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NORC AT THE UNIVERSITY OF CHICAGO The 2001 Index oJ Hospital Quality Colm O'Muircheartaigh Diana Jergovic Whitney Moore AsmaAli

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Page 1: The 2001 Hospital Hospitals/2001_Index... · NORC AT THE UNIVERSITY OF CHICAGO The 2001 Index oJ Hospital Quality Colm O'Muircheartaigh Diana Jergovic Whitney Moore AsmaAli

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

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Ns

lBed

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Inde

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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

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61

I

56

Hor

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al d

isor

ders

71

53

56

65

I

63

Kid

ney

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ase

63

66

62

57

I 54

Neu

rolo

gy a

nd n

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ery

68

54

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66

62

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66

63

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pira

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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

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seas

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logy

and

esp

irat

ory

diso

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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

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Un

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Un

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How

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Ang

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N

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M

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Geo

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55

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Yes

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92

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4

Yes

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60

27

00

00

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0

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1

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3 SO

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4

66

90

00

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3

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9

87

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80

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8

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55

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00

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Yes

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54

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32

8

61

0

83

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80

9

82

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75

No

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18

0

6

07

0

Yes

8

0

29

03

00

00

1

52

Y

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31

8

13

0

66

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1

37

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98

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8

Yes

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12

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2

Yes

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58

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00

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3

Yes

3

05

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2

Yes

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0

22

46

00

00

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49

Y

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30

5

28

0

94

Y

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4

71

80

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0

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7

Yes

3

03

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6

Yes

7

0

17

60

00

00

2

10

Y

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30

2

08

0

76

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1

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7

Yes

3

02

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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

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30

00

0

17

2

Yes

3

00

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1

Yes

9

0

26

91

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00

1

79

Y

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29

8

47

1

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Y

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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

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90

1

73

80

00

0

24

0

Yes

2

92

1

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1

16

Y

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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

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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

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0

11

0

Yes

2

89

3

5

09

9

Yes

9

0

39

64

00

00

1

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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

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80

2

44

50

00

0

19

4

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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

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5

45

27

00

00

1

59

N

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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

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tio

nal

M

ort

alit

y

COTH

sc

ore

RN

s

T

raum

a R

ank

Ho

spit

al

IHQ

sco

re

rate

M

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r (O

f 7

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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

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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

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~

l

i i

f

AppendixG

r bull Reputational Rankings for Special-Service Hospitals

i

I

I L

1~

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2001

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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

Page 2: The 2001 Hospital Hospitals/2001_Index... · NORC AT THE UNIVERSITY OF CHICAGO The 2001 Index oJ Hospital Quality Colm O'Muircheartaigh 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

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82

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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

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82

75

84

70

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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

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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

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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

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

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

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AppendixG

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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

Page 3: The 2001 Hospital Hospitals/2001_Index... · NORC AT THE UNIVERSITY OF CHICAGO The 2001 Index oJ Hospital Quality Colm O'Muircheartaigh Diana Jergovic Whitney Moore AsmaAli

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

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3 F

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Can

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73

59

70

70

Dig

esti

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69

52

60

63

Ear

nos

e a

nd th

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72

54

64

63

Ger

iatr

ics

35

81

Gyn

ecol

ogy

61

71

I H

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72

62

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61

I

56

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53

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ase

63

66

62

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54

62

66

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73

31

51

58

Rhe

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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

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ans

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ty p

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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

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nal

M

ort

alit

y

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ore

R

N s

R

ank

Ho

spit

al

10

0

sco

re

rate

M

embe

r (o

f 7

) D

isch

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es

to b

eds

Mem

oria

l S

loan

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teri

ng

can

cer

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ter

N

ew Y

ork

10

00

7

18

0

93

Y

es

60

51

67

21

2

2 U

niv

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ty 0

1 T

exas

M

D

A

nder

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cer

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ter

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98

2

68

5

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7

Yes

5

0

5103

2

68

3

Joh

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6

78

3

59

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4 D

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88

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60

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9

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M

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80

8

8

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5

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7

0

2022

1

38

14

C

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an H

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h P

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ners

In

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78

5

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7

0

2149

1

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15

U

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f P

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4

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(+2

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0

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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

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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

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3

Yes

8

0

310

10

8

Yes

4

5 U

niv

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ty o

f T

exas

M

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A

nder

son

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cer

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ter

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ston

5

72

1

59

0

89

Y

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60

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34

2

68

No

0

6 D

uke

Un

iver

sity

Med

ical

Cen

ter

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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

