Methodology: U.S. News & World Report Most Connected Hospitals

Transcription

1 Methodology: U.S. News & World Report Most Connected Hospitals Avery Comarow October 15, 2015

2 To Whom It May Concern: U.S. News & World Report s Most Connected Hospitals study is the sole and exclusive property of U.S. News & World Report, L.P., which owns all rights, including but not limited to copyright, in and to the attached data and material. Citation, reference, publication and any other form of disclosure is expressly forbidden. 2

3 Introduction Large numbers of U.S. hospitals fall short of fully embracing electronic medical records, bar-coded wrist bands, online patient portals and other hallmarks of the computerization of health care. When the federal government began doling out $30 billion nearly seven years ago to help underwrite the expense of moving from paper to computerized health care, some hospitals and health systems dived in. Many, however, have complied with federal meaningful use standards just enough to avoid penalties in the form of reduced Medicaid and Medicare reimbursements. Those penalties began to take effect in October Most Connected Hospitals recognizes 159 medical centers in the first group those that have dived in. Their responses to dozens of questions selected by U.S. News from the American Hospital Association s 2013 and 2014 AHA Annual Survey Information Technology Supplement demonstrate a commitment to health care s digital future. The IT Supplement to the AHA Annual Survey has been conducted since 2007 in partnership with the federal government s Office of the National Coordinator and achieves a response rate of about 60 percent. Survey responses reflecting 3,276 hospitals in the 2013 IT Supplement and 3,308 hospitals in the 2014 IT Supplement were received. To be considered for Most Connected Hospital status, a hospital had to meet dual requirements: 1) It had to register a high score based on its responses to the selected questions from the IT Supplement, and 2) it had to be among the 910 facilities recognized by U.S. News as nationally ranked or rated as high performing in in Best Hospitals (for complex care), Best Hospitals for Common Care or Best Children s Hospitals. Neither the American Hospital Association nor any commercial interest or sponsor had input into the U.S. News methodology, nor did the AHA endorse it. Domains U.S. News grouped selected questions and responses from the IT Supplement into three domains chosen to reflect a hospital s commitment to the digitalization of health care in three critical respects: Clinical connectedness evaluates a hospital s ability to exchange or share patient information electronically with other health care providers who need it. This capability is important not only inside a hospital but throughout a health care system and to all care providers beyond. Examples of such information in this domain are 1) digitally sending a patient s lab results to an independent medical practice and 2) notifying a primary care provider outside the hospital that a patient has been admitted to the hospital s emergency room. This domain was worth nearly half of a hospital s total score from the 2013 IT 3

4 Supplement and more than three-fifths of the total score from the 2014 IT Supplement. (The latter instrument included a greater number of possible responses.) Patient safety evaluates a hospital s ability to prevent causing harm to patients through computerized means, such as by using bar-coded wrist bracelets to verify patient s identities before medications and other treatments are administered. This domain was worth about one-third of a hospital s total score in 2013 and about one-fourth of the score in Patient engagement evaluates a hospital s ability to enlist patients in their own care by providing them with electronic access to their medical information and even giving them the ability to update or modify it, for example by calling up their electronic medical record and adding weekly blood pressure reporting. This domain was worth about one-fifth of a hospital s total score in 2013 and about one-tenth in A broad sampling of elements for each domain was chosen from the AHA IT Supplement for each year. The elements match from year to year as closely as possible. A complete list of the selected questions and responses for each year, with point allocations and numerical keys to each year s AHA IT Supplement, is provided below. Scoring Hospitals received 2 points, 1 point,.5 point or 0 points for each response or part of a response, depending on degree of electronic connectivity. More points generally were awarded, for example, for communicating electronically with providers outside than inside a hospital. Implementing computer-enabled safety enhancement across all clinical units similarly warranted more points than doing so in a single unit. There is a dearth of empirical data linking patient outcomes to specific hospital attributes that can be ascertained from such surveys. Scoring therefore involved judgments by U.S. News. The particular standard applied to make these judgments for Most Connected Hospitals was face validity. The maximum possible score across all three domains was 61 points in 2013 and 75 points in Clinical connectedness was worth 29 and 47 points in 2013 and 2014 respectively, patient safety 20 points in both surveys and patient engagement 12 points in 2013 and 8 points in To be recognized as a Most Connected Hospital, a site either had to earn either 90 percent of the points available in 2013, or 55 total points, or slightly more than 93 percent of the points available in 2014, or 70 total points. Limitations The methodology represents U.S. News best judgment but is constrained by certain limitations, most notably the following: 4

