Methodology

Performance Data

Recommended Care (Core Measures)
Composite Measures of Recommended Care
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
Emergency Care
Immunization
Readmission Rates
Mortality Rates
Reimbursement Rates
Health Care–Associated Infections
Health Information Technology
Inpatient Quality Indicators
Patient Safety Indicators
Prevention Quality Indicators
Population Health / Utilization and Costs

Compare Performance by Groups and Regions

Differences from CMS Hospital Compare

This site includes data on the performance of most U.S. hospitals. It does not include data on the following types of hospitals: Rehabilitation, Children's or Psychiatric. Unregistered users can compare up to 70 hospitals (or hospital groups or regions) in a single report. To add more hospitals to a single report, please register for the site and log in.

Recommended Care (Core Measures)

(Heart Attack Care, Heart Failure Care, Pneumonia Care, Surgical Care)
Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): Hospital Quality Alliance (CMS, Joint Commission)
Technical Specifications: http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx
Data Collection: Medical record, all-patients 18 years and older, all-payer.

These 31 measures report how often hospitals delivered recommended care processes in the following four areas: heart attack, heart failure, pneumonia, and surgical care improvement. This includes 13 "legacy" measures, which CMS has retired and for which hospitals are no longer required to report data.

Composite Measures of Recommended Care

(Heart Attack Care, Heart Failure Care, Pneumonia Care, Surgical Care)
Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): IPRO, Commonwealth Fund
Technical Specifications: https://sites.google.com/a/ipro.us/pelliki/home/qualitymine/category-measures-catalogue/composite-measures
Data Collection: Medical record, all-patient 18 years and older, all-payer.
WhyNotTheBest.org presents composite performance scores for each hospital for each of the following four conditions:

Overall Heart Attack Summary Rate (composite of four process-of-care measures for this condition)
Overall Heart Failure Summary Rate (composite of three process-of-care measures for this condition)
Overall Pneumonia Summary Rate (composite of two process-of-care measures for this condition)
Overall Surgical Care Improvement Summary Rate (composite of nine care processes used to improve surgical care/prevent surgical infections)

To create composite scores for each condition, the site uses a methodology prescribed by the Joint Commission. This approach suggests that the composite score be the number of times a hospital performed the appropriate action across all measures for that condition, divided by the number of opportunities the hospital had to provide appropriate care for that condition. Composite scores will not be displayed if all measures in that condition were less than 30 cases.

Scores are not weighted, except that measures with larger denominators do contribute more weight to the calculation of the mean for that measure. None of the measures is risk adjusted.

We also create an overall quality composite (Overall Recommended Care) that takes into account 27 Hospital Quality Alliance process-of-care measures (excluding the three legacy measures that are no longer being collected).

It is possible for a hospital to submit “0” on a particular measure, indicating that it had no patients whose treatment was relevant to that measure. For example, a hospital reporting seven measures of heart attack care could submit denominators of 0, 6, 2, 12, 30, 29, and 14 and still have a composite score calculated.

In all instances we calculate a weighted average, wherein we add all the numerators and divide by the total of the denominators.

We also rank hospitals on these composite measures, but to be ranked hospitals must satisfy the following additional criteria:

Measures must contain all available quarters worth of data.
Must report all indicators within the topics (i.e. be fully reported). For example, HF composite score will be ranked only if all 4 HF indicators were reported.
At least one indicator in the topic had denominator >= 30.

Some hospitals report enough data to be considered eligible for inclusion in the WhyNotTheBest.org top performers listing. These criteria are detailed below.

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Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: http://www.hcahpsonline.org/techspecs.aspx
Data Collection: Patient survey, all-patient 18 years and older, all-payer.

The site includes 10 measures from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This survey asks a random sample of recently discharged patients about important aspects of their hospital experience. HCAHPS is a relatively new survey, and hospitals across the U.S. are not yet achieving very high scores across all of the questions. Nevertheless, some hospitals are scoring significantly better than others, and a 2011 Press Ganey study [http://www.healthleadersmedia.com/content/QUA-276127/Hospital-HCAHPS-Scores-Beat-Expectations.html] found that some hospitals are achieving rapid improvement on these measures. Patients rate certain questions on a scale of 0 to 10, where 0 is the worst and 10 is the best. Responses to other questions consist of the following possible answers: Always, Usually, Sometimes, or Never. For example, one survey question asks how often their nurses communicated well, and respondents reported their nurses ("Always," "Usually," "Sometimes," or "Never") communicated well. Hospital rankings are displayed on the measure detail page when applicable.

www.hcahpsonline.org.

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Emergency Care

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Electronic health record, paper medical records, all emergency department patients, all-payer.

These two measures assess how quickly hospitals treat patients who come to the hospital emergency department. Reducing the time patients remain in the emergency department can improve access to treatment and increase quality of care. The measures are:

Median time from ED arrival to ED departure for admitted ED patients, and
Median admit decision time to ED departure time for admitted patients

Immunization

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Administrative claims, paper medical records, all-payer.

These measures assess whether hospitals screen their patients for influenza vaccine status (age 6 months and older) and pneumococcal vaccine status (age 65 and older and high risk patients age 6-64) and provide vaccine to patients prior to discharge if indicated. Influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. A sizable proportion of pneumococcal infections and deaths are potentially preventable through pneumococcal vaccination. The highest mortality from pneumococcal disease occurs among the elderly and patients who have underlying medical conditions.

Readmission Rates

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commision
Technical Specifications: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Administrative clinical data, Medicare fee-for-service patients 65 years and older.

These rates include patients readmitted to a hospital within 30 days of discharge from a previous hospital stay for heart attack, heart failure, or pneumonia. Readmissions rates reflect three years' worth of data. The site also includes a composite measure as calculated by IPRO: average Medicare hospital 30-day readmission rates for heart failure, heart attack, and pneumonia.

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Mortality Rates

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Joint Commission
Technical Specifications: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1141662756099
Data Collection: Administrative clinical data, Medicare fee-for-service patients 65 years and older.

