
char
ge
Rep
uta
tio
nal
M
ort
ali
ty
COTH
sc
ore
R
N
s T
raum
a p
lan
nin
g
Ran
k H
osp
Ital
IH
Q
sco
re
rate
M
embe
r (o
f 4
) D
isch
arg
es
to b
eds
Cen
ter
(of
3)
1 N
atio
nal
Jew
ish
Cen
ter
D
enve
r 1
00
0
501
0
22
N
o 3
0
121
37
5
No
3 2
May
o C
lin
ic
Ro
ches
ter
M
inn
8
S2
41
1
08
1
Yes
4
0
4391
1
31
Yes
3
3 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mo
re
63
3
2B0
0
95
Y
es
40
14
61
14
2
Yes
3
4 B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
54
6
21
2
08
9
Yes
4
0
5329
1
49
Y
es
3 5
Un
iver
sity
Ho
spit
al
Den
ver
45
7
151
0
83
Y
es
40
9
80
2
40
Y
es
3 6
Un
iver
sity
of
Cali
forn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
43
2
15
0
09
0
Yes
4
0
1015
1
75
N
o 3
7 M
assa
chu
sett
s G
ener
al H
osp
Ital
B
osto
n 43
1
16
4
11
4
Yes
4
0
3306
1
38
V
es
3 8
Cle
vel
and
Cli
nic
4
20
1
24
0
77
Y
es
40
27
32
19
4
No
3 9
Bri
gham
and
WO
men
s H
osp
ital
B
osto
n 3
69
9
0
08
2
Yes
4
0
2526
1
43
V
es
3 10
U
CSIl
Med
ical
Cen
ter
S
an D
iego
3
68
9
1
08
0
Yes
4
0
1130
1
48
Y
es
3 11
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r S
eatt
le
35
4
12
0
09
8
Yes
4
0
720
11
0
110
2 12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
A
nn A
rbo
r 3
48
8
1
08
7
Yes
4
0
1927
1
79
Ves
3
(+3
SO)
13
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
II
C
33
7
96
1
12
Y
es
40
29
49
18
1
Yes
3
14
Bo
sto
n M
edic
al C
ente
r 3
25
3
8
05
7
Yes
4
0
1105
2
10
Y
es
3 15
H
osp
ital
of
the U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
32
3
96
1
15
Y
es
40
15
07
16
1
Ves
3
16
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
32
2
74
0
95
Y
es
40
16
20
161
Y
es
3 1
7
Un
ivers
ity
of
Pit
tsb
urg
h M
edic
al C
ente
r 3
05
6
0
09
7
Yes
4
0
2957
1
67
Y
es
3 18
UC
LA M
edic
al C
ente
r
Los
Ang
eles
2
97
4
1
07
5
Yes
4
0
1910
1
08
Y
es
3 19
V
ale-
New
Hav
en H
osp
ital
N
ew H
aven
C
onn
2
95
5
3
09
3
Ves
4
0
2355
1
53
Y
es
3 20
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
85
5
5
10
0
Yes
4
0
1432
1
94
Y
es
3 21
U
niv
ersi
ty o
f N
orth
Car
oli
na
Ho
spit
als
C
hape
l H
ill
28
5
25
0
74
V
es
40
27
79
15
2
Yes
3
(+2
SO)
22
Van
der
bil
t U
niv
ersi
ty H
osp
ital
and
Cli
nic
N
ash
vil
le
27
9
35
0
87
V
es
40
20
51
24
0
Yes
3
23
Los
A
ng
eles
Cou
nty-
USC
Med
ical
Cen
ter
27
5
04
0
18
Y
es
40
46
9 1
67
Y
es
3 24
U
niv
ersi
ty o
f cali
forn
ia
Dav
is M
edic
al C
ente
r
Sac
ram
ento
2
73
1
2
06
7
Yes
4
0
1820
2
79
V
es
3 2
5
St
L
ou
is U
niv
ersi
ty H
osp
ital
2
73
1
0
06
2
Yes
4
0
1475
1
47
Y
es
3 26
C
ook
Cou
nty
Ho
spit
al
C
hica
go
27
3
00
0
49
Y
es
40
11
45
21
0
Yes
3
27
San
Fra
nci
sco
Gen
eral
Ho
spit
al M
edio
al C
ente
r 2
70
5
6
08
7
Yes
2
0
899
11
0
No
3 28
H
enne
pin
Cou
nty
Med
ical
Cen
ter
M
inn
eap
oli
s 2
67
0
0
05
2