5 Responses to the IT Supplement to the AHA Annual Survey were provided to AHA by hospital administrators. Self-reported data may not reflect an independent observer s assessment of the state of a hospital s connectedness. Similar survey responses from different hospitals may mask substantial real-world differences. Not all data from the AHA IT Supplement were included. Had responses to additional questions been included in the scoring, or had included questions been scored differently, some hospitals might have scored higher or lower than they did. Many hospitals did not respond to the AHA IT Supplement. Some might have qualified as Most Connected Hospitals if they had responded. The data are lagging. In part because of government requirements, hospitals across the country are in the process of rapidly deploying new health IT assets. Survey responses from 2013 and 2014 therefore likely understate to an unknown degree the progress that a hospital has made during Using data from 2013, on the other hand, suggests how rapidly and decisively a hospital has embraced new technologies to improve care. A hospital s level of digital connectedness may or may not correlate with the quality of care it delivers. To ensure that all Most Connected Hospitals have a demonstrated record of clinical excellence, each was required to be nationally ranked or high performing in at least one of the 31 clinical specialties and service lines that U.S. News evaluates as part of its hospital quality reporting program. Commentary That relatively few hospitals achieved Most Connected recognition may seem surprising. Electronic medical/health records were created in the 1960s, and it has been nearly seven years since the federal government began earmarking funds to underwriting much of the expense otherwise incurred by hospitals and providers in making the technology omnipresent. Compliance with federal meaningful use requirements, which spell out a timeline for implementing EMR/EHR technology throughout the health care provider community, has proven to be particularly troublesome. Both the 2013 and 2014 AHA IT Supplement included a question (Q16 in 2013, Q19 in 2014) intended to draw out hospitals on what hospital leaders see as the most significant roadblocks to meeting federal standards for receiving funds and for avoiding penalties for failing to comply: What is (are/would be) the primary challenge(s) in implementing an EMR/EHR system that meets the federal requirements for meaningful use? (Please check all that apply.) Eleven options were available in specific and one other and 10 in (The dropped option, Complexity associated with coordinating decision with system-level leadership, was checked by slightly more than one-fifth of the 2013 responders.) 5

6 Large numbers of hospitals checked many boxes in both years, presumably indicating significant problems they face in each of the areas identified. (Another possibility is that it may also reflect the frustration that hospital leaders have frequently and publicly expressed at the complexity and expense of implementation.) In both 2013 and 2014, more than half of the respondents to Q16/Q19 cited one or more of the following factors as a primary challenge in meeting meaningful use standards: Cited by >50% in: % 60% Ongoing cost of maintaining and upgrading systems 57% 54% Challenge/complexity of meeting all meaningful-use criteria within implementation timeline 55% 52% Upfront capital costs/lack of access to capital to install systems 54% 54% Obtaining physician cooperation The ability of IT staffs to get required systems in place and subsequently maintain them also was a source of anxiety; 45% of respondents in 2013 and 40% in 2014 selected Lack of adequate IT personnel in hospital to support implementation/maintenance as a primary challenge. By comparison, privacy and security concerns (22%/25%) and uncertainty about specific federal requirements (16%/18%) were well down the list of major impediments in moving the digitization of health care to the next level. Most Connected Hospitals survey elements The following section lists, by domain, the questions and scoring of responses used from the 2013 and 2014 IT Supplement to the AHA Annual Survey in determining Most Connected Hospitals recognition SURVEY QUESTIONS AND RESPONSES Clinical Connectedness Domain (29 points) Q3a Which of the following patient data does your hospital electronically exchange/share with one or more of the provider types listed below? Check all that apply. (maximum 24 points) b. Laboratory results (maximum 6 points) Q3a.b1 With hospitals in your system (1 point) Q3a.b2 With hospitals outside your system (2 points) Q3a.b3 With ambulatory providers in your system (1 point) 6