These rates take into account deaths within 30 days from all causes after an initial hospitalization with a principal diagnosis of heart attack, heart failure, or pneumonia. Mortality rates displayed on this site reflect three years' worth of data. The site also includes a composite measure as calculated by IPRO: average Medicare hospital 30-day mortality rates for heart failure, heart attack, and pneumonia.

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Reimbursement Rates

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: https://www.cms.gov/HospitalQualityInits/32_MedicarePaymentAndVolume.asp
Data Collection: Claims/payment data, Medicare patients, acute care hospitals only.

Spending per Hospital Patient with Medicare:

This measure shows whether Medicare spends more, less or about the same per Medicare patient treated in a specific hospital, compared to how much Medicare spends per patient nationally. This measure includes any Medicare Part A and Part B payments made for services provided to a patient during the 3 days prior to the hospital stay, during the stay, and during the 30 days after discharge from the hospital.

Note: A value of 1 means that Medicare spends about the same amount per patient for an episode of care initiated at this hospital as it does per hospital patient nationally. A value >1 indicates that Medicare spends more per patient and a value <1 means that Medicare spends less per patient for an episode of care initiated at this hospital than it spends per hospital patient nationally. So, for example, a value of 1.50 indicates that Medicare spends 50% more per patient at this hospital compared to what it spends per patient nationally and a value of 0.70 indicates that Medicare spends 30% less per patient at this hospital compared to national spending.

Median Medicare reimbursement rates for patients whose primary diagnosis was: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, or diabetes. Rates are also reported for patients undergoing: cardiac pacemaker implants, hernia procedures, laparoscopic cholecystectomy, or major joint replacement. Medicare payments for the same diagnosis-related group may vary. According to CMS, a hospital may get a higher payment for any or all of the following reasons:

It is classified as a teaching hospital
It treats a high percentage of low-income patients (disproportionate share)
It may treat unusually expensive cases (outlier payments)
It pays its employees more compared to the national average because the hospital is in a high-cost area (wage index). Note: The hospital's wage index is calculated using the hospital's payroll records, contracts and other wage related documentation.

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Health Care–Associated Infections

(Central Line Associated Bloodstream Infections)
Data Source(s): Centers for Medicare & Medicaid Services (CMS)/Centers for Disease Control (CDC)/National Healthcare Safety network (NHSN)
Measure Author(s): Centers for Disease Control (CDC)/National Healthcare Safety network (NHSN)
Technical Specifications: http://www.cdc.gov/HAI/pdfs/stateplans/id.pdf, http://www.cdc.gov/nhsn/PDFs/Newsletters/NHSN_NL_OCT_2010SE_final.pdf
Data Collection: Medical record, all ICU patients (including pediatric), all-payer.

WhyNotTheBest.org includes data on the incidence of central line-associated bloodstream infections (CLABSIs), a type of infection introduced when a central-line catheter or tube is placed in a large vein in the neck, chest, or arm to enable the rapid administration of fluids, blood, or medications to critically ill patients. CLABSIs can be prevented through proper insertion and care of the central line.

The data come from all 50 states, including data from 3,780 hospitals.

To locate hospitals reporting CLABSI data, search via hospitals' Location/Characteristics using the "Hospitals Reporting…" filter, choosing the "Health Care-Associated Infections" option.

The risk of infection varies across different types of intensive care units (ICUs). Therefore, the CLABSI data are reported as standardized infection ratios (SIRs), a measure developed by the Centers for Disease Control and Prevention to summarize comparisons of data from an individual ICU to national infection rates for that particular type of ICU.

This analysis adjusts for the fact that the data come from varying ICU mixes, requiring comparisons to different average infection rates. For instance, the average infection rate for cardiac ICUs nationwide is two per 1,000 central line days, so a particular cardiac ICU with a rate of three infections per 1,000 days has 50 percent more infections than average. For surgical ICUs, the national average rate is 2.3 infections per 1,000 central line days, so a surgical ICU reporting a rate of 4.6 infections per 1,000 central line days has 100 percent more infections than average. The SIR pools these comparisons across all ICUs for which a hospital reports CLABSI data.

Thus a SIR = 1 means that the hospital's ICUs produced CLABSIs at the same rate overall as would be predicted from national rates for the particular mix of ICUs for which that hospital reported data.A SIR > 1 indicates the hospital had more infections than predicted from national rates, and a SIR < 1 implies it had fewer infections than predicted. So, for example, a hospital with a SIR of 1.50 reported 50 percent more infections than would be predicted from national rates, and one with a SIR of 0.70 reported 30 percent fewer infections than national rates for its mix of ICUs.

We publish reported infections for all hospitals that meet either of the following sample size requirements:

At least 1,000 central line days (CLDs) OR
At least three infections, regardless of the number of central line days. A hospital that reports three or more infections, even in fewer than 1,000 CLDs, could not achieve better than a rate of three infections/1,000 CLDs; this is 50 percent higher than the national infection rate for medical ICUs.

In summary, the Standardized Infection Ratio is calculated as follows:

For each reporting ICU, multiply the number of central line days by the published national infection rate for the ICU type, divided by 1,000, to estimate the number of infections predicted for that ICU if it were to report CLABSIs at the same frequency as the national rate (CLD x national rate / 1,000).
Within each hospital, calculate the sum of predicted infections and the sum of reported infections across all reporting ICUs.
Calculate SIR = (total reported infections/total predicted infections). For CLABSI data, a SIR of 1.0 indicates that a hospital is performing just as would be predicted from national rates.

Data Limitations: Most hospitals that track the incidence of central line-associated bloodstream infections in their intensive care units (ICUs) rely on infection preventionists to manually identify such infections. Based on definitions from the Centers for Disease Control and Prevention, these individuals use objective criteria, such as positive blood culture, as well as subjective criteria, such as determining whether recovery of a common skin commensal in the blood represents a true infection vs. a contamination, to identify bloodstream infections. Recently, a computer algorithm has been developed for identifying bloodstream infections through objective criteria only; the algorithm thus provides an objective standard against which to benchmark infection preventionists' determination of infection rates.