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l 4

06

6

1

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9

Yes

7

0

34

3

15

2

Yes

4

11

Mem

oria

l S

loan

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teri

ng

Can

cer

Cen

ter

New

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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

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k H

osp

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land

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nic

2

May

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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

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s H

osp

ital

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Duk

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niv

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ty M

edic

al C

ente

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m

NC

7

Tex

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stit

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Luk

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scop

al H

osp

ital

H

oust

on

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Sta

nfo

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niv

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ty H

osp

ital

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tan

ford

C

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f

9 Em

ory

un

iver

sity

Ho

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0

Bet

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rael

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edic

al C

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ton

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B

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osp

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Lou

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12

W

illi

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spit

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h

13

Un

iver

sity

of

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osp

ital

at

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Un

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sity

of

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n F

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ter

1

5

Lah

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ton

M

ass

1

6

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Ho

spit

al

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Orl

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iona

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edic

al C

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do

Fla

18

Hen

ry F

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Ho

spit

al

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roit

1

9

Thom

as

Jeff

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n U

niv

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ty H

osp

ital

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ph

ia

20

Sum

ma

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lth

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tem

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kron

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21

U

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f P

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ter

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2

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ton

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ter

2

3

St

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ty H

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Nor

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lin

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osp

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W

inst

onmiddotS

alem

2

5

Un

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sity

Med

ical

Cen

ter

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son

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riz

2

6

Un

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sity

of

Mic

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n M

edic

al C

ente

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nn A

rbor

2

7

Mou

nt

Sin

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edic

al C

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k

28

N

ew Y

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ter

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eles

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Un

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ison

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L

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idge

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t

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Geo

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ton

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M

edic

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42

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9

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9

55

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Yes

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78

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66

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87

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Yes

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87

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70

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8

Yes

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Yes

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54

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32

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61

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83

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80

9

82

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No

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18

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6

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0

Yes

8

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29

03

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00

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52

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31

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13

0

66

Y

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90

1

37

00

00

1

98

Y

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2

81

60

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Yes

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12

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Yes

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18

58

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Yes

3

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Yes

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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

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6

Yes

7

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60

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Y

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2

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15

30

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7

Yes

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Yes

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39

93

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30

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74

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Yes

3

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Yes

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91

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79

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29

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47

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4

25

30

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7

Yes

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91

6

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Yes

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76

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29

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37

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Y

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90

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50

40

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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

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

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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

Page 4: The 2001 Hospital Hospitals/2001_Index... · NORC AT THE UNIVERSITY OF CHICAGO The 2001 Index oJ Hospital Quality Colm O'Muircheartaigh Diana Jergovic Whitney Moore AsmaAli

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

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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

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ogy

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N s

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ank

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spit

al

10

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sco

re

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M

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r (o

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isch

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to b

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Mem

oria

l S

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ter

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ew Y

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10

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7

18

0

93

Y

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60

51

67

21

2

2 U

niv

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ty 0

1 T

exas

M

D

A

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ter

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98

2

68

5

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7

Yes

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3

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6

78

3

59

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1

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0

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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

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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

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hv

ille

3

4

Un

iver

sity

of

Was

hing

ton

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ical

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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

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

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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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

Page 5: The 2001 Hospital Hospitals/2001_Index... · NORC AT THE UNIVERSITY OF CHICAGO The 2001 Index oJ Hospital Quality Colm O'Muircheartaigh Diana Jergovic Whitney Moore AsmaAli

(

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

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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

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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

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est

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ank

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re

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ter

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67

21

2

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1 T

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A

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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

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B

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Yes

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46

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Un

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and

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7

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Yes

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spit

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le

27

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76

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ter

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27

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FG

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2

70

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Yes

7

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186

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2

Yes

4

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2001

H

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28

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4

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80

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Yes

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Yes

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Yes

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91

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Yes

2

91

6

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Yes

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76

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29

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37

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90

1

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40

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8

Yes

2

95

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6

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29

3

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80

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70

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4

Yes

2

93

0

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5

No

80

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16

00

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Y

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29

3

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89

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1

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80

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0

24

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Yes

2

92

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1

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1

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29

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76

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4

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76

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Yes

2

91

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Yes

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75

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Y

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28

9

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Yes

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Yes

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Yes

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28

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76

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80

2

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12

1

Yes

2

89

0

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9

Yes

8

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28

37

00

00

1

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Y

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28

9

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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