7 Q3a.b4 With ambulatory providers outside your system (2 points) Q3a.b5 c. Medication history (maximum 6 points) Q3a.c1 With hospitals in your system (1 point) Q3a.c2 With hospitals outside your system (2 points) Q3a.c3 With ambulatory providers in your system (1 point) Q3a.c4 With ambulatory providers outside your system (2 points) Q3a.c5 d. Radiology reports (maximum 6 points) Q3a.c1 With hospitals in your system (1 point) Q3a.c2 With hospitals outside your system (2 points) Q3a.c3 With ambulatory providers in your system (1 point) Q3a.c4 With ambulatory providers outside your system (2 points) Q3a.c5 e. Clinical/summary care record (maximum 6 points) Q3a.c1 With hospitals in your system (1 point) Q3a.c2 With hospitals outside your system (2 points) Q3a.c3 With ambulatory providers in your system (1 point) Q3a.c4 With ambulatory providers outside your system (2 points) Q3a.c5 Q3b If you exchange or share clinical/summary care records with other providers, what is the primary mechanism? (maximum 1 point) EHR or other electronic means (1 point) Manually (e.g. fax or mail) (0 points) Q4a Do any current arrangements exist in your area to share electronic patientlevel clinical data through an electronic health information exchange (HIE) or a regional health information organization (RHIO)? (0 points) Arrangement(s) exist(s) (select participation level in Q4b) Arrangement(s) do(es) not exist (select 2nd or 3rd participation level in Q4b) Do not know Q4b [If arrangement(s) exist(s) for Q4a] Please indicate your level of participation in a state, regional or local health information exchange (HIE) or health information organization (HIO). (maximum 1 point) Participating and actively exchanging data in at least one HIE/RHIO (1 point) Have the electronic framework to participate but not participating in any HIE or HIO at this time (0 points) Do not have the electronic framework to participate and not participating in any HIE/RHIO at this time (0 points) 7

8 Q5a When a patient visits your emergency department, do you routinely provide electronic notification to the patient s primary care physician? (0 points) Yes (select notification type(s) in Q5b) No Do not know Do not have ED Q5b [If yes to Q5a] Are electronic notifications provided to primary care physicians below (check all that apply)? (maximum 2 points) Inside system (1 point) Outside system (1 point) Q6a Are providers at your hospital able to query electronically for a patient s health information (e.g. medications, outside encounters) from sources outside your organization or system? (maximum 1 point) Patient Safety Domain (20 points) Q1 Does your hospital currently have a computerized system which allows for: Computerized Provider Order Entry (provider directly enters own orders that are transmitted electronically) (maximum 2 points) Q1c3 Medications (maximum 2 points) Decision Support (maximum 10 points) Q1b4 Clinical reminders (e.g. pneumococcal vaccine) (maximum 2 points) Q1c4 Drug allergy alerts (maximum 2 points) 8

9 Q1d4 Drug-drug interaction alerts (maximum 2 points) Q1e4 Drug-lab interaction alerts (maximum 2 points) Q1f4 Drug dosing support (maximum 2 points) Bar Coding or Radio Frequency Identification (RFID) for Closed-Loop Medication Tracking (maximum 4 points) Q1a5 Medication administration (maximum 2 points) Q1b5 Patient verification (maximum 2 points) 9

10 Q2 Do you currently have an electronic system that allows you to do the following [re: medication management]: Q2a3 Compare a patient s inpatient and preadmission lists (maximum 1 point) Q2b3 Provide an updated medication list at time of discharge (maximum 1 point) Q2c3 Check inpatient prescriptions against an internal formulary (maximum 1 point) Q2d3 Automatically track medications with an electronic medication administration record (emar) (maximum 1 point) Patient Engagement Domain (12 points) Q2 Do you currently have an electronic system that allows you to do the following: Discharge Instructions and Care Summary Documents Q2a4 Provide patient an electronic copy of their discharge instructions upon request. (maximum 1 point) Q2b4 Provide patient with an electronic copy of their record upon request within 3 business days. (maximum 1 point) Q7 Are patients able to do any of the following regarding their health/medical records? (Please check all that apply.) (maximum 7 points) View information from their health/medical record online (1 point) 10

