Through more than three decades of national hospital rankings, no organization had graded hospitals based on how rarely they delivered unnecessary care. The Lown Institute changed that with the release of its hospital index earlier this year.
Lown, a nonpartisan think tank focused on helping create a more just health care system, ranked 3,282 U.S. hospitals on three major categories: value, patient outcomes and civic leadership. To assign grades in these categories, the researchers who created the rankings considered hospital performance on more than 40 individual metrics.
For the value category, hospitals were graded on how often they delivered 13 commonly overused services, such as unnecessary hysterectomy and imaging for simple headaches. Vikas Saini, MD, President of the Lown Institute, said the research team started with a list of 30 services for which there was evidence of overuse, and chose to focus on services exclusively or primarily delivered in the hospital setting.
In another first, the index’s civic leadership component included an ‘inclusivity’ category that rewarded hospitals that served their full communities, including people of color and those with lower income or education levels. The civic leadership portion also incorporated hospitals’ community benefit spending and pay equity.
“Our main goal was to change the framing of the conversation from the important but relatively narrow focus on specific outcomes [in other rankings] to also look more broadly at a range of other things,” Dr. Saini said. “There are number of other factors that can be measured and that should matter.”
Patient outcomes still played a major role in determining a hospital’s score. These outcomes included clinical outcomes, patient satisfaction, and patient safety, which together accounted for 50 percent of each hospital’s rating. Still, Lown did not intend the rankings as a guide for patients. “We didn’t design this as a consumer-oriented tool that patients should use to figure out the best place for a knee replacement,” Dr. Saini said. “Rather, we meant it as a new framing for media, think tanks, hospital leadership, and regulatory and policy people.”
The #1 hospital overall was JPS Health Network in Fort Worth, Texas, while the top-ranked hospital for value was Kings County Hospital Center in Brooklyn, New York.
Dr. Saini said that a number of hospital leaders contacted Lown after the study’s release. “They have asked for more technical details; they would like to understand how we came to conclusions, and how they could do better,” Dr. Saini said. “Some of our metrics are not easily addressed by hospital leadership teams; it’s a tough challenge.”
Lown intends to release a new version of the recommendations in 2021. Dr. Saini said the Lown team would explore patterns they saw in the data they collected for the 2020 survey.
“We think there are underlying patterns that may help illuminate paths forward for improvement,” he said. “For example, there are safety net hospitals that have significant avoidance of overuse and some that don’t. Similarly, there are academic medical centers that do very well on avoiding overuse and a few that don’t. Explaining variability among hospitals is not cut and dried. It’s not just the type of hospital, but culture and other factors that matter.”