Yes
4
0
1959
1
05
Y
es
3 29
U
niv
ersi
ty o
f C
inci
nn
ati
Ho
spit
al
26
4
07
0
66
Y
es
40
17
63
15
7
Yes
3
30
Geo
r-ge
tow
n U
niv
ersi
ty H
osp
ital
w
ash
ing
ton
D
C
26
2
04
0
59
Y
es
40
99
3 1
09
Y
es
3 31
C
lar-
ian
Hea
lth
Part
ners
In
dia
nap
Oli
S
26
0
12
0
79
Y
es
40
42
95
16
7
Yes
3
32
Ru
sh-P
resb
yte
rian
-St
L
uk
es
Med
ical
Cen
ter
C
hica
go
25
4
28
0
82
Y
es
40
18
56
11
4
No
3 33
H
enry
Fo
rd H
osp
ital
D
etr
oit
2
54
1
4
08
5
Yes
4
0
3875
1
82
Y
es
3 34
U
niv
ersi
ty o
f V
irg
inia
Hea
lth
Sci
ence
s C
ente
r C
harl
ott
esv
ille
2
53
2
2
08
3
Yes
4
0
2302
2
27
No
3
35
W
est
Jeff
ers
on
Med
ical
Cen
ter
M
arre
ro
La
2
52
0
0
05
3
No
40
14
94
11
3
Ves
3
36
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hio
251
0
0
07
1
Yes
4
0
6185
1
49
Y
es
3 37
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
iCS
M
adis
on
25
0
05
0
70
Y
es
40
14
28
13
6
Yes
3
38
Un
iver
sity
Med
ical
Cen
ter
Tuc
son
A
riz
2
50
0
4
07
2
Yes
4
0
1071
1
72
Y
es
3 39
F
G
McG
aw H
osp
ital
at
Loy
ola
Un
iver
sity
M
ayw
ood
Ill
2
49
1
8
08
6
Yes
4
0
1415
1
62
V
es
3 40
U
niv
ersi
ty o
f Il
lin
ois
Ho
spit
al a
nd C
11
nic
s
Chi
cago
2
49
0
5
06
6
Yes
3
5
779
12
9
Yes
3
41
Ohi
o S
tate
Un
iver
sity
Med
ical
Cen
ter
Col
umbu
s 2
46
0
0
06
3
Yes
3
5
1677
1
01
Yes
3
42
Un
iver
sity
of
Ala
bam
a H
osp
ital
at
Bir
min
gham
2
45
3
7
10
3
Yes
4
0
2116
1
51
Ves
2
43
Har
bo
rvie
w M
edic
al C
ente
r
Seett
le
24
4
24
0
89
Y
es
30
80
5 2
33
Y
es
3 44
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
2
44
2
3
09
2
Ves
4
0
1334
1
34
Y
es
3 45
T
rum
an M
adic
al C
ente
r-W
est
K
ansa
s C
ity
M
o
24
4
00
0
64
Y
es
35
99
1 1
14
Y
es
3 46
M
emor
ial
Med
ical
Cen
ter
S
avan
nah
G
a
24
2
00
0
71
Y
es
40
14
03
14
2
Yes
3
47
Tou
ro
Infi
rmar
y
lew
Orl
ean
s 24
1
00
0
65
V
es
40
14
07
06
5
Ves
3
48
St
Jo
sep
h H
osp
ital
D
enve
r 2
41
0
0
05
5
No
40
25
11
10
3
No
3 49
L
os A
ng
eles
Cou
nty-
Har
bor-
UC
LA
Med
ical
Cen
ter
24
0
13
0
10
No
4
0
420
16
5
Yes
2
50
Bay
lor
Un
iver
sity
Med
ical
Cen
ter
D
alla
s 2
40
1
2
08
7
Ves
4
0
3026
1
22
V
es
3
-
J 1
2001
R
heum
atol
ogy
Bes
t H
osp
ital
lis
t
Hos
pita
lwid
e T
echn
olog
y D
isch
arge
R
epu
tati
on
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mo
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sco
re
RN
s
plan
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R
ank
Ho
spit
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sco
re
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M
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bed
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)
May
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Roo
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Min
n
10
00
4
96