11 Download information from their health/medical record (1 point) Request amendment to change/update their health/medical record (1 point) Request refills for prescriptions online (1 point) Schedule appointments online (1 point) Pay bills online (1 point) Submit patient-generated data (e.g. blood glucose, weight) (1 point) Q8 What mechanism(s) do you use to provide patients with the ability to access their health information and manage their healthcare electronically (such as those capabilities listed in Q7)? (Please check all that apply.) (maximum 3 points) Personal health record (1 point) Patient/consumer portal (1 point) Secure messaging with providers (1 point) Other (please specify) (0.5 point if a mechanism is specified and no other points are awarded for this question) 2014 SURVEY QUESTIONS AND RESPONSES Clinical Connectedness Domain (47 points) Q4 Which of the following patient data does your hospital electronically exchange/share with one or more of the provider types listed below? Check all that apply. (maximum 24 points) b. Laboratory results (maximum 6 points) With hospitals inside your system (1 point) With hospitals outside your system (2 points) With ambulatory providers inside your system (1 point) With ambulatory providers outside your system (2 points) c. Medication history (maximum 6 points) With hospitals inside your system (1 point) With hospitals outside your system (2 points) With ambulatory providers inside your system (1 point) With ambulatory providers outside your system (2 points) d. Radiology reports (maximum 6 points) With hospitals inside of your system (1 point) With hospitals outside of your system (2 points) With ambulatory providers in same system (1 point) With ambulatory providers outside system (2 points) 11

12 e. Clinical/summary care record in any format (maximum 6 points) With hospitals inside of your system (1 point) With hospitals outside system (2 points) With ambulatory providers in same system (1 point) With ambulatory providers outside system (2 points) Q5 When a patient transitions to another care setting or organization outside your hospital system, how does your hospital routine send and/or receive a summary of care record? Check all that apply. (maximum 8 points) b. efax using EHR Send (1 point) Receive (1 point) c. Secure messaging using EHR (via DIRECT or other secure protocol) Send (1 point) Receive (1 point) d. Provider portal Send (1 point) Receive (1 point) e. Via health information exchange organization or other third party Send (1 point) Receive (1 point) Q6 When a patient transitions to another care setting or organization, does your hospital routinely electronically send and/or receive (NOT efax) a summary of care record in a structured format (e.g. CCDA) with the following providers? Check all that apply. (maximum 8 points) a. Other hospitals outside your system Send (1 point) Receive (1 point) b. Ambulatory care providers outside your system Send (1 point) Receive (1 point) c. Long-term-care providers (inside or outside your system) 12

13 Send (1 point) Receive (1 point) d. Behavioral health providers (inside or outside your system) Send (1 point) Receive (1 point) Q7 Does your EHR integrate any type of clinical information received electronically (not efax) from providers or sources outside your hospital system/organization without the need for manual entry? This could be done using software to convert scanned documents into indexed, discrete data that can be integrated into EHR. (maximum 1 point) Yes, routinely (1 point) Yes, but not routinely (0.5 points) N/A (0 points) Q8 If yes, does your EHR the information contained in summary of care records received electronically (not efax) without the need for manual entry? This could be done using software to convert scanned documents into indexed, discrete data that can be integrated into EHR. (maximum 1 point) Yes, routinely (1 point) Yes, but not routinely (0.5 points) N/A (0 points) Q9a Do providers at your hospital routinely have necessary information available electronically from outside providers or sources when treating a patient that was seen by another health provider/setting? (maximum 1 point) Q9b Do providers at your hospital query electronically for patients health information (e.g. medications, outside encounters) from sources outside your organization or hospital system? (maximum 1 point) No, don t have capability) Q10a When a patient visits your emergency department (ED), do you routinely provide electronic notification to the patient s primary care physician? (0 points) Yes (select notification type(s) in Q10b) 13

14 No Do not know Do not have ED Q10b [If yes to Q10a] Are electronic notifications provided to primary care physicians listed below? (check all that apply) (maximum 2 points) Inside system (1 point) Outside system (1 point) Q11 Please indicate your level of participation in a state, regional or local health information exchange (HIE) or health information organization (HIO). (maximum 1 point) HIE/HIO is operational in my area and we are participating and actively exchanging data in at least one HIE/RHIO (1 point) HIE/HIO is operational in my area but we are not participating (0 points) HIE/HIO is not operational in my area (0 points) Patient Safety Domain (20 points) Q1 Does your hospital currently have a computerized system which allows for (maximum 16 points): Computerized Provider Order Entry to transmit orders electronically (maximum 2 points) Q1c3 Medications Decision Support (maximum 12 points) Q1b4 Clinical reminders (e.g. pneumococcal vaccine) (maximum 2 points) Q1c4 Drug allergy alerts (maximum 2 points) 14