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28

7

00

0

84

Y

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80

2

44

50

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4

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2

86

0

0

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0

Yes

8

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79

90

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0

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9

Yes

2

85

0

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7

Yes

8

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40

88

00

00

1

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Y

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28

4

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0

70

N

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5

45

27

00

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1

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83

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6

No

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15

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0

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9

No

28

3

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71

No

8

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31

45

00

00

1

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N

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2001

H

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Ho

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M

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n

10

00

6

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66

Y

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70

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59

13

1

Yes

2

Mas

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89

5

27

0

91

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96

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52

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64

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70

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Yes

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H

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36

2

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72

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1

43

Y

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rael

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55

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62

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Un

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ter

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4

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Yes

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27

No

7

Un

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of

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Se

n F

ranc

isco

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ter

45

3

14

5

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Yes

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0

416

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5

No

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3

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Yes

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0

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1

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Y

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9 C

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land

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4

37

9

3

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6

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No

(+

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m

10

U

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ichi

gan

Med

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ter

Ann

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or

41

6

82

0

66

Y

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10

8

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1

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Y

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11

Un

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of

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41

1

89

0

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70

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1 1

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Y

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12

UCLA

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ter

lo

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41

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4

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Yes

7

0

752

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Yes

13

u

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0

4

05

6

Yes

1

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31

9

11

0

No

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Ne

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ork

Pre

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3

83

1

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1

54

Y

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70

15

52

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Yes

15

V

and

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Un

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Ho

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3

78

3

9

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24

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Yes

16

N

orth

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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

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al

soo

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Joh

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Hop

kins

Ho

spit

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Eye

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stit

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)

Bal

tim

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71

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ty o

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iam

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asC

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mer

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46

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Wil

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57

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l

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chu

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firm

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UCLA

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ter

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93

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los

Ang

eles

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03

8

Duk

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ty M

edio

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ente

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Dur

ham

N

C

B3

9

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y U

niv

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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

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nic

R

och

este

r

Min

n

63

12

N

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ork

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ar I

nfi

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61

13

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arn

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h H

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t

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58

14

C

lev

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lin

ic

54

16

M

eth

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(Cul

len

Eye

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te)

H

oust

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39

16

U

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ty o

f W

isco

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Ho

spit

al a

nd C

lin

ics

M

adis

on

37

17

H

osp

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of

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Un

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sity

of

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nsy

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Ph

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elp

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3

6

I

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r

middot

2001

P

edia

trio

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al S

core

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k H

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ton

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Hop

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11

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13

U

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los

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16

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18

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22

Un

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24

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4

38

9

27

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Ho

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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

Page 6: The 2001 Hospital Hospitals/2001_Index... · NORC AT THE UNIVERSITY OF CHICAGO The 2001 Index oJ Hospital Quality Colm O'Muircheartaigh Diana Jergovic Whitney Moore AsmaAli

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

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CO

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Imiddot

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V

olum

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73

59

70

70

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69

52

60

63

Ear

nos

e a

nd th

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72

54

64

63

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iatr

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35

81

Gyn

ecol

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61

71

I H

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72

62

65

61

I

56

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63

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63

66

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82

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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

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ear

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ans

per

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ty p

erye

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82

75

84

70

62

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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

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al o

f th

e U

niv

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f P

enn

sylv

ania

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ph

ia

40

0

91

0

82

Y

es

60

18

44

16

1

10

Sta

nfo

rd U

niv

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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

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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

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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

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h P

art

ners

In

dia

nap

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

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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