0
72
Y
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50
1
31
3
2 Jo
hns
Hop
kins
Has
p ta
l 8
alti
mo
rs
85
9
38
0
08
2
Yes
5
0
14
2
3 3
Ho
spt
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or
Sp
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l S
urge
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09
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Y
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45
1
57
3
4 B
righ
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s H
osp
ital
B
osto
n 7
17
2
54
0
81
Y
es
50
1
43
3
5 C
leve
land
Cli
nic
6
76
2
03
0
67
Y
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50
1
94
3
6 M
assa
chus
etts
Gen
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Ho
spit
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ton
66
4
22
1
09
3
Yes
5
0
1 3
8
3 7
UCLA
Med
ical
Cen
ter
lo
s A
ngel
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66
2
21
2
08
3
Yes
5
0
10
8
3 B
U
niv
ersi
ty o
f A
laba
ma
Ho
spit
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t B
irm
ingh
am
64
1
20
8
09
6
Yes
5
0
15
1
2 9
Duk
e U
niv
ersi
ty M
edic
al C
ente
r D
urha
m
NC
5
68
1
34
0
93
Y
es
50
1
81
3
10
U
niv
ersi
ty o
f C
alif
orn
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San
Fra
nois
co M
edic
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ente
r 5
58
1
23
0
85
Y
es
40
1
75
3
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
alif
5
37
1
12
0
86
Y
es
30
1
61
3
12
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
52
1
82
0
82
Y
es
50
1
79
3
(+3
SD)
13
B
arne
s-Je
wis
h H
osp
ital
S
t
lou
is
49
2
57
0
82
Y
es
50
1
49
3
14
H
osp
ital
fo
r Jo
int
Dis
ease
s-O
rtho
pedi
c In
stit
ute
N
ew Y
ork
48
9
59
0
55
No
3
0
09
3
3 1
5
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 4
86
7
8
10
5
Yes
5
0
11
8
3 1
6
los
Ang
eles
Cou
nty-
USC
Med
ical
can
ter
48
4
00
0
20
Y
es
35
1
S7
3
17
U
niv
ersi
ty o
f P
itts
bu
rgh
Med
ical
Cen
ter
47
7
46
0
84
Y
es
50
1
67
3
la
St
lu
kes
Ho
spit
al
New
burg
h
NY
4
74
0
0
00
1
No
35
0
80
3
19
U
niv
ersi
ty H
osp
ital
D
enve
r 4
70
3
6
07
4
Yes
-4
0
24
0
3 2
0
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
46
9
32
0
77
Y
es
50
1
98
3
21
Doc
tors
Com
mun
ity H
osp
ital
L
anha
m
Md
4
69
0
0
00
7
No
35
0
97
2
(+2
SO)
22
Den
ver
Hea
lth
and
Ho
spit
als
48
1
00
0
21
No
4
0
17
0
2 2
3
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
46
6
53
1
02
Y
es
50
1
61
3
24
R
ehab
ilit
atio
n I
nst
itu
te o
f C
hica
go
46
3
00
0
03
Y
es
25
0
34
2
25
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
DC
4
62
0
9
05
3
Yes
5
0
10
9
3 2
6
Nat
ion
al R
ehab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
4
58
0
0
00
9
No
25
0
38
3
27
N
orth
wes
tern
Mem
