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50 Top Cardiovascular Hospitals Study: Illuminating Leadership Excellence

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Jean Chenoweth leads performance improvement and the 100 Top Hospitals program at IBM Watson Health.

Now in its 19th year, the Watson Health 50 Top Cardiovascular Hospitals study, formerly the Truven Health Analytics 50 Top Cardiovascular Hospitals study, uses a balanced national scorecard of hospital performance metrics to identify the 50 highest performing cardiovascular service lines in the nation. (See sidebar for list of winners.)

By using only public data and peer reviewed methods, this study identifies 50 hospitals that have the highest balanced performance across the cardiovascular service to set national benchmarks for three classes of hospitals:

  • teaching with cardiovascular residencies
  • teaching hospitals without cardiovascular residencies
  • community hospitals

These benchmarks are used by other hospitals to target achievable higher performance. The data produced for individual hospitals provides insights into the outcomes of service line management on relative clinical performance, cost and efficiency versus peers.

How can cardiovascular service line management use this study?
Unique to the 50 Top Cardiovascular Hospitals study is the ability to use its objective results to determine whether statistically meaningful progress is occurring, whether improvement efforts are likely to lead to cardiovascular center of excellence performance levels and whether consistency of performance is likely to be achieved.

To provide these managerial insights, we measure improvement of performance over five consecutive years and the resultant performance across four patient populations: patients with heart attacks or heart failure, as well as patients undergoing heart bypass surgery (CABG) and coronary angioplasty (percutaneous coronary intervention or PCI).

The insights from this data shed light on whether the service line dyad (administrative and clinical) leaders are targeting broad service line excellence or only subspecialties within the service line, whether inadvertent bias influences selection of measures for improvement, and whether consistency of performance is likely to be achieved.

What does it mean for the community?
The 50 Top Cardiovascular Hospital award winners outperform peers in a number of ways which are important to the community, even though the study is not designed for or released to consumers. This year’s cardiovascular review found that, compared to non-winning cardiovascular hospitals in the study, the top performers had:

  • Significantly higher inpatient survival (21% to 47.4% higher)
  • Fewer patients with complications (17.9% to 20.4% fewer)
  • Higher 30-day survival rates for acute myocardial infarction (AMI), heart failure (HF) and coronary artery bypass grafting (CABG) patients (0.3 to 0.9 percentage points higher)
  • Lower readmission rates for AMI, HF and CABG patients (0.6 to 0.9 percentage points lower)
  • Average lengths of stay for CABG patients that were nearly one day lower than non-winners and 0.3 to 0.5 days lower for AMI, HF and percutaneous coronary intervention (PCI)
  • $1,333 to $5,745 less in total costs per patient case (the smallest difference was for HF and largest was for CABG)

While these measures alone do not guarantee an individual patient a perfect outcome, the study results suggest that the physicians and management staff of the 50 Top Cardiovascular Hospital winners are committed to clinical excellence, lower costs and effectively driving positive improvement across the service line.

What does this study offer for the future improvement of cardiovascular service line management?
The cardiovascular services line is often the hospital’s highest profile service line typically impacting the lives of thousands of inpatients and outpatients each year. The 50 Top Cardiovascular Hospitals study focuses on measuring improvement, resultant performance, alignment across the service line and consistency of high performance – all essential to achieving reliability. Reliability is a long term goal of healthcare leaders to assure the best possible outcomes at the lowest possible costs.

Illuminating leadership excellence
The goal of the Watson Health 100 Top Hospitals program (of which the 50 Top Cardiovascular Hospitals study, and the 15 Top Health Systems study, are a part) is to illuminate leadership excellence that results in balanced organizational outcomes.

The 100 Top Hospitals program is an ongoing research project dedicated to adding to management literature through objective measurement of leadership’s impact on organizational outcomes of health systems, hospitals and service lines. Each study is designed to expand healthcare management knowledge regarding the improvement and resultant performance levels of the highest performing organizations as measured by a national comparative balanced scorecard.

The 100 Top Hospitals methods and analytics provide national benchmarks for targeting achievable higher performance by health systems, hospitals and hospital cardiovascular service lines. The study benchmarks and data have provided a framework for important research by academics in governance, leadership performance and compensation, CEO best practices, Baldrige Award winner performance and improvement, cardiovascular staffing and a variety of other topics.

The full Watson Health 50 Top Cardiovascular Hospitals study is available on the Truven website. Read the Modern Healthcare coverage here.

The evolution of the 100 Top Program as part of Watson Health
In the longer term, our goal is to combine all of the 100 Top program’s study methods, analytics, deeper clinical data and Watson’s capability to continuously learn.  We believe this powerful combination will allow us to further light the way to service line, hospital and health system managerial and clinical excellence.

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