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and

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ens

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spit

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Bos

ton

35

5

37

0

73

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es

60

14

15

14

3

19

Un

iver

sity

of

Ken

tuck

y H

osp

ital

le

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n

351

0

5

05

6

Yes

7

0

1047

2

20

20

fo

x C

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can

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Cen

ter

P

hil

adel

ph

ia

35

0

56

0

83

Y

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50

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46

15

8

21

H

lee M

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ter

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ampa

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35

0

15

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65

Y

es

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16

44

16

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22

Un

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of

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ter

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3

49

0

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Y

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13

48

22

7

23

Van

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bil

t U

niv

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ty H

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and

Cli

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N

ash

vil

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34

8

17

0

67

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24

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hand

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osp

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at

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Un

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Gei

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le

34

7

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0

46

Y

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15

7

25

All

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Gen

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spit

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urg

h

34

6

00

0

57

Y

es

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12

22

191

26

U

niv

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ty o

f A

laba

ma

Ho

spit

al a

t B

irm

ingh

am

34

4

17

0

67

Y

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80

16

15

151

27

B

eth

Isra

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ss M

edic

al C

ente

r

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ton

34

3

15

0

66

Y

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55

14

14

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8

28

Un

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Ho

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Yes

5

5

1287

2

54

29

U

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r 3

42

2

7

05

7

Yes

5

0

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24

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30

Un

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ter

T

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34

2

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0

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lt

31

Yal

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34

2

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3

32

Art

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41

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33

U

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34

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Sum

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33

9

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81

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35

New

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33

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31

03

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36

Un

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cali

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San

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Med

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ter

33

5

30

0

71

Yes

6

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17

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fG

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3

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62

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39

Nor

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33

3

19

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Y

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21

181

40

fa

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ter

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32

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Yes

5

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1248

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56

41

G

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mo

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mo

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33

2

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12

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20

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42

Un

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Ho

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and

3

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12

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Un

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St

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3

29

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5

Yes

6

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13

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45

Hen

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ord

Ho

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Detr

oit

3

27

0

0

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6

Yes

6

5

1473

1

92

46

B

arn

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h H

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ital

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t

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32

6

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56

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9

47

luth

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hSys

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3

26

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1420

1

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48

G

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n U

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ty H

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ital

W

ashi

ngto

n

DC

3

24

0

5

05

0

Yes

7

0

776

10

9

49

Coo

k C

ount

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ital

C

hica

go

32

3

04

0

49

Y

es

50

49

1 2

10

50

W

ashi

ngto

n H

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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

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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

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Un

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36

2

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72

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55

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11

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gin

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Cen

ter

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45

4

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Yes

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7

Un

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sity

of

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isco

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ter

45

3

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9

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No

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41

6

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Yes

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13

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Yes

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52

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Yes

16

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Hen

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Yes

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Yes

7

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Yes

2

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Duk

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m

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3

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2

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Yes

7

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Yes

21

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58

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Yes

8

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Yes

2

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ton

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3

57

2

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0

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1

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Y

es

23

U

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bu

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Cen

ter

35

4

16

0

65

Y

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70

12

59

16

7

Yes

2

4

Ohi

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tate

Un

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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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10

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Yes

2

5

Ho

spit

al o

f th

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niv

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ty o

f P

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nia

P

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adel

ph

ia

34

5

23

0

13

Y

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70

86

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Y

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26

S

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ty H

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ital

3

43

0

7

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0

Yes

1

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637

14

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Yes

2

7

Un

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sity

of

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bam

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osp

ital

at

Bir

min

gham

3

43

1

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Yes

1

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1080

1

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Y

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28

U

niv

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ty H

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P

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lan

d

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3

42

2

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Y

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60

32

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Yes

2

9

Un

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sity

of

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as M

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h H

osp

ital

s

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33

9

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Y

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30

G

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Med

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ter

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enix

3

38

1

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7

Yes

7

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58

0

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7

Yes

31

U

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ty o

f N

orth

Car

oli

na

Ho

spit

als

Cha

pel

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l 3

37

0

6

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Yes

6

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15

2

Yes

32

U

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ty o

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nsin

Hos

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l an

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Hn

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Mad

ison

3

37

0

5

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3

Yes

7

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13

6

Yes

33

W

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ont

Ho

spit

al

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h

33

7

06

0

80

Y

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70

14

14

18

8

Yes

3

4

Flo

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Med

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Cen

ter

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la

33

7

00

0

51

No

6

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1

67

Y

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35

U

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ty o

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and

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36

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U

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Dav

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33

4

06

0

59

Y

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70

55

7 2

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Y

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37

Sha

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Ho

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t th

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f F

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da

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vil

le

33

3

05

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Y

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57

Y

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38

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Ho

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33

2

38

1

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10

8

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1

53

Y

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Gen

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32

9

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Y

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60

76

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Y

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40

L

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3

29

0

0

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9

Yes

5

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656

13

5

Yes

41

A

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Gen

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Ho

spit

al

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h

32

8

00

0

66

Y

es

60

6

10

1

91

Y

es

42

Mou

nt S

inai

Med

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Cen

ter

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k 3

27

6

4

16

7

Yes

7

0

1555

1

57

Y

es

43

Geo

rget

own

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sity

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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

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0

55

Y

es

80

12

74

16

1

Yes

(+

2 SD

) 1

6

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der

bil

t U

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ty H

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an

d C

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c

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hv

ille

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92

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6

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5

Yes

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0

83

3

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Yes

1

9

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ey H

itch

cock

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nic

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url

ing

ton

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ass

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91

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05

4

Yes

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0

886

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2

Yes

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0

Bri

gham

and

Wom

ens

Ho

spit

al

Bos

ton

28

7

51

1

09

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es

80

69

7 1

43

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as

21

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klan

d M

emor

ial

Ho

spit

al

Dal

las

28

8

41

0

65

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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