oria
l H
osp
ital
C
hica
go
45
4
39
0
92
Y
es
40
1
70
3
28
T
he
Inst
itu
te f
or
Reh
abil
itat
ion
and
Res
earc
h H
oust
on
45
3
00
0
13
No
1
5
06
9
3 2
9
Un
iver
sity
of
Chi
cago
Ho
spit
als
45
2
29
0
90
Y
es
50
1
94
3
30
C
ard
inal
Hil
l R
ehab
ilit
atio
n H
osp
ital
L
exin
gton
K
y
44
9
00
0
01
No
0
5
05
5
3 31
B
eth
Isra
el
Dea
cone
ss M
edic
al C
ente
r B
osto
n 4
47
2
6
08
4
Yes
4
0
15
8
3 3
2
Reh
abil
itat
ion
In
stit
ute
of
Mic
higa
n
Det
roit
4
47
0
0
01
2
No
25
0
39
2
33
S
t
lou
is U
niv
ersi
ty H
osp
ital
4
44
0
4
07
1
Yes
5
0
14
7
3 3
4
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
44
4
05
0
66
Y
es
40
1
72
3
35
Coo
k C
ount
y H
osp
ital
C
hica
go
44
3
00
0
55
Y
es
30
2
10
)
36
Su
nnyv
iew
Ho
spit
al a
nd R
ehab
ilit
atio
n C
ente
r S
chen
ecta
dy
NY
4
42
0
0
00
7
No
10
0
43
2
37
B
osto
n M
edic
al C
ente
r 4
39
1
6
07
5
Yes
3
0
21
0
3 3
8
Un
iver
sity
of
Wis
cons
in H
osp
ital
and
Cli
niC
S
Mad
ison
4
39
0
8
07
7
Yes
5
0
13
6
3 3
9
Hil
lsid
e R
ehab
ilit
atio
n H
osp
ital
W
arre
n
Ohi
o 4
38
0
0
01
2
No
15
0
30
2
40
U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nic
s
Iow
a C
ity
4
36
1
4
08
6
Yes
5
0
13
4
3 41
U
niv
ersi
ty o
f M
aryl
and
Med
ical
Sys
tem
B
alti
mor
e 4
35
1
6
09
2
Yes
5
0
19
4
3 4
2
Sum
ma
Hea
lth
Sys
tem
A
kron
O
hiO
4
35
0
0
06
8
Yes
4
0
14
9
3 4
3
UCSD
Med
ical
Cen
ter
San
Die
go
43
5
26
0
90
Y
es
30
1
48
3
44
R
ush
-pre
sby
teri
an-S
t
luk
es
Med
ical
can
ter
Chi
cago
4
34
0
0
07
0
Yes
5
0
11
4
3 4
5
Yal
e-N
ew H
aven
Ho
spit
al
New
Hav
en
Con
n
43
4
15
0
92
Y
es
50
1
53
3 4
6
Hen
ry F
ord
Ho
spit
al
Det
roit
4
34
0
0
07
3
Yes
4
5
18
2
3 4
7
Un
iver
sity
of
Cal
ifo
rnia
D
avis
Med
ical
can
ter
S
acra
men
to
43
4
00
0
76
Y
es
50
2
19
3
48
H
enne
pin
coun
ty M
edic
al c
ante
r M
inne
apol
is
43
2
00
0
61
Y
es
35
1
05
3
49
W
est
Jeff
erso
n M
edic
al C
ente
r M
arre
ro
lao
43
2
00
0
55
No
4
0
11
3
3 5
0
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
43
2
09
0
87
Y
es
50
1
67
3
~
-
2001
U
rolo
gy B
est
Has
pi ta
l li
st
Tec
hnol
ogy
Rep
uta
tio
nal
M
Ort
alit
y CO
TH
sco
re
RN
s
Tra
uma
Ran
k H
osp
ital
IH
O so
ore
rate
M
embe
r (o
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isch
arge
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bed
s C
ente
r
John
s H
opki
ns H
osp
ital
B
alti
mor
e 1
00
0
70
7
07
8
Yes
7
5
1231
1
42
Y
es
2 C
leve
land
Cli
nio
6
94
4
14
0
50
Y
es
80
1
61
8
19
4
No
3 M
ayo
Cli
nic
R
oche
ster
M
inn
6
80
3
92
0
50
Y
es
80
3
81
8
13
1
Yes
4
UCLA
Med
ical
Cen
ter
Lo
s A
ngel
es
50
0
25
7
12
3
Yes
8
0
14
50
1
08
Y
es
5 N
ew Y
ork
Pre
sby
teri
an H
osp
ital
4
41
1
79
0
79
Y
es
80
30
61
13
2
Yes
6
Mem
oria
l S
loan
middotKet
teri
ng
Can
cer
Cen
ter
New
Yor
k 4
35
1
73
0
56
Y
es
70