15 Q1d4 Drug-drug interaction alerts (maximum 2 points) Q1e4 Drug-lab interaction alerts (maximum 2 points) Q1f4 Drug dosing support (maximum 2 points) Bar Coding or RFID for Closed-Loop Medication Tracking Q1a5 Medication administration (maximum 2 points) Q1b5 Patient verification (maximum 2 points) Q2 Do you currently have a computerized system which allows [regarding medication management] for (maximum 4 points): 15

16 Q2a3 Compare a patient s inpatient and preadmission lists (maximum 1 point) Q2b3 Provide an updated medication list at time of discharge (maximum 1 point) Q2c3 Check inpatient prescriptions against an internal formulary (maximum 1 point) Q2d3 Automatically track medications with an electronic medication administration record (emar) (maximum 1 point) Patient Engagement Domain (8 points) Q3 Are patients treated at your hospital able to do the following regarding their health/medical records? (Please check all that apply.) Q3a3 View their health/medical information online (maximum 1 point) Q3b3 Download information from their health/medical record (emar) (maximum 1 point) Q3d3 Request an amendment to change/update their health/medical record (maximum 1 point) 16

17 Q3e3 Request refills for prescriptions online (maximum 1 point) Q3f3 Schedule appointments online (maximum 1 point) Q3g3 Pay bills online (maximum 1 point) Q3h3 Submit patient-generated data (e.g. blood, glucose, weight) (maximum 1 point) Q3i3 Secure messaging with providers (maximum 1 point) 17

18 Most Connected Hospitals The following 159 centers in 37 states are recognized as Most Connected Hospitals They are ordered alphabetically within each state Hospital Total points (of 75) Clinical connectedness (of 47) Patient safety (of 20) Patient engagement (of 8) Total points (of 61) Alabama University of Alabama Hospital at Birmingham Birmingham 66/75 41/47 18/20 7/8 55/61 Arkansas Mercy Hospital Fort Smith Fort Smith 63.5/ /47 20/20 8/8 55/61 Arizona Mayo Clinic Phoenix 56/75 28/47 20/20 8/8 59/61 California Cedars-Sinai Medical Center Los Angeles 61/75 34/47 20/20 7/8 59/61 Kaiser Permanente Baldwin Park Medical Center Baldwin Park 70/75 42/47 20/20 8/8 47/61 Mills-Peninsula Health Services Burlingame 62/75 34/47 20/20 8/8 59/61 Providence Holy Cross Medical Center Mission Hills 70.5/ /47 20/20 7/8 NR 1 Rady Children's Hospital San Diego 71/75 43/47 20/20 8/8 58/61 Resnick Neuropsychiatric Hospital at UCLA Los Angeles 68/75 41/47 20/20 7/8 58/61 Stanford Health Care-Stanford Hospital Stanford 69/75 41/47 20/20 8/8 59/61 UCLA Medical Center Los Angeles 70/75 43/47 20/20 7/8 51/61 University of California, Davis Medical Center Sacramento 71/75 44/47 20/20 7/8 56/61 1 NR=nonresponder 18

19 University of California, Irvine Medical Center Orange 56.5/75 31/ /20 7/8 57.5/61 Colorado Children's Hospital Colorado Aurora 66/75 39/47 20/20 7/8 59/61 Medical Center of the Rockies Loveland 75/75 47/47 20/20 8/8 60/61 Memorial Hospital Colorado Springs 75/75 47/47 20/20 8/8 60/61 PeNR ose-st. Francis Health Services Colorado Springs 75/75 47/47 20/20 8/8 59/61 Porter Adventist Hospital Denver 74/75 46/47 20/20 8/8 59/61 Poudre Valley Hospital Fort Collins 75/75 47/47 20/20 8/8 60/61 University of Colorado Hospital Aurora 75/75 47/47 20/20 8/8 59/61 Connecticut Greenwich Hospital Greenwich 75/75 47/47 20/20 8/8 61/61 Yale-New Haven Hospital New Haven 75/75 47/47 20/20 8/8 61/61 Delaware Nanticoke Memorial Hospital Seaford 62.5/ /47 20/20 5/8 55/61 Cleveland Clinic Florida Weston 70/75 44/47 18/20 8/8 NR 1 Memorial Regional Hospital Hollywood 47/75 21/47 20/20 6/8 60/61 Memorial Hospital Miramar Miramar 47/75 21/47 20/20 6/8 60/61 Hawaii Kaiser Permanente Moanalua Medical Center Honolulu 71.5/ /47 20/20 7/8 57/61 Iowa UnityPoint Health-Trinity Regional Medical Center Fort Dodge 71/75 43/47 20/20 8/8 36/ NR=nonresponder 19