A study published in the Journal of the American Medical Association compared rates of infections identified by infection preventionists at 20 ICUs in four medical centers with those found at the same ICUs through the computer algorithm. The researchers found significant differences between infection rates identified by the two different methods—suggesting that surveillance methods may vary across hospitals due to varying application of standard definitions of bloodstream infections. The researchers say their findings raise concerns about the validity of comparisons across medical institutions and call for surveillance measures that are as reliable and objective as possible.

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Health Information Technology (HIT)

AHA HIT Measures

Data Source(s): American Hospital Association's electronic health record adoption database
Measure Author(s): American Hospital Association, The Commonwealth Fund
Technical Specifications: http://www.ahadata.com/ahadata/files/2011/hospitalehradoptionsurvey2011questionnaire.pdf
Data Collection: Annual Survey of hospitals

The site includes three measures assessing the use of health information technology (HIT): 1) Hospital electronic medical record (EMR) adoption indicates whether a hospital has adopted a basic or comprehensive EMR; 2) Percent of admissions within the region taking place at hospitals with at least a Basic EMR and 3) Percent of admissions within the region taking place at hospitals with a Comprehensive EMR. The data come from the American Hospital Association's electronic health record adoption database, which provides information on indicators that illustrate the depth and level of technology integration within hospitals.

To be qualified as a comprehensive electronic medical record system, the system must: 1) record patients' clinical and demographic data, 2) enable users to view and manage results of laboratory tests and imaging, 3) enable users to manage order entry (including electronic prescriptions), and 4) support clinical decision-making (including warning about drug interactions or contraindications). The principal differences between a comprehensive EMR system and a basic EMR system are the absence of certain order-entry capabilities and clinical decision support in a basic system.

CMS HIT Measures

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS
Technical Specifications: http://www.qualitynet.org/dcs/ContentServer?cid=1196289981244&pagename=QnetPublic%2FPage%2FQnetTier2&c=Page
Data Collection: Self-reported by hospitals

These measures assess how outpatient hospital departments (such as emergency, imaging, surgery, and clinics) use electronic health records.

The first measure (Able to receive lab results electronically) assesses whether a facility has the ability to receive electronic laboratory data directly into a certified electronic health record and whether the facility actually uses this feature. Facilities answer the following questions:

Does/did your facility have the ability to receive laboratory data electronically directly into your ONC certified EHR system as discrete searchable data? (Yes/No)
Did your facility use this feature during the performance period? (Yes/No)

The second measure (Tracking clinical results between visits) assesses whether a facility tracks results of laboratory tests, diagnostic tests (like screenings), or patient referrals using a certified electronic health record. This measure applies to all outpatient departments associated with the facility that bill under the Outpatient Prospective Payment System (OPPS). This may include the emergency department (ED), the outpatient imaging department, the outpatient surgery department, and the facility’s clinics.

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Inpatient Quality Indicators, Patient Safety Indicators, Prevention Quality Indicators

Data Sources: Individual contributing state departments of health and hospital associations.
Measure Authors: Agency for Healthcare Research and Quality (AHRQ)
Technical Specifications: http://www.qualityindicators.ahrq.gov/
Data Collection: Administrative clinical data, uniform billing data, all patients, all payers.

The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data.
On WhyNotTheBest.org, we report on a subset of the Inpatient Quality Indicators (IQIs), Patient Safety Indicators (PSIs), and Prevention Quality Indicators (PQIs).

Currently, we have data from hospitals in 16 states: Arizona, California, Florida, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Nevada, Oklahoma, Rhode Island, Texas, Vermont, Virginia, and Washington. Additionally, we have data for PQIs in 900 counties within the 16 states listed above.

Note: In January 2013, all data for AHRQ measures were re-analyzed using the newest version of MONAHRQ for the 16 states listed above. This refresh included data for time periods that were previously published on this site.

The Commonwealth Fund's publication of the AHRQ Quality Indicators means that--for the first time--performance data from multiple states can be compared side by side.

While most data on the website are collected nationally under strict standards, data for the AHRQ measures are collected by the states and are therefore subject to minor variations in the method and manner of collection, validation, and reporting. Users are cautioned that comparing facilities across state lines may be less accurate than similar comparisons using federal data. All quality measures go through periods of development, refinement, and standardization, and we expect the consistency of these measures to improve over time.

The Inpatient Quality Indicators (IQIs) are a set of measures that reflect quality of care inside hospitals; they include mortality rates, utilization rates, and volume. We report ten IQIs on WhyNotTheBest.org because they are either endorsed by the National Quality Forum or related to conditions reported in other data sets included here (i.e., acute myocardial infarction, heart failure, and pneumonia).

The ten IQIs are:

Mortality for Selected Procedures Composite -- IQI 90 - The IQI 90 composite score combines hospital mortality information for eight major surgeries - esophageal resection (IQI 08), pancreatic resection (IQI 09), abdominal aortic aneurism repair (IQI 11), coronary artery bypass graft (IQI 12), craniotomy (IQI 13), hip replacement (IQI 14), percutaneous coronary intervention (IQI 30), and carotid endarterectomy (IQI 31). The composite score is the weighted average of the scaled and reliability-adjusted ratios of the eight component indicators with an expected score of 1. A score <1 indicates that the hospital had fewer deaths following these surgeries than other hospitals with a similar case mix. A score >1 indicates the hospital had more deaths following these surgeries than other hospitals with a similar case mix.
Mortality for Selected Conditions Composite -- IQI 91 - The IQI 91 composite score combines hospital mortality information for six common conditions - acute myocardial infarction (IQI 15), heart failure (IQI 16), acute stroke (IQI 17), gastrointestinal hemorrhage (IQI 18), hip fracture (IQI 19), and preumonia (IQI 20). The composite score is the weighted average of the scaled and reliability-adjusted ratios of the six component indicators with an expected score of 1. A score <1 indicates that the hospital had fewer deaths following these conditions than other hospitals with a similar case mix. A score >1 indicates the hospital had more deaths following these conditions than other hospitals with a similar case mix.
Risk-adjusted Mortality Rates for Medical Conditions -- Congestive heart failure IQI 16 - This measure is used to assess the number of deaths per 100 discharges with principal diagnosis code of congestive heart failure (CHF).
Risk-adjusted Mortality Rates for Medical Conditions -- Stroke IQI 17 - This measure is used to assess the number of deaths per 100 discharges with principal diagnosis code of stroke.
Risk-adjusted Mortality Rates for Medical Conditions -- Hip fracture IQI 19 - This measure is used to assess the number of deaths per 100 discharges with principal diagnosis code of hip fracture.
Risk-adjusted Mortality Rates for Medical Conditions,--Pneumonia IQI 20 - This measure is used to assess mortality per 100 discharges with principal diagnosis code of pneumonia.
Risk-adjusted Mortality Rates for Medical Conditions -- Acute myocardial infarction (AMI) IQI 15 -- This measure is used to assess the number of deaths per 100 discharges with the principle diagnosis of heart attack (acute myocardial infarction).
Coronary artery bypass graft (CABG) - area rate IQI 26 (STATE and COUNTY ONLY) - This measure is used to assess the number of coronary artery bypass grafts (CABGs) per 100,000 population.
Percutaneous transluminal coronary angioplasty -(PTCA) - area rate IQI 27 (STATE and COUNTY ONLY) - This measure is used to assess the number of percutaneous transluminal coronary angioplasty (PTCA) procedures per 100,000 population.
Hysterectomy - area rate IQI 28 (STATE and COUNTY ONLY) -- This measure is used to assess the number of hysterectomies per 100,000 female population.

The IQIs include seven measures of mortality rates, which have been shown to vary across institutions and there is evidence that high mortality may be associated with worse quality of care. WhyNotTheBest.org thus includes two different types of mortality data from two different sources.

CMS Hospital Compare -- CMS mortality rates are 30-day, all-cause mortalities among patients hospitalized with a principal diagnosis of heart attack, heart failure, and pneumonia. All-cause mortality is defined as death from any cause within 30 days after the admission date, regardless of whether the patient dies while still in the hospital or after discharge. It measures deaths that occur within 30 days of a hospital admission, rather than inpatient mortality only, or mortality over some other post-discharge period. The CMS mortality rates measure deaths among Medicare patients only.
AHRQ Inpatient Quality Indicators -- AHRQ defines mortality as in-hospital mortality following procedures for common medical conditions. It measures mortality among all patients -- not just those in Medicare.

The Patient Safety Indicators reflect quality of care inside hospitals, but focus on potentially avoidable complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses. On this site we report the following PSIs:

Patient Safety for Selected Procedures Composite -- PSI 90 - The PSI 90 composite score combines information for eight common patient safety problems in the hospital - pressure ulcer (PSI 03), iatrogenic pneumothorax (PSI 06), infection due to medical care (PSI 07), postoperative hip fracture (PSI 08), postoperative pulmonary embolism or deep vein thrombosis (PSI 12), postoperative sepsis (PSI 13), postoperative wound dehiscence (PSI 14), and accidental puncture or laceration (PSI 15). The composite score is the weighted average of the scaled and reliability-adjusted ratios of the eight component indicators with an expected score of 1. A score <1 indicates that the hospital had fewer selected patient safety events than other hospitals with a similar case mix. A score >1 indicates the hospital had more selected patient safety events than other hospitals with a similar case mix.
Risk-adjusted Failure to Rescue PSI 4 -- This measure is used to assess the number of deaths per 1,000 patients having developed specified complications of care during hospitalization.
Risk-adjusted Postoperative pulmonary embolism or deep vein thrombosis PSI 12 -- This measure is used to assess the number of cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) per 1,000 surgical discharges with an operating room procedure.
Risk-adjusted Decubitus ulcer PSI 3 -- This measure is used to assess the number of cases of decubitus ulcer per 1,000 discharges with a length of stay greater than 4 days.
Risk-adjusted Selected Infections Due to Medical Care PSI 7 -- This measure is used to assess the number of cases of infections per 1,000 discharges. The Central Venous Catheter-related Blood Stream Infections indicator is intended to flag cases of infection due to medical care, primarily those related to intravenous (IV) lines and catheters.
Risk-adjusted Postoperative hip fracture PSI 8 -- This measure is used to assess the number of cases of in-hospital hip fracture surgical discharges with an operating room procedure, per 1,000 discharges.
Risk-adjusted Postoperative Sepsis PSI 13 -- This measure is used to assess the number of cases of sepsis per 1,000 elective surgery patients with an operating room procedure and a length of stay of 4 days or more.
Transfusion reaction PSI 16 -- This measure is used to assess the number of cases of transfusion reaction either from incompatible or mismatched blood.
Foreign body left during procedure - area rate PSI 21 (STATE and COUNTY ONLY) -- This measure is used to assess the number of discharges with foreign body accidentally left in during procedure per 100,000 population.
Iatrogenic pneumothorax - area rate PSI 22 (STATE and COUNTY ONLY) -- This measure is used to assess the number of cases of iatrogenic pneumothorax per 100,000 population.
Selected infections due to medical care - area rate PSI 23 (STATE and COUNTY ONLY) -- This measure is used to assess the number of cases of infections per 100,000 population. The Central Venous Catheter-related Blood Stream Infections indicator is intended to flag cases of infection due to medical care, primarily those related to intravenous (IV) lines and catheters.
Accidental puncture or laceration - area rate PSI 25 (STATE and COUNTY ONLY) -- This measure is used to assess the number of cases of technical difficulty (e.g., accidental cut or laceration during procedure) per 100,000 population.
Transfusion reaction - area rate PSI 26 (STATE and COUNTY ONLY) -- The Transfusion Reaction indicator is intended to flag cases of major reactions due to transfusions (ABO and Rh). This indicator is defined both on a provider level (by including cases based on secondary diagnosis associated with the same hospitalization) and on an area level (by including all cases of transfusion reactions). This measure reflects the number of cases of transfusion reaction per 100,000 population.
Postoperative hemorrhage or hematoma requiring a procedure - area rate PSI 27 (STATE and COUNTY ONLY) -- This measure is used to assess the number of cases of hematoma or hemorrhage requiring a procedure per 100,000 population.