11
61
21
2
No
1 D
uke
Un
iver
sity
Med
ical
Cen
ter
D
urha
m
NC
4
13
1
49
0
81
Y
es
80
1
75
8
18
1
Yes
8 M
assa
chus
etts
Gen
eral
Ho
spit
al
Bos
ton
40
7
15
3
09
6
Yes
8
0
1401
1
38
Y
es
9 B
arne
s-Je
wis
h H
osp
ital
S
t
Lou
iS
39
0
12
9
08
2
Yes
8
0
1778
1
49
Y
es
10
S
tan
ford
Un
iver
sity
Ho
spit
al
Sta
nfo
rd
Cal
if
38
5
15
2
12
9
Yes
5
0
973
16
1
Yes
11
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
ncis
co M
edic
al C
ente
r 3
57
1
07
0
62
Y
es
70
78
3 1
75
No
(+
3 SO
) 1
2
Met
hodi
st H
osp
ital
H
oust
on
33
8
10
9
11
0
Yes
6
5
1381
1
33
No
1
3
Un
iver
sity
of
Tex
as
M
D
And
erso
n C
ance
r C
ente
r H
oust
on
33
0
10
8
11
1
Yes
6
0
69
0
26
8
No
14
U
niv
ersi
ty o
f M
ichi
gan
Med
ical
Cen
ter
Ann
Arb
or
32
0
60
0
78
Y
es
80
1
28
5
17
9
Yes
1
5
Cla
rian
Hea
lth
Par
tner
s
Ind
ian
apo
lis
31
0
54
0
86
Y
es
80
14
97
16
7
Yes
1
6
Nor
thw
este
rn M
emor
ial
Ho
spit
al
Chi
cago
3
07
3
7
04
8
Yas
7
0
95
9
17
0
Yes
1
7
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enns
ylva
nia
P
hil
adel
ph
ia
30
0
31
0
55
Y
es
80
12
74
16
1
Yes
(+
2 SD
) 1
6
Van
der
bil
t U
niv
ersi
ty H
osp
ital
an
d C
11ni
c
Nas
hv
ille
2
92
5
6
11
5
Yes
7
0
83
3
24
0
Yes
1
9
Lah
ey H
itch
cock
Cli
nic
B
url
ing
ton
M
ass
2
91
2
7
05
4
Yes
7
0
886
15
2
Yes
2
0
Bri
gham
and
Wom
ens
Ho
spit
al
Bos
ton
28
7
51
1
09
Y
es
80
69
7 1
43
Y
as
21
Par
klan
d M
emor
ial
Ho
spit
al
Dal
las
28
8
41
0
65
Y
es
80
2
83
1
98
Y
es
22
U
niv
ersi
ty o
f W
ashi
ngto
n M
edic
al C
ente
r
seatt
le
27
9
27
0
24
Y
es
80
5
32
1
10
No
2
3
Un
iver
sity
of
Vir
gin
ia H
ealt
h S
cien
ces
cen
ter
Ch
arlo
ttes
vil
le
27
7
28
0
51
Y
es
70
73
2 2
27
No
2
4
Nor
th C
aro
lin
a B
apti
st H
osp
ital
W
inst
onmiddot S
alem
2
77
1
8
07
7
Yes
8
0
957
16
1
Yes
2
5
Shan
ds H
osp
ital
at
the
Un
iver
sity
of
Flo
rid
a
Gai
nes
vil
le
27
7
15
0
57
Y
es
65
90
5 1
57
Y
es
26
Car
oli
nas
Med
ical
Cen
ter
C
har
lott
e
N C
2
78
0
0
03
3
Yes
8
0
908
18
4
Yes
27
U
niv
ersl
ty o
f W
isco
nsin
Hos
pita
l an
d C
lin
ios
Mad
ison
2
74
0
5
04
5
Yes
8
0
1151
1
36
Y
es
28
Ne
w Y
ork
Un
iver
sity
Med
ioal
Cen
ter
27
3
16
0
66
Y
es
80
16
70
11
8
Yes
2
9
Hen
ry F
ord
Ho
spit
al
Det
roit
2
72
0
0
04
3
Yes
7
5
1079
1
82
Y
es
30
U
niv
ersi
ty H
osp
ital
D
enve
r 2
70
1
0
00
0
Yes
6
0
371
24
0
Y9$
31
Th
omas
Jef
fers
on
Un
iver
sity
Ho
spit
al
Ph
ilad
elp
hia
2
67
1
4
06
9
Yes
7
0
1011
1
23
Y
es
32
Y
ale-
New
Hav
en H
osp
ital
Ne
w H
aven
C
onn
2
67
0
5
06
8
Yes
8
0
98
4
15
3
Yes
33
W
ashi
ngto
n H
osp
ital
Cen
ter
Was
hing
ton
D
C
26
7
00
0
42
Y
es
60
9
17
1
92
Y
es
34
A
lban
y M
adic
al C
ente
r A
lban
y
NY
2
66
0
5
04
7
Yes
6
0
77
3
16
7
Yes
3
5
36
Lo
s A
ngel
es C
ount
ymiddotU
SC M
edic
al C
ente
r W
illi
am B
eaum
ont
Ho
spit
al
Roy