20 University of Iowa Hospitals and Clinics Iowa City 69/75 41/47 20/20 8/8 58/61 Illinois Edward Hospital Naperville 74/75 46/47 20/20 8/8 49/61 Loyola University Medical Center Maywood 70.5/ /47 20/20 7/8 47/61 Indiana IU Health North Hospital Carmel 64/75 36/47 20/20 8/8 58/61 Kansas Stormont-Vail HealthCare Topeka 75/75 47/47 20/20 8/8 58/61 Kentucky Kosair Children's Hospital Louisville 70/75 42/47 20/20 8/8 39/61 Norton Hospital Louisville 70/75 42/47 20/20 8/8 39/61 Massachusetts Beth Israel Deaconess Medical Center Boston 71/75 43/47 20/20 8/8 60/61 Brigham and Women's Hospital Boston 64/75 37/47 20/20 7/8 55/61 Maryland Anne Arundel Medical Center Annapolis 63/75 36/47 20/20 7/8 58/61 Michigan Battle Creek Hospital Battle Creek 62.5/ /47 20/20 8/8 58/61 Beaumont Hospital Grosse Pointe 74/75 46/47 20/20 8/8 56/61 Beaumont Hospital Royal Oak 74/75 47/47 20/20 7/8 56/61 1 Beaumont Hospital Troy 73/75 46/47 19/20 8/8 56/61 Bronson Methodist Hospital Kalamazoo 62.5/ /47 20/20 8/8 58/61 HeNR y Ford Hospital Detroit 72/75 44/47 20/20 8/8 56/61 1 NR=nonresponder 20

21 HeNR y Ford Wyandotte Hospital Wyandotte 72/75 44/47 20/20 8/8 17/61 Metro Health Hospital Wyoming 68/75 40/47 20/20 8/8 55/61 Oakwood Hospital and Medical Center Dearborn 75/75 47/47 20/20 8/8 42/61 Sparrow Hospital Lansing 70/75 43/47 20/20 7/8 54/61 University of Michigan Hospitals and Health Centers Ann Arbor 70/75 42/47 20/20 8/8 53.5/61 Minnesota Abbott Northwestern Hospital Minneapolis 65/75 38/47 20/20 7/8 58/61 Fairview Southdale Hospital Edina 56.5/ /47 20/20 5/8 57/61 St. Cloud Hospital Saint Cloud 70/75 42/47 20/20 8/8 57/61 Mercy Hospital Coon Rapids 65/75 38/47 20/20 7/8 58/61 United Hospital of St. Paul Saint Paul 65/75 38/47 20/20 7/8 58/61 Unity Hospital Fridely 65/75 38/47 20/20 7/8 58/61 University of Minnesota Medical Center Minneapolis 56.5/ /47 20/20 5/8 57/61 Montana Heartland Regional Medical Center Saint Joseph 54/75 26/47 20/20 8/8 56/61 University of Missouri Health Care Columbia 67.5/75 42/ /20 8/8 55/61 North Carolina Carolinas Medical Center Charlotte 68.5/ /47 20/20 8/8 61/61 Carolinas Medical Center-Lincoln Lincolnton 68.5/ /47 20/20 1 8/8 59/61 Duke University Hospital Durham 70/75 43/47 20/20 7/8 55/61 Southeastern Regional Medical Center Lumberton 73/75 45/47 20/20 8/8 52/61 1 NR=nonresponder 21