The Prevention Quality Indicators (PQIs) measure hospital admissions that might have been avoided with better medical care outside of the hospital. The PQIs are based on the county where patients live, and presumably receive their primary outpatient care, not on where hospitals are located. PQIs provide a good starting point for assessing the quality of health services in the community. We report the following state and county-level PQIs (STATE and COUNTY ONLY):

Overall Preventive Care (PQI 90) -- AHRQ collects various measures related to preventive quality improvement. This measure is a weighted average of those measures collected by AHRQ. Only hospitals that saw 30 or more patients are included. The composite measure takes into account nearly all PQIs, including: PQI 1 - Diabetes Short-Term Complications Admission Rate; PQI 3 - Diabetes Long-Term Complications Admission Rate; PQI 5 - Chronic Obstructive Pulmonary Disease Admission Rate; PQI 7 - Hypertension Admission Rate; PQI 8 - Congestive Heart Failure Admission Rate; PQI 10 - Dehydration Admission Rate; PQI 11 - Bacterial Pneumonia Admission Rate; PQI 12 - Urinary Tract Infection Admission Rate; PQI 13 - Angina Without Procedure Admission Rate; PQI 14 - Uncontrolled Diabetes Admission Rate; PQI 15 - Asthma Admission Rate; and PQI 16 - Rate of Lower-Extremity Amputation Among Patients with Diabetes. This is the number of hospitalizations per 100,000 population.
Overall Acute Preventive Care (PQI 91) -- AHRQ collects various measures related to preventive quality improvement of acute conditions. This measure is a weighted average of those measures collected by AHRQ. Only hospitals that saw 30 or more patients are included. The composite measure takes into account: PQI 10 - Dehydration Admission Rate; PQI 11 - Bacterial Pneumonia Admission Rate; and PQI 12 - Urinary Tract Infection Admission Rate. This is the number of hospitalizations per 100,000 population.
Overall Chronic Preventive Care (PQI 92) -- AHRQ collects various measures related to preventive quality improvement of chronic conditions. This measure is a weighted average of those measures collected by AHRQ. Only hospitals that saw 30 or more patients are included. The composite measure takes into account: PQI 1 - Diabetes Short-Term Complications Admission Rate; PQI 3 - Diabetes Long-Term Complications Admission Rate; PQI 5 - Chronic Obstructive Pulmonary Disease Admission Rate; PQI 7 - Hypertension Admission Rate; PQI 8 - Congestive Heart Failure Admission Rate; PQI 13 - Angina Without Procedure Admission Rate; PQI 14 - Uncontrolled Diabetes Admission Rate; PQI 15 - Asthma Admission Rate; and PQI 16 - Rate of Lower-Extremity Amputation Among Patients with Diabetes. This is the number of hospitalizations per 100,000 population.
Perforated Appendix (PQI 2) -- This measure is used to assess the number of admissions for perforated appendix per 100 admissions for appendicitis within a county. As a Prevention Quality Indicator (PQI), admission for perforated appendix is not a measure of hospital quality, but rather one measure of outpatient and other health care.
Hypertension Admissions (PQI 7) -- This measure is used to assess the number of admissions for hypertension per 100,000 population. As a Prevention Quality Indicator (PQI), hypertension is not a measure of hospital quality, but rather one measure of outpatient and other health care. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting.
Uncontrolled Diabetes Admissions (PQI 14) -- This measure is used to assess the number of admissions for uncontrolled diabetes per 100,000 population.As a Prevention Quality Indicator (PQI), uncontrolled diabetes is not a measure of hospital quality, but rather one measure of outpatient and other health care. Rates of diabetes may vary systematically by area, creating bias for this indicator.
Adult Asthma Admissions (PQI 15) This measure is used to assess the number of admissions for asthma in adults per 100,000 population. As a Prevention Quality Indicator (PQI), adult asthma is not a measure of hospital quality, but rather one measure of outpatient and other health care. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Admission rates that are drastically below or above the average or recommended rates should be further examined.
Dehydration Admissions (PQI 10) --This measure is used to assess the number of admissions for dehydration per 100,000 population. As a Prevention Quality Indicator (PQI), dehydration is not a measure of hospital quality, but rather one of the measures of outpatient and other health care.
This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Some dehydration care takes place in emergency rooms. As such, combining inpatient and emergency room data may give a more accurate picture of this indicator.
Bacterial Pneumonia Admissions (PQI 11) --This measure is used to assess the number of admissions for bacterial pneumonia per 100,000 population. As a Prevention Quality Indicator (PQI), admission for bacterial pneumonia is not a measure of hospital quality, but rather one measure of outpatient and other health care. This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Because some pneumonia care takes place in an emergency room setting, combining inpatient and emergency room data may give a more accurate picture of this indicator.
Urinary Tract Infection Admissions (PQI 12) --This measure is used to assess the number of admissions for urinary tract infection per 100,000 population. As a Prevention Quality Indicator (PQI), admission for urinary tract infection is not a measure of hospital quality, but rather one measure of outpatient and other health care. This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Some urinary tract infection care takes place in emergency rooms. As such, combining inpatient and emergency room data may give a more accurate picture of this indicator.
Angina Admissions (PQI 13) --This measure is used to assess the number of admissions for angina (without procedures) per 100,000 population.
As a Prevention Quality Indicator (PQI), angina without procedure is not a measure of hospital quality, but rather one measure of outpatient and other health care. This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality of care by shifting care to an outpatient setting. Some angina care takes place in emergency rooms. Combining inpatient and emergency room data may give a more accurate picture.
Lower Extremity Amputations (PQI 16) --This measure is used to assess the number of admissions for lower-extremity amputation among patients with diabetes per 100,000 population. As a Prevention Quality Indicator (PQI), lower-extremity amputations among patients with diabetes is not a measure of hospital quality, but rather one measure of outpatient and other health care. PQIs are correlated with each other and may be used in conjunction as an overall examination of outpatient care.
Diabetes Short-term Complications Admissions (PQI 1) --This measure is used to assess the number of admissions for diabetes short-term complications per 100,000 population. As a Prevention Quality Indicator (PQI), short-term diabetes complication rate is not a measure of hospital quality, but rather one measure of outpatient and other health care. Rates of diabetes may vary systematically by area, creating bias for this indicator. Examination of both inpatient and outpatient data may provide a more complete picture of diabetes care.
Congestive Heart Failure Admissions (PQI 8) --This measure is used to assess the number of admissions for congestive heart failure (CHF) per 100,000 population. As a Prevention Quality Indicator (PQI), CHF is not a measure of hospital quality, but rather one measure of outpatient and other health care. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Some CHF care takes place in emergency rooms. As such, combining inpatient and emergency room data may give a more accurate picture of this indicator.
Diabetes Long-term Complications Admissions (PQI 3) --This measure is used to assess the number of admissions for diabetic long-term complications per 100,000 population. As a Prevention Quality Indicator (PQI), diabetes long-term complication rate is not a measure of hospital quality, but rather one measure of outpatient and other health care. Rates of diabetes may vary systematically by area, creating bias for this indicator. Examination of both inpatient and outpatient data may provide a more complete picture of diabetes care.
Chronic Obstructive Pulmonary Disease Admissions (PQI 5)--This measure is used to assess the number of admissions for chronic obstructive pulmonary disease (COPD) per 100,000 population. As a Prevention Quality Indicator (PQI), COPD is not a measure of hospital quality, but rather one measure of outpatient and other health care. This indicator has unclear construct validity, because it has not been validated except as part of a set of indicators. Providers may reduce admission rates without actually improving quality by shifting care to an outpatient setting. Some COPD care takes place in emergency rooms, so combining inpatient and emergency room data may give a more accurate picture.