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ter

Ch

arlo

ttes

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le

27

7

28

0

51

Y

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70

73

2 2

27

No

2

4

Nor

th C

aro

lin

a B

apti

st H

osp

ital

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inst

onmiddot S

alem

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77

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8

07

7

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0

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Yes

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5

Shan

ds H

osp

ital

at

the

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iver

sity

of

Flo

rid

a

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nes

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le

27

7

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0

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90

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26

Car

oli

nas

Med

ical

Cen

ter

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har

lott

e

N C

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78

0

0

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Yes

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0

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18

4

Yes

27

U

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ty o

f W

isco

nsin

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pita

l an

d C

lin

ios

Mad

ison

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74

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0

1151

1

36

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28

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w Y

ork

Un

iver

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Med

ioal

Cen

ter

27

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0

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8

Yes

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ry F

ord

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Det

roit

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5

1079

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82

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30

U

niv

ersi

ty H

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ital

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enve

r 2

70

1

0

00

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Yes

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0

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Y9$

31

Th

omas

Jef

fers

on

Un

iver

sity

Ho

spit

al

Ph

ilad

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9

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7

0

1011

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32

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New

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en H

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aven

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onn

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67

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8

0

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15

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Yes

33

W

ashi

ngto

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osp

ital

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ter

Was

hing

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C

26

7

00

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es

34

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lban

y M

adic

al C

ente

r A

lban

y

NY

2

66

0

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04

7

Yes

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0

77

3

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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

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h

26

5

26

4

14

0

0

00

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06

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Yes

Y

es

60

8

0

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1

73

0

16

7

18

8

Yes

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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

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Yes

8

0

412

27

9

Yes

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8

Nor

th S

hore

Un

iver

sity

Ho

spit

al

Man

hass

et

NY

2

63

0

0

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5

Yes

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0

35

4

12

7

Yes

3

9

Sum

ma

Ilea

lth

Sys

tem

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kron

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hio

26

2

00

0

04

5

Yes

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5

775

14

9

Yes

4

0

St

L

ouis

Un

iver

sity

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spit

al

26

1

18

0

72

Y

es

75

4

25

1

47

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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

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ucso

n

Ari

z

25

9

00

0

26

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3

56

1

72

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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

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6

0

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1

90

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es

44

L

ehig

h V

alle

y H

osp

ital

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llen

tow

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Pa

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57

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9

Yes

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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

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yste

m

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tim

ore

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04

0

77

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75

83

3 1

94

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es

47

Un

iver

sity

of

Nor

th C

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lin

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s C

hape

l H

ill

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09

0

78

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60

80

1 1

52

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48

U

niv

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ty o

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hica

go H

osp

ital

s 2

56

2

0

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9

Yes

8

0

701

19

4

Yes

4

9

Bex

ar C

ount

y H

osp

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Dis

trio

t

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Ant

onio

2

56

0

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00

0

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8

5

229

12

1

Yes

5

0

Geo

rget

own

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iver

sity

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spit

al

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hing

ton

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C

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5

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0

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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

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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

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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

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arn

es-J

ewis

h H

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t

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is

58

14

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lev

elan

d C

lin

ic

54

16

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eth

od

ist

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spit

al

(Cul

len

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Inst

itu

te)

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oust

on

39

16

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niv

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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

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nsy

lvan

ia

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elp

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6

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-~

r

middot

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P

edia

trio

s R

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al S

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k H

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ild

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ton

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hns

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kins

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lo

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7 U

niv

H

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s o

f C

lev

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d

(Rai

nbow

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ies

amp C

hil

dre

ns

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p J

8

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llS C

hil

dre

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spit

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Yor

k P

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spit

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(Bab

ies

amp C

hil

dre

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spit

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10

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s H

osp

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inci

nn

ati

11

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ild

ren

s M

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cago

12

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ayo

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nic

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este

r M

inn

13

U

niv

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ty o

f C

a11

forn

ia

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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

