The hospital database contains more than 800 data elements for over 6,000 U.S. acute care and specialty hospitals. Virtually every general acute care hospital with 25 or more beds in service is included in the database, as well as all hospitals with bonds rated by Standard & Poor’s Corporation. The primary source of these data is the Medicare cost report, which is filed annually by every U.S. hospital that participates in the Medicare program. Data from the Medicare cost report are used in calculating the cost measure for this study.

The 100 Top Hospitals studies focus exclusively on general, short-term, acute care, non-federal U.S. hospitals. In the 100 Top Hospitals: Stroke Benchmarks for Success study, we focused on hospitals that treat patients in the most visible area of neurology: ischemic stroke.

433 Occlusion and stenosis of precerebral arteries, including embolism, narrowing, obstruction, or thrombosis of the basilar, carotid, and vertebral arteries

434 Occlusion of cerebral arteries, including cerebral thrombosis, embolism, or unspecified artery inclusion

436 Acute, but ill-defined, cerebrovascular disease

THE HOSPITAL PEER GROUPS: Teaching and residency programs have a profound effect on the types of patients a hospital treats and the scope of services it provides. When analyzing the performance of an individual hospital, it is crucial that you evaluate it against other like hospitals. To address this, we assigned each hospital to one of three peer groups according to its teaching and residency program status. The study group included:

• 100 Teaching Hospitals with Neurology Residency Programs
• 598 Teaching Hospitals without Neurology Residency Programs
• 1,265 Community Hospitals

We chose this stratification to maintain consistency with the representation of hospitals in each group both throughout the country and in our study group.

PERFORMANCE MEASURES AND SCORING: We compiled a group of six measures of clinical quality practices and efficiency of operations that we believe constitutes the most reliable, scientific way possible to produce benchmarks for superior hospital performance. We also believe that using publicly available data for all hospitals supports this goal. The measures we used were:

1. Stroke patient volume
2. Risk-adjusted patient mortality index
3. Risk-adjusted patient complications index
4. Severity-adjusted average length of stay
5. Wage- and severity-adjusted average cost
6. Percentage of stroke patients discharged to home or HHA

Within each of the three peer groups, we scored hospitals on the basis of their performance on each of the measures relative to other hospitals in their group. First, each hospital was given a single score for each of the six measures. These scores were then summed to arrive at a total score for each hospital within each of the three peer groups. Because of the vital role of quality of care in assessing a hospital, the scores for the patient mortality and patient complications indices were double weighted, that is, those scores were multiplied by two before being added to the other measures.