All of the AHRQ Quality Indicators are calculated using the AHRQ Version 4.2 software that generates observed rates, expected rates, risk-adjusted rates, and lower and upper 95 percent confidence limits for risk-adjusted rates. Observed rates are the raw rates. Expected rates are the rates the hospital would have if it performed the same as the reference population given the hospital's actual case mix (e.g., age, gender, modified DRG and comorbidities). Risk-adjusted and expected rates are derived from applying the average case mix of a baseline file that reflects a large proportion of the U.S. hospitalized or residential population. Tthe PQIs were calculated as hospitalizations per 100,000 persons for the entire dataset and by county. The three composites were constructed by summing the hospitalizations across the component conditions and dividing by the population.

Read more: http://www.qualityindicators.ahrq.gov/.
Interpretation:

Around each measure’s rate we calculate the 95 percent confidence interval, which takes the denominator into account. A rate with a small denominator would yield a very wide confidence interval, and a large denominator would yield a smaller confidence interval. If the statewide rate falls within the hospital’s confidence interval then there is no statistically significant difference between the hospital and the statewide rate. If the statewide rate falls outside of the hospital’s confidence interval then there is a statistically significant difference. For measures where a higher rate is desirable and the hospital's confidence intervals are above the statewide rate, then the hospital is reported as performing better than the state. Conversely, for measures where a lower rate is desirable and the hospital's confidence intervals falls below the statewide rate, then the hospital is reported as performing better than the state.

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Population Health and Utilization & Costs (State and HRR Only)

Data Source(s): Centers for Medicare & Medicaid Services (CMS)
Measure Author(s): CMS, Institute of Medicine
Technical Specifications
Data Collection: Medicare fee-for-service patients 65 years and older

The site includes the following measures of population health:

Average Hierarchical Condition Category (HCC) risk score expressed as a Ratio to the National Average (see definition below);
Percent of Medicare beneficiaries with Diabetes; and
Percent of Medicare beneficiaries with Heart Failure.

It also includes the following measures of utilization and costs:

Standardized Risk-Adjusted Per Capita Costs -- total annual Medicare payments per beneficiary standardized to remove geographic differences in payment rates for individual services and adjusted for differences in beneficiaries’ health using the risk-adjusted model that CMS uses to pay Medicare Advantage plans;
Inpatient Days Per 1000 Beneficiaries -- annual number of hospital inpatient days covered by Medicare per 1,000 Medicare beneficiaries in the geographic area, including inpatient acute care hospitals paid under the Prospective Payment System (PPS), critical access hospitals, and other inpatient hospitals as inpatient psychiatric facilities and cancer hospitals;
Imaging (IMG) standardized per user Medicare costs -- total annual Medicare payments for imaging services per Medicare beneficiary in the geographic area who used imaging services during the year, standardized to remove geographic differences in payment rates for imaging services;
Lab Tests service events per 1000 Medicare beneficiaries -- annual number of lab tests per 1,000 Medicare beneficiaries in the geographic area; and
Emergency Department Visits per 1000 Beneficiaries -- annual number of hospital emergency department visits (including both visits that result in an admission and visits that do not result in an admission) per 1,000 Medicare beneficiaries in the geographic area.

These measures are reported at the HRR level, and for Medicare patients only. They are drawn from the Institute of Medicine's datasets on geographic variation.
The Hierarchical Condition Category (HCC) risk score model is used by CMS to adjust capitation payments to private health care plans for the health expenditure risk of their enrollees. The model measures disease burden, taking into account HCC categories, which are correlated to diagnosis codes. The following explanation comes from the Institute of Medicine (IoM) site:

CMS developed a risk-adjustment model that uses HCCs (Hierarchical Condition Categories) to assign risk scores. Those scores estimate how beneficiaries’ FFS spending will compare to the overall average for the entire Medicare population. The risk score for the overall average is set at 1.0; beneficiaries with scores greater than that are expected to have above-average spending, and vice versa. Risk scores are based on a beneficiary’s age and sex; whether the beneficiary is eligible for Medicaid, first qualified for Medicare on the basis of disability, or lives in an institution (usually a nursing home); and the beneficiary’s diagnoses from the previous year. To facilitate comparisons of risk scores between an HRR or state and the average for the study population, we normalized an area’s HCC score to the average for the study population. Given that the average HCC score for the study population is 1.15, this resulted in a decrease in the HCC score for all geographic regions. CMS uses HCCs to determine the diagnosis-related portion of the risk score. The HCC system for 2008 includes a total of 189 conditions, with related conditions grouped into 70 disease hierarchies. For example, one hierarchy has three different diseases that affect the liver: end-stage liver disease, cirrhosis, and chronic hepatitis. Each condition has a weight that reflects its marginal contribution to a beneficiary’s total expected Medicare costs. Under the HCC system, CMS calculates the diagnosis-related portion of a beneficiary’s risk score by adding up the weights for the most severe diagnosis that the beneficiary has in each disease hierarchy. Continuing the example above, a beneficiary with both cirrhosis (weight = 0.519) and acute hepatitis (weight = 0.303) would receive credit only for the cirrhosis diagnosis.

The researchers who developed the HCC system adopted this approach after finding that having multiple conditions within a hierarchy did not increase overall patient spending substantially. We used total risk scores to adjust spending data at the HRR and state level.

By standardizing payment amounts and adjusting for differences in beneficiaries’ health status, these data provide a more accurate picture of how resource use varies for Medicare beneficiaries across the country.

Read More: IoM website.

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Data Not Available

Note that not all hospitals report data for all measures; the site only publishes data when there are at least four quarters' worth of data available for a particular measure. Not all hospitals report all data for all measures.

There is never data available in certain cases:

There are no state averages for readmissions and CMS mortality measures.
There are no top 1 percent, top 5 percent, top 10 percent or top 25 percent benchmark data for reimbursement rates.
There are no top 25 percent benchmark data for mortality rates and readmission rates
There are no benchmark data for HCAHPS ratings of 7 or 8. There are also no benchmark data for HCAHPS rating 6 or lower (except for state and national averages).
There is no national average for CLABSIs.
There are no national benchmark data for the AHRQ Inpatient Quality Indicators and Patient Safety Indicators.

In some cases, data is not reported by a facility or is not calculated for a benchmark. In other cases, data is reported but does not meet the minimum criteria for inclusion. In the latter case, N/A will be accompanied by a footnote.

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Compare Performance by Groups and Regions

WhyNotTheBest.org allows users to explore data by hospital characteristics and regions of the U.S.

Compare by Groups

Users can compare hospitals by characteristics such as size, ownership, health system membership, and type—for example, comparing performance of all hospitals in health systems to those not belonging to health systems, or comparing all safety net hospitals to all for-profit hospitals.

Users also can follow the map links from group reports to examine the geographic distribution of U.S. hospitals by various characteristics.

Compare by Regions

Compare by Regions reports enable users to explore aggregated hospital performance by region (i.e., rolled up measurements from all the hospitals within a region) or population health in communities around the nation (i.e., indicators of population health and utilization/costs from the Institute of Medicine). For example, users can select a group of counties or HRRs, and then add in benchmarks from the relevant states as well as the national average.

WhyNotTheBest.org includes regional data for the nation, states, counties, and hospital referral regions (HRRs). Please note: not all measures are available for both county and HRR aggregation.

Users can follow the map links from regional reports to explore regional performance on an interactive map.

Top Performers

For each measure included on the site (excluding reimbursement rates, CLABSI data, and AHRQ IQIS and PSIs), the site identifies the top 1 percent of performers—the “top performers.” It also includes other benchmarks: the top 5 percent, top 10 percent and the top 25 percent, as well as top performers by hospital type (e.g., safety net, teaching, etc.).

Top Performers on Process-of-Care Measures

To appear among the top performers on the CMS process-of-care measures, a hospital must have reported data for every available measure and recorded data on 30 or more patients for each of the four conditions (heart failure, heart attack, pneumonia, and surgical care improvement).

No explicit weighting was incorporated, but higher-occurring cases give weight to that measure in the average. Since these are process measures (versus outcome measures), no risk adjustment was applied.

Top Performers on HCAHPS

To appear among the top performers on the HCAHPS data, hospitals are ranked according to the percentage of survey respondents giving a 9 or 10 rating of overall hospital care. The site uses the results of the following question as a measure of patients' overall experiences:

"Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?"

Note that the site does not apply exclusion criteria to create these performance rankings. All hospitals are included in the calculation of the percentile scores.

Benchmarks

For the purposes of calculating benchmarks, we identified hospitals in the following way:

Safety Net Hospitals: membership in the National Association of Public Hospitals and Health Systems and/or serving 30 percent or more Medicaid patients
Rural Hospitals: Hospitals designated by CMS as Critical Access Hospitals
Teaching Hospitals: membership in the Council of Teaching Hospitals and Health Systems
Academic Health Centers: membership in the Association of American Medical Colleges
For-Profit: based on ownership, from the American Hospital Association database
Not-for-Profit/Private: based on ownership, from the American Hospital Association database
Government – Non-Federal: based on ownership, from the American Hospital Association database
Government – Federal: based on ownership, from the American Hospital Association database
Health Systems: based on system classification from the American Hospital Association database

A system is defined by AHA as either a multihospital or a diversified single hospital system. A multihospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital preacute or postacute health care organizations. System affiliation does not preclude network participation. Read more about health systems.

Note that these multi-hospital systems are often horizontally integrated collections of hospitals—as opposed to integrated delivery systems, which WhyNotTheBest.org defines as a system with two or more facilities, including one non-hospital (e.g., a nursing home). The integrated delivery systems identified on the WhyNotTheBest.org map are drawn from an SDI list of high-performing systems; for more information please see the SDI website.

Top 1 percent, Top 5 percent, Top 10 percent, Top 25 percent: Top n percent is the lowest score achieved by a hospital in the top n percent (i.e. the minimum threshold to be in the top n percent).

Benchmark calculations are based on hospitals that meet the eligibility criteria for high perfomer status, which is: a hospital must have reported data for every available measure and recorded data on 30 or more patients for each of the four conditions (heart failure, heart attack, pneumonia, and surgical care improvement).

