Hospital Quality Ratings

What are the hospital quality ratings?

To achieve the best possible results, health care quality is:

Quality ratings are based on data from hospitals about how well they provide care and patient survey results about their experience in the hospital. There are four types of quality ratings included on the site: recommended care, results of care, practice patterns, and patient experience. This report shows hospitals’ quality ratings on several different topics, including patient safety and specific health conditions. The ratings come from three different sources:

How do I select hospitals to compare?

You can select hospitals in three ways:

What are the health topics?

Quality ratings are organized into topics by health conditions or by information that people are interested in, such as patient safety or patient satisfaction. With the exception of some information in "Childbirth", all information refers to adult patients.

For more information on the ratings included in each topic, visit Rating Details.

What types of ratings are in the health topics?

Health topics include different types of ratings that measure different aspects of health care quality. In the quality ratings table, each tab shows one type of rating. Not all types of ratings are available for every health topic. The different types of ratings are explained below.

How did we analyze this data?

MONAHRQ does not analyze data to calculate quality measures’ rates. Quality measures with pre-calculated rates from multiple data sources can be imported to MONAHRQ. These rates are compared with national and state benchmark for reporting. Below is the list of the datasets:

How are the quality ratings assigned?

A hospital is rated by comparing it to a national or state average of other hospitals. Ratings are assigned using two different methods. The key at the top of the quality ratings table tells you which method is used.

For the AHRQ Quality Indicators and CMS Hospital Compare measures in "Results of care" and "Practice patterns," the ratings are determined by comparing the hospital’s score to the state or national average score:

This method includes a significance test for most the measures. A significance test means we only rate a hospital as better or worse than average when we are at least 95% confident we are correct. Otherwise, we rate the hospital as average. Experts believe that being 95% confident is acceptable.

For the CMS Hospital Compare measures in the "Recommended care" group and the HCAHPS patient experiences measures. Hospitals are assigned a rating of better, average, or below. The ratings are determined by comparing the hospital’s score to the scores of other hospitals:

What are the hospital comparison groups?

A hospital is rated by comparing it to other hospitals. You can compare hospitals with the rest of the nation or with other hospitals in your state(s). The default is to compare hospitals in your state(s). To change this use the selection box "Select a comparison group."

Comparison groups for the AHRQ Quality Indicators:
Nationwide benchmarks are calculated by AHRQ based on analysis of 44 states from the 2010 AHRQ's Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Because the national comparison data comes from AHRQ, and the data MONAHRQ uses to calculate the individual indicators values is local, the years of these two datasets may be different.

Local comparisons are calculated directly by MONAHRQ based on data from hospitals in your state(s). MONAHRQ calculates the comparison values and individual AHRQ Quality Indicators from the same dataset.

Comparison groups for the CMS Hospital Compare and patient experience ratings:
Nationwide comparisons are calculated by CMS based on data they collect directly from hospitals for Hospital Compare. CMS calculates the comparison values and individual rating values from the same dataset.

Local comparisons are calculated directly by MONAHRQ based on information from the CMS Hospital Compare Website. The comparison values and individual measure are derived from the same dataset.

Are the ratings risk adjusted?

Risk adjustment is a statistical process of accounting for how sick patients are before they enter the hospital. This statistical process aims to 'level the playing field' by accounting for health risks that patients have before they enter the hospital.

AHRQ Quality Indicators: Most AHRQ Quality Indicators are risk adjusted. To learn which indicators are risk adjusted, visit Rating Details. For more information on the risk adjustment methods used for the AHRQ QIs, visit the AHRQ QI Website.

CMS Hospital Compare ratings: Hospital Compare ratings in the "Results of care" group are risk adjusted. Other Hospital Compare ratings are not risk adjusted. For more information on the risk adjustment methods used by Hospital Compare, visit the Hospital Compare Website.

HCAHPS patient experience ratings: HCAHPS ratings are not risk adjusted.

How do I interpret the hospital quality ratings tables?

The ratings tables show quality ratings for hospitals. You can use this information to help you choose a hospital. The best way is to search for patterns in the ratings. Some hospitals do well in all areas. Others do well in some areas but not others. Still others show problems everywhere. Look for these patterns. At the same time, if there is a surgery, medical condition, or health risk that is of particular concern to you, you should give more weight to information related to those concerns.

Each row shows the ratings for one hospital. To sort rows by hospital, select "Hospital Name." Each column shows the results for one quality rating. To sort the ratings, select a rating name. The ratings tables are divided into tabs that show ratings by type, such as "Results of care" or "Recommended care." A hospital is rated by comparing it to other hospitals. The selection box "Select a comparison group" shows you which group of hospitals you're using for comparison.

Some hospital ratings are per 100 cases, per 1,000 cases, or are counts of how many times a procedure or condition has occurred. The information icon for each hospital rating has more information.

How do I interpret the bar charts?

The bar charts show the specific scores used to create the hospital ratings. There is one bar for each hospital and one bar for each comparison group. The bar chart orders hospitals from best to worst. Depending on the type of rating, larger scores or smaller scores may be better. Better scores are at the top of the chart and worse scores are at the bottom. Each bar is labeled with the score. In the detailed statistics, confidence intervals appear in parentheses.

Each chart tells you how to interpret the length of the bars in that chart:

How do I interpret the detailed statistics tables?