22 University of North Carolina Hospitals Chapel Hill 71/75 43/47 20/20 8/8 NR Vidant Medical Center Greenville 70.5/ /47 19/20 8/8 49/61 North Dakota Altru Hospital Grand Forks 67.5/ /47 20/20 8/8 59/61 Sanford Fargo Medical Center Fargo 68/75 40/47 20/20 8/8 58/61 Sanford Medical Center Bismarck 71/75 43/47 20/20 8/8 23.5/61 Nebraska Children's Hospital and Medical Center Omaha 64/75 38/47 20/20 6/8 57/61 New Hampshire Dartmouth-Hitchcock Medical Center Lebanon 61/75 35/47 18/20 8/8 55/61 New Jersey Hackensack University Medical Center Hackensack 72/75 44/47 20/20 8/8 58/61 Morristown Medical Center Morristown NR NR NR NR 58/61 Overlook Medical Center Summit 72/75 44/47 20/20 8/8 58/61 St. Peter's University Hospital New Brunswick 74/75 47/47 20/20 7/8 58/61 New York Mount Sinai Hospital New York 67/75 42/47 20/20 5/8 59/61 NYU Langone Medical Center New York 49/75 21/ /20 8/8 59/61 Rochester General Hospital Rochester 67/75 43/47 20/20 4/8 58/61 UR Medicine Strong Memorial Hospital Rochester 71/75 43/47 20/20 8/8 52/61 Ohio Akron Children's Hospital Akron 69.5/75 43/ /20 8/8 56/61 Bethesda North Hospital Cincinnati 73/75 45/47 20/20 8/8 NR 1 NR=nonresponder 22

23 Cleveland Clinic Cleveland 70/75 44/47 18/20 8/8 54/61 Euclid Hospital Euclid 70/75 44/47 18/20 8/8 54/61 Fairview Hospital Cleveland 69/75 44/47 17/20 8/8 55/61 Grandview Medical Center Dayton 69/75 41/47 20/20 8/8 60/61 Grant Medical Center-Ohio Health Columbus 72/75 44/47 20/20 8/8 55/61 Hillcrest Hospital Cleveland 70/75 44/47 18/20 8/8 NR Kettering Medical Center Kettering 69/75 41/47 20/20 8/8 60/61 Lutheran Hospital Cleveland 70/75 44/47 18/20 8/8 46/61 Metro Health Medical Center Cleveland 59/75 31/47 20/20 8/8 57/61 Miami Valley Hospital Dayton 65/75 38/47 20/20 7/8 58/61 Ohio State University James Cancer Hospital Columbus 62.5/75 36/ /20 8/8 57.5/61 Ohio State University Wexner Medical Center Columbus NR NR NR NR 60/61 Riverside Methodist Hospital-Ohio Health Columbus 28.5/75 11/ /20 4/8 56/61 South Pointe Hospital Warrensville Heights 70/75 44/47 18/20 8/8 NR Southwest General Health Center Middleburg Heights 52/75 28/ /20 4/8 55/61 St. Elizabeth Boardman Hospital Boardman 65/75 38/47 20/20 7/8 58/61 St. Elizabeth Youngstown Hospital Youngstown 63/75 36/47 20/20 7/8 58/61 St. Joseph Warren Hospital Warren 62/75 35/47 20/20 7/8 58/61 University Hospitals Case Medical Center Cleveland 74/75 46/47 20/20 8/8 45/61 University of Cincinnati Medical Center Cincinnati 67/75 39/47 20/20 8/8 56/61 1 NR=nonresponder 23

24 University of Toledo Medical Center Toledo 50/75 26/47 20/20 4/8 61/61 Oregon Legacy Meridian Park Medical Center Tualatin 65/75 38/47 20/20 7/8 58/61 Oregon Health and Science University Hospital Portland 70/75 42/47 20/20 8/8 NR Rogue Valley Medical Center Medford 70/75 43/47 20/20 7/8 50/61 Pennsylvania Chester County Hospital West Chester 47/75 25/47 17/20 5/8 55/61 Children's Hospital of Pittsburgh of UPMC Pittsburgh NR NR NR NR 60/61 Geisinger Medical Center Danville 74/75 46/47 20/20 8/8 57/61 Guthrie Robert Packer Hospital Sayre 70/75 42/47 20/20 8/8 56/61 Hospitals of the University of Pennsylvania-Penn Presbyterian Philadelphia 49/75 24/47 18/20 7/8 55/61 Lancaster General Hospital Lancaster 63/75 39/47 16/20 8/8 58/61 Pennsylvania Hospital Philadelphia 48/75 23/47 18/20 7/8 55/61 UPMC Hamot Erie 71/75 43/47 20/20 8/8 57/61 UPMC McKeesport McKeesport 67/75 43/ /20 7/8 56/61 UPMC St. Margaret Pittsburgh 67/75 42/47 17/20 8/8 59/61 UPMC-University of Pittsburgh Medical Center Pittsburgh 70/75 46/47 16/20 8/8 57/61 Williamsport Regional Medical Center Williamsport 73/75 45/47 20/20 8/8 56/61 South Carolina Medical University of South Carolina Charleston 73/75 47/47 18/20 8/8 NR 1 NR=nonresponder 24