To review notes on how scores on this site may vary from scores on public reports, or for more details on how we aggregate scores read about Comparative Reporting.

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Interactive Map

The WhyNotTheBest.org interactive map shows performance variation on the national, state, county, and hospital referral region (HRR) levels. It also includes overlays tracking quality improvement activity and displaying health care performance recognitions in various ways, as described below.

The map includes health care performance measures, in the following categories:

Process-of-care;
Patient experience;
Health Information Technology adoption;
Population Health
Utilization and Costs;
Readmission rates;
Mortality rates
Inpatient Quality Indicators;
Patient Safety Indicators; and
Prevention Quality Indicators.

For the measures from CMS Hospital Compare, the hospital performance values were adjusted by the denominator so that hospitals with higher reported numbers of observations carried a greater weight toward the regional rate. Weighting was also used to address hospitals that share identifiers. CMS Hospital Compare provides data at the level of Medicare Provider Numbers (MPNs). For the map, hospitals sharing MPNs were weighted so as to not overcount their data. This also allowed hospitals to contribute to the regional rate, regardless of whether their shared MPNs crossed counties. The HCAHPS measures of patient experience are an exception. As denominators are not provided for these data, we instead calculate an unweighted average. Starting in 2012, HCAHPS values are weighted by the total admissions to the hospitals. Note: for some regions there are no data displayed, since there are no hospitals located in that region.

CMS periodically retires measures, which are referred to on WhyNotTheBest.org as "legacy" measures. While legacy measures are included in the tabular reports, they do not appear on the map.

Overlays

The interactive map also includes overlays that let users explore the following:

Hospital Types - Identifies hospitals with selected characteristics. These include: Joint Commission accreditation; American College of Surgeons approved Cancer Program; Residency Training approved by ACGME; Medical School affiliation; National League of Nursing nursing school; Commission on Accreditation of Rehabilitation Facilities accreditation; membership in Council of Teaching Hospitals; Blue Cross contracting or participating; Medicare certification; American Osteopathic Association accreditation; Catholic Church operated; and membership in the Federation of American Health Care Systems. We derive all of the above designations from the American Hospital Association database. We also display hospitals that have the following characteristics: Academic Medical Center; Safety Net Hospital; membership in the National Assoiation of Public Hospitals. For more information on these characteristics, read about the benchmarks.

The hospital type overlay shows the number of hospitals matching the selected criteria in a given area. The squares are placed at the state / county / geographic center and are sized and numbered according to the number of hospitals they represent.

Physician Recognitions - demonstrates the distribution of physicians who have been recognized for providing high-quality care by the National Committee for Quality Assurance and/or Bridges To Excellence recognition programs, based on medical record data. Although these recognitions are awarded at various levels, the map overlay conflates all recognitions into a single layer. Choosing a specialty will display the number of physicians in the selected specialty who have achieved any recognition from these two organizations.

The physician recognition overaly shows the number of physicians matching the selected criteria in a given area. The circles are placed at the state / county / geographic center and are sized and numbered according to the number of physicians they represent.

The Medical Home layer displays the number of medical home recognitions that are present in a given area.

Accountable Care Organizations – shows the location of the 32 Pioneer accountable care organizations (ACOs) as well as the Medicare Shared Savings Program accountable care organizations (there were 219 as of March 2013). Mousing over the hexagons that display the numbers of ACOs in a particular region brings up a list of the ACOs, links to their websites, and the estimated numbers of participating physicians and members, when available. The locations shown on the overlay are generated by the maling address of each ACO.

Beacon Communities – shows the location, name, and website of the 17 regions receiving funds from the HHS Office of the National Coordinator for Health IT to strengthen their health IT infrastructure and thereby improve health and control costs. The locations shown on the overlay are generated by combining counties included in their service area, as of November 2012.

Integrated Delivery Systems – shows the location of the integrated delivery systems around the nation as of November 2011. WhyNotTheBest.org defines an integrated delivery system as a health system with two or more facilities, including one non-hospital facility (e.g., a nursing home). The integrated delivery systems identified on the WhyNotTheBest.org map are drawn from an SDI list of high-performing systems; for more information please see the SDI website. The locations shown on the overlay are generated by creating a 25-mile radius from a fixed location (e.g., a hospital).

Chartered Value Exchanges – shows the location of the 24 community-based collaboratives funded by the Agency for Healthcare Research and Quality to improve health care quality and promote transparency. The locations shown on the overlay are generated by combining counties included in their service area, as of November 2012.

Medical Homes - shows the location of primary care practices recognized as patient-centered medical homes, through the National Committee on Quality Assurance Patient-Centered Medical Home program and/or the Bridges to Excellence program). The locations shown on this overlay are generated by a 25-mile radius around the address of each recognized practice.

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Differences from CMS Hospital Compare

WhyNotTheBest.org (WNTB) publishes indicators derived from the publicly available dataset provided by the Hospital Compare website hospitalcompare.hhs.gov

There are certain instances when scores published on WNTB differ from Hospital Compare. Please note the following criteria used by WNTB:

HHS does not publish numerators. WNTB derives a numerator from the data by multiplying the score by the denominator. i.e. 80% of 100 cases results in a numerator of 80.
At least 50% of hospitals must report a given measure for that measure to be published to WNTB.
Aggregate scores (e.g. county, HRR, state averages) for process of care and patient experience are weighted by hospital admissions.
Comparator benchmarks (e.g. Top 10%, Safety Net Hospitals) only include those hospitals meeting inclusion criteria of reporting all available measures for all available quarters.
In instances where a minimum denominator is required, WNTB requires 30. Hospital Compare requires 25.
WNTB calculates some AHRQ Quality Indicators using state-contributed all-payer data. Medicare uses Medicare-only data.

For further information about the methodology, please contact wntb@cmwf.org.

Methodology

Performance Data

AHA HIT Measures

CMS HIT Measures

Compare by Groups

Compare by Regions

Top Performers on Process-of-Care Measures

Top Performers on HCAHPS

Top Performers on Readmission and Mortality Rates

Overlays