al o
ak
Mic
h
26
5
26
4
14
0
0
00
0
06
2
Yes
Y
es
60
8
0
65
1
73
0
16
7
18
8
Yes
Y
es
37
U
niv
ersi
ty o
f C
alif
orn
ia
Dav
is M
edio
al C
ente
r
Sao
ram
ento
2
64
1
0
05
1
Yes
8
0
412
27
9
Yes
3
8
Nor
th S
hore
Un
iver
sity
Ho
spit
al
Man
hass
et
NY
2
63
0
0
05
5
Yes
8
0
35
4
12
7
Yes
3
9
Sum
ma
Ilea
lth
Sys
tem
A
kron
O
hio
26
2
00
0
04
5
Yes
6
5
775
14
9
Yes
4
0
St
L
ouis
Un
iver
sity
Ho
spit
al
26
1
18
0
72
Y
es
75
4
25
1
47
Y
es
41
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
26
0
21
0
66
Y
es
70
1
12
9
09
3
No
42
Un
iver
sity
Med
ical
Cen
ter
T
ucso
n
Ari
z
25
9
00
0
26
Y
es
65
3
56
1
72
Y
es
43
U
niv
ersi
ty o
f L
ou
isv
ille
Ho
spit
al
Lo
uis
vil
le
Ky
2
58
0
8
00
0
Yes
6
0
28
1
90
Y
es
44
L
ehig
h V
alle
y H
osp
ital
A
llen
tow
n
Pa
2
57
0
0
05
9
Yes
6
0
96
5
13
5
Yes
4
5
FG
M
cGaw
Ho
spit
al a
t L
oyol
a U
niv
ersi
ty
May
woo
d
Ill
2
57
1
4
09
9
Yes
7
0
84B
1
62
Y
es
46
Un
iver
sity
of
Mar
ylan
d M
edio
al S
yste
m
Bal
tim
ore
25
6
04
0
77
Y
es
75
83
3 1
94
Y
es
47
Un
iver
sity
of
Nor
th C
aro
lin
a H
osp
ital
s C
hape
l H
ill
25
6
09
0
78
Y
es
60
80
1 1
52
Y
es
48
U
niv
ersi
ty o
f C
hica
go H
osp
ital
s 2
56
2
0
10
9
Yes
8
0
701
19
4
Yes
4
9
Bex
ar C
ount
y H
osp
ital
Dis
trio
t
San
Ant
onio
2
56
0
5
00
0
Yes
8
5
229
12
1
Yes
5
0
Geo
rget
own
Un
iver
sity
Ho
spit
al
Was
hing
ton
D
C
25
5
13
0
57
Y
es
80
34
9 1
09
Yes
~
l
i i
f
AppendixG
r bull Reputational Rankings for Special-Service Hospitals
i
I
I L
1~
r-
2001
E
yes
Rep
uta
tio
nal
Sco
re
Rep
uta
tio
nal
R
ank
Ho
spit
al
soo
re
Joh
ns
Hop
kins
Ho
spit
al
(Wilm
er
Eye
In
stit
ute
)
Bal
tim
ore
71
2
2 U
niv
ersi
ty o
f M
iam
i (B
asC
om
Pal
mer
Ey
e In
stit
ute
) 6
46
3
Wil
ls E
VQ
Hos
pita
l--
h
ilad
llip
hia
57
0
(+3
l
4 M
assa
chu
sett
s E
ye
and
Ear
In
firm
ary
B
osto
n 4
00
5
UCLA
Med
ioal
Cen
ter
(JII
IIIS
Ste
in E
ye
Inst
itu
te)
lo
s A
ngeJ
es
30
3
(+2
SO)
6 U
niv
ersi
ty o
f Io
wa
Ho
spit
als
and
Cli
nio
s
Iow
a C
ity
1
93
7
USC
Un
iver
sity
Ho
spit
al
(Doh
eny
Eye
In
stit
ute
)
los
Ang
eles
1
03
8
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
B3
9
Emor
y U
niv
ersi
ty H
osp
ital
A
tlan
ta
BO
10
U
niv
ersi
ty o
f C
alif
orn
ia
San
Fra
nci
sco
Med
ical
Cen
ter
66
11
M
ayo
Cli
nic
R
och
este
r
Min
n
63
12
N
ew Y
ork
Eye
an
d E
ar I
nfi
rmar
y
61
13
B
arn
es-J
ewis
h H
osp
ital
S
t
Lou
is
58
14
C
lev
elan
d C
lin
ic
54
16
M
eth
od
ist
Ho
spit
al
(Cul
len
Eye
Inst
itu
te)
H
oust
on
39
16
U
niv
ersi
ty o
f W
isco
nsin
Ho
spit
al a
nd C
lin
ics
M
adis
on
37
17
H
osp
ital
of
the
Un
iver
sity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
6
I
-~
r
middot
2001
P
edia
trio
s R
epu
tati
on
al S
core
Ran
k H
osp
ital
Ch
ild
ren
s H
osp
ital
Bos
ton
2 C
hil
dre
ns
Ho
spit
al o
