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December 16, 2016

At low-performing hospitals, patients are three times more likely to die, study finds

Daily Briefing

Patients admitted to low-performing hospitals are three times more likely to die and 13 times more likely to suffer from complications than those admitted to the highest-performing hospitals, according to a study published Wednesday in PLOS One.

For the study, researchers analyzed 22 million hospital admissions from 2011 for patients from 18 states. The researchers examined 24 health outcomes, including for diabetes, cardiovascular disease, and pneumonia.

Under the study terms, the researchers agreed to keep the hospitals' identities confidential.


After adjusting for patient factors such as age and income, the researchers found wide variation in outcomes between hospitals and even within hospitals. For example, "a hospital that had excellent outcomes for heart care might have poor outcomes in treating diabetes," the New York Times reports.

In addition, patients at low-performing hospitals (the bottom 10 percent) were:

  • About 20 times more likely to experience a central-line infection;
  • More than twice as likely to die after an acute event, such as a heart attack or stroke; and
  • More than three time as likely to contract postoperative sepsis.

The report defied some conventional wisdom: Some of the highest-performing hospitals mainly served low-income, minority patients, while some low-performing hospitals were in higher-income areas.

Barry Rosenberg, the study's lead author, said that while patient demographics play a role in hospital performance, other factors such as the skill of the care team and hospital culture represent the "other half of the story."

He added, "Quite simply, this study found that where you live can determine if you live. ... The closest hospital may not always be the best hospital."

Calls for more transparency

The researchers noted that patients often do not have the ability to compare outcomes at different hospitals. Justin Dimick, co-author of the paper, said patients are entitled to more information. "This paper raises the question of why don't we have broader outcomes measurement and transparency around performance," he said. Without this information, he added, patients can't accurately assess the quality of hospitals in their area or their insurance network.

Study co-author Atul Gawande, a surgeon at Brigham and Women's Hospital and author, said, "It's been known that hospitals vary in quality, but it hadn't been recognized exactly how large the variation is between high performing and low performing hospitals. This clearly indicates that greater outcomes transparency and greater focus on performance improvement are necessary. We have a tremendous opportunity to improve outcomes for patients" (Abelson, New York Times, 12/14; Ross, "On Call," STAT News, 12/15; Boston Consulting Group release, 12/14).

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