25 Sanford USD Medical Center Sioux Falls 69/75 42/47 20/20 7/8 55/61 Texas Children's Medical Center Dallas Dallas 70/75 42/47 20/20 8/8 59/61 Texas Health Arlington Memorial Hospital Arlington 71.5/ /47 20/20 7/8 60/61 Texas Health Harris Methodist Hospital Fort Worth Fort Worth 71.5/ /47 20/20 7/8 60/61 Texas Health Harris Methodist Hospital Southwest Fort Worth 71.5/ /47 20/20 7/8 60/61 Texas Health Presbyterian Hospital Dallas Dallas 71.5/ /47 20/20 7/8 60/61 Texas Health Presbyterian Hospital Denton Denton 71.5/ /47 20/20 7/8 60/61 Texas Health Presbyterian Hospital Plano Plano 71.5/ /47 20/20 7/8 60/61 Trinity Mother Frances Hospital-Tyler Tyler 67/75 39/47 20/20 8/8 59/61 University of Texas Medical Branch Hospitals Galveston 72/75 46/47 20/20 6/8 44/61 UT Southwestern Medical Center Dallas NR NR NR NR 56/61 Utah University of Utah Hospitals and Clinics Salt Lake City 64/75 37/ /20 7/8 60/61 Virginia Carilion Roanoke Memorial Hospital Roanoke 73/75 46/47 20/20 7/8 59/61 Sentara CarePlex Hospital Hampton 74/75 46/47 20/20 8/8 59/61 Sentara Leigh Hospital Norfolk 74/75 46/47 20/20 8/8 59/61 Sentara Norfolk General Hospital Norfolk 74/75 46/47 20/20 8/8 58/61 Sentara Princess Anne Hospital Virginia Beach 74/75 46/47 20/20 8/8 59/61 1 NR=nonresponder 25

26 Sentara Williamsburg Regional Center Williamsburg 67/75 39/47 20/20 8/8 59/61 Winchester Medical Center Winchester 73/75 45/47 20/20 8/8 43.5/61 Washington Evergreen Health Medical Center Kirkland 60/75 37/47 17/20 6/8 55/61 Providence Holy Family Hospital Spokane NR NR NR NR 57/61 Providence Regional Medical Center Everett 59/75 34/47 20/20 5/8 55/61 Providence Sacred Heart Medical Center and Children's Hospital Spokane NR NR NR NR 59/61 Virginia Mason Medical Center Seattle 59/75 33/47 18/20 8/8 56/61 Wisconsin Appleton Medical Center Appleton 75/75 47/47 20/20 8/8 NR Aspirus Wausau Hospital Wausau 68/75 43/47 19/20 6/8 57/61 Aurora Lakeland Medical Center Elkhorn 43/75 17/47 18/20 8/8 56/61 Aurora Medical Center of Oshkosh Oshkosh NR NR NR NR 56/61 Aurora Medical Center Kenosha NR NR NR NR 55/61 Aurora Sheboygan Memorial Medical Center Sheboygan NR NR 1 NR NR 56/61 Aurora St. Luke's Medical Center Milwaukee 71/75 44/47 19/20 8/8 56/61 Bellin Memorial Hospital Green Bay 66.5/ /47 19/20 7/8 56/61 Community Memorial Hospital Menomonee Falls 59/75 34/47 20/20 5/8 55/61 Froedtert Hospital and the Medical College of Wisconsin Milwaukee 59/75 34/47 20/20 5/8 57/61 Gundersen Lutheran La Crosse NR NR NR NR 57/61 1 NR=nonresponder 26

27 Mayo Clinic Health Eau Claire Eau Claire 72.5/ /47 20/20 8/8 38/61 Mercy Health Hospital Janesville 65/75 38/47 20/20 7/8 57/61 Meriter Hospital Madison NR NR NR NR 55/61 St. Vincent Hospital Green Bay 46/75 18/47 20/20 8/8 59/61 University of Wisconsin Hospital and Clinics Madison NR NR 1 NR NR 59/61 West Virginia West Virginia University Hospitals Morgantown 71/75 44/47 20/20 7/8 61/61 Wyoming Cheyenne Regional Medical Center Cheyenne NR NR NR NR 57/61 Wyoming Medical Center Casper 70/75 42/47 20/20 8/8 28/61 NR=nonresponder 27