f P
hil
adel
ph
ia
3 Jo
hns
Hop
kins
Ho
spit
al
BaU
iID
ore
4 C
hil
dre
ns
Ho
spit
al o
f P
itts
bu
rgh
5
Ch
ild
ren
s H
osp
ital
D
enve
r 6
Ch
ild
ren
s H
osp
ital
lo
s A
ngel
es
7 U
niv
H
osp
ital
s o
f C
lev
elan
d
(Rai
nbow
Bab
ies
amp C
hil
dre
ns
Hos
p J
8
Tex
llS C
hil
dre
ns
Ho
spit
al
Hou
ston
9
New
Yor
k P
resb
yte
rian
Ho
spit
al
(Bab
ies
amp C
hil
dre
ns
Ho
spit
al)
10
Ch
ild
ren
s H
osp
ital
Med
ical
Cen
ter
C
inci
nn
ati
11
Ch
ild
ren
s M
emor
ial
Ho
spit
al
Chi
cago
12
M
ayo
Cli
nic
R
och
este
r M
inn
13
U
niv
ersi
ty o
f C
a11
forn
ia
San
Fra
nci
sco
Med
ical
cen
ter
14
UCLA
(M
atte
I C
hild
ren
lS C
ente
r)
los
Ang
eles
15
lu
cil
le P
acka
rd C
hil
dre
ns
Ho
spit
al
Sta
nfo
rd
Cali
f
16
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
17
Duk
e U
niv
ersi
ty M
edio
al C
ente
r
Dur
ham
N
C
18
Ch
ild
ren
s H
osp
ital
and
Med
ical
Cen
ter
S
eatt
le
19
Ch
ild
ren
s N
atio
nal
Med
ical
Cen
ter
Was
hing
ton
D
C
20
U
niv
ersi
ty o
f M
iam
i Ja
ckso
n M
emor
ial
Ho
spit
al
21
Ch
ild
ren
s H
osp
ital
B
uff
alo
N
Y bull
22
Un
iver
sity
of
Mic
higa
n H
osp
ital
s
Ann
Arb
or
23
St
Ch
rist
op
her
s H
osp
ital
P
hil
adel
ph
ia
24
Met
ho
dis
t H
osp
ital
H
oust
on
Rep
uta
tio
nal
S
core
49
4
38
9
27
4
12
2
11
6
10
9
10
9
99
9
4
89
8
7
74
7
2
62
6
0
5S
4
9
48
4
3
39
3
7
37
3
6
32
(+3
SD)
(+2
SlY
j
i r-
2001
p
sych
iatr
y R
epu
tati
on
al S
oore
Rep
uta
tio
nal
R
ank
Ho
spit
al
Soo
re
Mas
sach
use
tts
Gen
eral
Ho
spit
al
Bos
ton
31
8
2 N
ew Y
ork
pre
sby
teri
an H
osp
ital
25
2
3 C
F
M
enni
nger
Mem
oria
l H
osp
ital
T
opek
a
Kan
2
10
4
MoL
ean
Ho
spit
al
Bel
mon
t
Mas
s
20
6
5 Jo
hn
s H
opki
ns H
osp
ital
B
alti
mor
e 19
9
+3
SOl
6 UC
LA N
euro
PIgt
iQh
atl
ic
Hos
rgt
1al
105
Ang
eles
~8~_
Il
ifJl
7
Duk
e U
niv
ersi
ty M
edic
al C
ente
r
Dur
ham
N
C
10
0
8 Y
ale-
New
Hav
en
Ho
spit
al
New
Hav
en
Con
n
92
9
May
o C
lin
iC
Ro
ches
ter
M
inn
8
8
10
Un
iver
sity
of
Pit
tsb
urg
h M
edic
al C
ente
r 5
6
11
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
52
12
S
hepp
ard
and
Eno
ch P
ratt
Ho
spit
al
Bal
tim
ore
52
13
U
niv
ersi
ty o
f C
ali
forn
ia
san
Fra
nci
sco
Med
ical
Cen
ter
46
14
U
nv
ars
ity
of
Mic
higa
n M
edic
al C
ente
r A
nn A
rbor
4
0
e
15
Ho
spit
al o
f th
e U
niv
erS
ity
of
Pen
nsy
lvan
ia
Ph
ilad
elp
hia
3
7
16
Mou
nt S
inai
-NY
U M
edic
al C
ente
r
New
Yor
k 3
5
17
Cle
vel
and
Cli
nic
3
1
l r-shy
2001
R
ehab
ilit
atio
n R
epu
tati
on
al S
core
Rep
uta
tio
nal
R
ank
Ho
spit
al
Soo
re
Reh
abil
itat
ion
In
stit
ute
of
Chi
cago
6
37
2
The
In
stit
ute
fo
r R
ehab
ilit
atio
n a
nd
Res
earc
h
Hou
ston
3
74
3
Un
iver
sity
of
Was
hina
ton
Med
ioal
Cen
ter
$l
I1It
tle
32
9
___j+
3 S
O)
4 K
essl
er I
nst
itu
te f
or
Reh
abil
itat
ion
W
est
Ora
nge
