JHQ 312: State-Level Hospital Quality in the United States: Analyzing Variation and Trends from 2013 to 2021-JHQ 312 Article

JHQ 312 Article

Pdf Summary

This study develops a composite hospital quality index to measure and compare state-level hospital performance across the United States (all 50 states plus Washington, DC) from 2013 to 2021 using CMS Hospital Compare data covering roughly 3,000 acute-care hospitals. The index combines three CMS risk-adjusted measures that are consistently available over the period: 30-day readmission rates, 30-day mortality rates (for six major conditions), and patient experience (HCAHPS). Each measure is standardized into a yearly z-score (with readmission and mortality reverse-coded so higher scores indicate better quality), weighted by hospital bed counts, and averaged to create a single index with mean 0 and standard deviation 1.<br /><br />Nationally, outcomes improved modestly over time: the average 30-day readmission rate fell from 15.8% (2013) to 15.1% (2021), and 30-day mortality fell from 12.3% to 11.2%. In contrast, patient experience declined from 72.1 to 69.7. In 2021, there was substantial interstate variation. Eight states significantly outperformed the U.S. average on the quality index, led by Utah (about 0.56 standard deviations above average), followed by Hawaii, South Dakota, and Oregon. Fourteen states performed significantly worse, with Nevada, West Virginia, Florida, and Arkansas among the lowest.<br /><br />Trend analysis shows uneven progress: 24 states improved their index between 2013 and 2021 (with Washington, DC showing the largest gain), while others declined (including New Hampshire, Vermont, and Massachusetts). The authors note limitations, including omission of process measures (not available after 2014) and potential distortion from COVID-19-era shifts. The study concludes that while average quality improved, persistent state disparities suggest the need for targeted policy action and diffusion of best practices from high-performing states.

Keywords

composite hospital quality index

CMS Hospital Compare

state-level hospital performance

30-day readmission rates

30-day mortality rates

HCAHPS patient experience

risk-adjusted measures

bed-count weighted z-scores

interstate variation 2013-2021

COVID-19 impact on hospital quality