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spit

al

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nfo

rd

Cali

f

16

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sach

use

tts

Gen

eral

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spit

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ton

17

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e U

niv

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ty M

edio

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ente

r

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ham

N

C

18

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ild

ren

s H

osp

ital

and

Med

ical

Cen

ter

S

eatt

le

19

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ild

ren

s N

atio

nal

Med

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Cen

ter

Was

hing

ton

D

C

20

U

niv

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f M

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i Ja

ckso

n M

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spit

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21

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ild

ren

s H

osp

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B

uff

alo

N

Y bull

22

Un

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sity

of

Mic

higa

n H

osp

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s

Ann

Arb

or

23

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Ch

rist

op

her

s H

osp

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ph

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ho

dis

t H

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H

oust

on

Rep

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core

49

4

38

9

27

4

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2

11

6

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9

10

9

99

9

4

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8

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7

2

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4

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48

4

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39

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3

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32

(+3

SD)

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i r-

2001

p

sych

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oore

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ank

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spit

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re

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sach

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tts

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spit

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ton

31

8

2 N

ew Y

ork

pre

sby

teri

an H

osp

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25

2

3 C

F

M

enni

nger

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oria

l H

osp

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opek

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mon

t

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s

20

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alti

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9

+3

SOl

6 UC

LA N

euro

PIgt

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atl

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rgt

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~8~_

Il

ifJl

7

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e U

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edic

al C

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r

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ham

N

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10

0

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ale-

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Hav

en

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spit

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en

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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

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r 5

6

11

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nfo

rd U

niv

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ty H

osp

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tan

ford

C

ali

f

52

12

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hepp

ard

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ch P

ratt

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spit

al

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tim

ore

52

13

U

niv

ersi

ty o

f C

ali

forn

ia

san

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nci

sco

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ical

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ter

46

14

U

nv

ars

ity

of

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higa

n M

edic

al C

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r A

nn A

rbor

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0

e

15

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spit

al o

f th

e U

niv

erS

ity

of

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nsy

lvan

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ilad

elp

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16

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nt S

inai

-NY

U M

edic

al C

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r

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k 3

5

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vel

and

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nic

3

1

l r-shy

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ehab

ilit

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n R

epu

tati

on

al S

core

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uta

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ank

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spit

al

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re

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abil

itat

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stit

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of

Chi

cago

6

37

2

The

In

stit

ute

fo

r R

ehab

ilit

atio

n a

nd

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earc

h

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ston

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74

3

Un

iver

sity

of

Was

hina

ton

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ioal

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ter

$l

I1It

tle

32

9

___j+

3 S

O)

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er I

nst

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te f

or

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abil

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est

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ayo

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raig

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lew

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c()l~

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ate

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sity

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ical

Cen

ter

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olum

bus

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1

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hom

as J

effe

rso

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niv

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osp

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ph

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oho

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ter

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rbor

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auld

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spit

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hab

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n H

osp

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ashi

ngto

n

DC

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6

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nt

Sin

ai M

edic

al C

ente

r

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Yor

k 6

7

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ns

Hop

kins

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spit

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tim

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9

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ert

Ein

stei

n M

ed

Cen

ter

(Mos

s R

ehab

H

osp

)

Ph

ilad

elp

hia

5

6

17

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nfo

rd U

niv

ersi

ty H

osp

ital

S

tan

ford

C

ali

f

39

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heph

erd

Cen

ter

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tlan

ta

39

1

9

Un

iver

sity

Ho

spit

al

Den

ver

31

2

0

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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

Page 7: The 2001 Hospital Hospitals/2001_Index... · NORC AT THE UNIVERSITY OF CHICAGO The 2001 Index oJ Hospital Quality Colm O'Muircheartaigh Diana Jergovic Whitney Moore AsmaAli

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

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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

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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

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nal

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ank

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al

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rate

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7

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51

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6

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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

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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

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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

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

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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

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

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

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

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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

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uta

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re

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ns

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(Wilm

er

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stit

ute

)

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tim

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71

2

2 U

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iam

i (B

asC

om

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mer

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e In

stit

ute

) 6

46

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ls E

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h

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57

0

(+3

l

4 M

assa

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s E

ye

and

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firm

ary

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osto

n 4

00

5

UCLA

Med

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ter

(JII

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in E

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lo

s A

ngeJ

es

30

3

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10

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f C

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ter

66

11

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r

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63

12

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58

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(Bab

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amp C

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s H

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11

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(M

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22

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nv

ars

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of

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nn A

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nt S

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core

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ank

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In

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r R

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earc

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ter

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I1It

tle

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as J

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ashi

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r

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ns

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ert

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ed

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rd U

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tan

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ter

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1

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sity

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spit

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ver

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2

0

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e U

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enn

sylv

ania

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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

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