Different statistics are available for different quality indicators. For more information on which statistics are available for each indicator, visit the Rating Details page. Numbers in the measure details table are not scaled. These are raw statistics.

Hospital Utilization

What is hospital utilization?

Hospital utilization means use of hospital services, such as the number and length of hospital stays for different health conditions or procedures. It includes information on:

How did we analyze this data?

Hospital utilization is calculated from hospital discharge data collected from hospitals in your state(s). Each discharge is counted as a separate hospital stay. No risk adjustment is applied. Condition or procedure categories are assigned based on DRG, MDC, or diagnosis or procedure codes. Diagnosis and procedure codes are grouped using AHRQ's Clinical Classification Software.

To report information on costs, MONAHRQ uses AHRQ's Cost-to-Charge Ratio Files. AHRQ creates these files using CMS data. They are calculated at the hospital level. Demographic breakdowns by age category, gender, race, and payer type are calculated using demographic information available in the hospital discharge data. National and regional values are derived from AHRQ's HCUP Nationwide Inpatient Sample (NIS). Regions are defined by the Bureau of the Census Midwest, Northeast, South, and West.

How do I select hospitals to compare?

You can select hospitals in four ways:

What are the conditions and procedures?

For each hospital stay, hospitals assign one or more codes that describe the diagnosis and the procedures that were performed. You can select conditions and procedures by:

How do I interpret the tables?

Information is provided for each selected hospital by condition or procedure grouping. Select the titles in the top row to sort the results. Tables may include the following:

If you select a specific hospital you will get the following:

You may notice some special codes in the tables:

Avoidable Hospital Stays

What are avoidable hospital stays?

An avoidable hospital stay is one that might have been avoided with better medical care outside of the hospital. For example, a person with diabetes who receives good care from her primary care physician might not need a hospital stay for diabetes complications. Hospital stays like these are not always avoidable, but they are potentially avoidable with good quality health care. For more information on avoidable hospital stays, visit the About Hospital Quality page or the related My Quality Improvement Guide resources.

Information about avoidable hospital stays is presented by county or community, not by hospital. It is based on where patients live, not on where hospitals are located. High rates of avoidable hospital stays can point to possible breakdowns in health care in the community.

How did we analyze this data?

MONAHRQ reports on avoidable hospital stays using data calculated by AHRQ's Quality Indicators software, version 4.5. These measures are the area-level AHRQ Quality Indicators. The calculations use hospital discharge data.

To determine rates per county, MONAHRQ uses county populations from the US Census Bureau data.

How do I interpret the tables?

This table presents data on a selected quality indicator by county. A higher risk-adjusted rate indicates that the county residents had a higher number of hospital stays for this condition than would be expected if they all were receiving the best quality health care. It is more likely than not that some of these stays could have been avoided. A lower rate indicates that the county residents had fewer than expected hospital stays and that residents may be receiving higher quality care.

How do I interpret the maps?

The maps show how many hospital stays in each county could potentially have been avoided for each 100,000 county residents. Darker colors represent higher rates, and lighter colors represent lower rates. Counties are labeled with numbers to save space. The county names appear below the map.

To assign map colors, rates are divided into 3, 4, or 5 groups, depending on how much the rates vary. When there are not enough data to report a rate, the map color is grey. The key tells you whether the rates shown are risk adjusted or observed.

County Rates of Hospital Use

What are county rates of hospital use?

County rates show use of hospital services by county, such as the number and length of hospital stays for different health conditions or procedures. These rates are based on where patients live, not where the hospitals they visit are located.

How did we analyze this data?

County rates are calculated based on hospital discharge data collected from hospitals in your state(s). Each discharge is counted as a separate hospital stay. Rates are determined by where the patient lives, not by hospital location . No risk adjustment is applied. Condition or procedure categories are assigned based on DRG, MDC, or principal or all-listed diagnosis or procedure.

To report rates by county, MONAHRQ uses county populations from US Census Bureau data. County rates show the number of hospital discharges per 1,000 county residents. To estimate cost information, MONAHRQ uses AHRQ's cost-to-charge ratios. AHRQ creates these files using CMS data. They are calculated at the hospital level. The national and regional values shown in the tables are derived from 2011 data from AHRQ's HCUP Nationwide Inpatient Sample (NIS). Regions are defined by the Census Bureau: Midwest, Northeast, South, and West.

Numerators for demographic breakdowns by age category, gender, and race are calculated using demographic information provided in the hospital discharge data. Denominators for each demographic category are obtained from Census data.

What are the conditions and procedures?

For each hospital stay, hospitals assign one or more codes that describe the diagnosis and the procedures that were performed. You can select conditions and procedures by:

How do I interpret the tables?

Information is provided for each selected county by condition or procedure grouping. Select the titles in the top row to sort the results. Tables may include the following:

If you select a specific county you will get following:

You may notice some special codes in the tables:

How do I interpret the maps?

The maps show the number of hospital stays in each county for each 1,000, 10,000, or 100,000 county residents. Darker colors represent higher rates, and lighter colors represent lower rates. The darkest color represents the highest 20% of rates, the next darkest color is the next highest 20% of rates, and so on. The lightest color is the lowest 20% of rates. Counties are labeled with numbers with the county names below the map.

When there are not enough data to report a value, the map color is grey.