N
J
23
8
5 M
ayo
Cli
nic
R
och
este
r
Min
n
20
3
6 C
raig
HQ
spit
al
Eng
lew
ood
c()l~
__
__
__
_
___2
00
(+
2 SO
l 7
New
Yor
k U
niv
ersi
ty M
edic
al C
ente
r 1
40
8
Ohi
o st
ate
Un
iver
sity
Med
ical
Cen
ter
C
olum
bus
11
1
9 T
hom
as J
effe
rso
n U
niv
ersi
ty H
osp
ital
P
hil
adel
ph
ia
10
7
10
Ran
oho
Los
AlII
igos
Med
ioal
Cen
ter
D
owne
y
Cali
f
10
0
11
Un
iver
sity
of
Mio
higa
n M
edio
al C
ente
r A
nn A
rbor
9
6
12
Sp
auld
ing
Reh
abil
itat
ion
Ho
spit
al
Bos
ton
69
13
N
atio
nal
Rs
hab
ilit
atio
n H
osp
ital
W
ashi
ngto
n
DC
8
6
14
Mou
nt
Sin
ai M
edic
al C
ente
r
New
Yor
k 6
7
15
Joh
ns
Hop
kins
Ho
spit
al
Bal
tim
ore
5
9
16
Alb
ert
Ein
stei
n M
ed
Cen
ter
(Mos
s R
ehab
H
osp
)
Ph
ilad
elp
hia
5
6
17
Sta
nfo
rd U
niv
ersi
ty H
osp
ital
S
tan
ford
C
ali
f
39
18
S
heph
erd
Cen
ter
A
tlan
ta
39
1
9
Un
iver
sity
Ho
spit
al
Den
ver
31
2
0
Ho
spit
al o
f th
e U
niv
ersi
ty o
f P
enn
sylv
ania
P
hil
adel
ph
ia
31
L
AppendixH
The 2001 Honor Roll
Lj
l
r
t
The Honor Roll
To lend additional perspective we have constructed a measure called the Honor Roll to
indicate excellence across a broad range ofspecialties
To be listed on the Honor Roll a hospital has to rank at least 2 standard deviations
(SD s) above the mean in at least 6 ofthe 16 specialties A hospitals ranking in the Honor
Roll is based on points assigned as follows
bull For ranking between 2 and 3 standard deviations above the mean in a specialty a
hospital receives one point
bull For ranking at least 3 standard deviations above the mean a hospital receives two
points
We chose to use a standard deviation based criteria rather than simply adding up a
hospitals rankings in individual specialties for three reasons (1) the number ofoutstanding
hospitals varies from specialty to specialty (2) setting a threshhold is more informative because
it establishes a level ofalmost excellent and (3) it gives some measure ofthe distance
between hospitals which rankings do not
f
middot1
THE 2001 HONOR ROLL
16
Mayo Clinic Rochester Minn 27 13 1
Massachusetts General Hospital Boston 26 12 2
4 Cleveland Clinic 23 11 1
5 UCLA Medical Center Los Angeles 22 8 6
6 Duke University Medical Center Durham NC 20 8 4
7 Barnes-Jewish Hospital St Louis 18 6 6
7 University of Michigan Medical Center Ann Arbor 18 6 6
7 University of California San Francisco Medical Center 18 7 4
10 Stanford University Hospital Stanford Calif 17 6 5
11 Brigham and Womens Hospital Boston 16 6 4
12 University of Washington Medical Center Seattle 12 4 4
13 New York Presbyterian Hospital 12 5 2
14 Hospital of the University of Pennsylvania Philadelphia 11 3 5
15 University of Chicago Hospitals 9 1 7
16 University QfPittsburgh Medical Center 9 2 5 1 1
l
i