The hospitals were rated not on high-tech treatments or cutting-edge research but on how reliably they followed recommended protocols for treating five of the most common conditions for which people are hospitalized: heart attack, heart failure, pneumonia, surgical infection and children’s asthma.
The hospitals were judged, for example, on how often they gave aspirin on arrival to heart attack patients, gave pneumonia and flu vaccines appropriately, and provided proper treatment to prevent blood clots.
These measures were chosen because they are evidence-based treatments that directly improve outcomes for patients, said the commission’s president, Mark Chassin. In addition, he said, many of the measures are identical to pay-for-performance requirements in federal and state programs as well as many private payers.
Numerous hospital-rating systems exist, but this is the first time the influential accreditation organization has singled out excellent performance on “the best of the best” quality measures, Chassin said. The 405 top performers — which represent about 14 percent of more than 3,000 accredited hospitals that report the relevant data — were not listed in any particular order; they simply made the cut. Some made the list for achieving high scores in one category of care. Others had high marks in all five categories.
“To not be listed in the top 405 hospitals, you can imagine, for Johns Hopkins, was quite startling, and we are absolutely redoubling our efforts to make sure we focus on these things,” said Peter Pronovost, Hopkins’s senior vice president for patient safety and quality.
Most hospitals not on the list are performing reasonably or even very well, Chassin said.
Some other rating systems, he said, rely heavily on a hospital’s reputation or on outcomes, both of which are flawed measurement approaches, he said. A hospital’s reputation may have more to do with research capacity and “brand-new treatment opportunities for patients.”
By contrast, the 22 specific measures identified by the commission are basic “bread-and-butter metrics,” he said. “They are not controversial. Everybody agrees they should be done.”
Those hospitals that did not make the list might be distracted by “more glamorous things, like new technology,” he said.
The Washington Hospital Center did not qualify as a top performer because it missed the required score of 95 percent on three of 22 measures, two of them by less than two percentage points.