Labor and Delivery Excellence Award™
Gynecologic Surgery Excellence Award™
Obstetrics and Gynecology Excellence Award™
Contents
Healthgrades Obstetrics and Gynecology Awards 2022 Methodology
Performance Measurement: Ratings and Awards
Using Ratings to Communicate Performance
Using Awards to Communicate Performance
Labor and Delivery Excellence Award™ Methodology
Clinical Excellence Award Determination
Gynecologic Surgery Excellence Award™ Methodology
Clinical Excellence Award Determination
Obstetrics and Gynecology Excellence Award™ Methodology
Clinical Excellence Award Determination
Appendix A. All-Payer States Citations and Disclaimers
Performance Measurement: Ratings and Awards
To help consumers evaluate and compare hospital performance specific to specialty service lines and specialty focus areas, Healthgrades communicates performance in two ways—through ratings and awards.
Patient Outcome Data for All Patients
To measure performance, Healthgrades analyzed patient outcome data for all patients (all-payer data) provided by 16 individual states for years 2018 through 2020. The 16 states evaluated were:
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*See Appendix A. All-Payer States Citations and Disclaimers
In-Hospital Complications-Based Procedures & Conditions
Patient outcomes data for four conditions or procedures were analyzed:
- C-Section Delivery
- Gynecologic Procedures
- Hysterectomy
- Vaginal Delivery
The first and most fundamental way that Healthgrades communicates performance is through star ratings. Star ratings are an evaluation of the hospital’s actual performance compared to its predicted performance. Hospital predicted performance is calculated based on risk adjustment of the acuity of a hospital’s patient population. For more details, see the Healthgrades Obstetrics and Gynecology Ratings 2022 Methodology.
The purpose of risk adjustment is to obtain fair statistical comparisons of mortality and complication rates between hospitals while accounting for differences in underlying risk factors observed in the data among disparate populations or groups. Significant differences in clinical and demographic risk factors are found among patients treated in different hospitals. Therefore, it is necessary to make accurate and valid comparisons of clinical outcomes with a methodology using risk-adjustment techniques. Risk factors may include age, gender, specific procedure performed, and comorbid conditions, such as hypertension or diabetes.
Developing the Healthgrades hospital star performance categories involves four steps:
1. The hospital predicted value (predicted number of complications at each hospital) is calculated by summing the individual patient record predicted values determined from logistic regression models discussed above.
2. The hospital predicted value is compared with the actual or observed value (e.g., actual number of complications at each hospital).
3. A test is conducted to determine whether the difference between the predicted and actual values is statistically significant. This test is performed to make sure that differences were very unlikely to be caused by chance alone. A z-score is used to establish a 90% confidence level.
4. Hospital performance categories are determined based upon the outcome of the test for statistical significance.
For each condition or procedure, hospital performance is evaluated and stratified into three categories:
★★★★★ Better Than Expected – Actual performance was better than predicted and the difference was statistically significant at alpha = 0.1.
★★★ As Expected – Actual performance was not statistically significantly different from what was predicted at alpha = 0.1.
★ Worse Than Expected – Actual performance was worse than predicted and the difference was statistically significant at alpha = 0.1.
Healthgrades uses z-scores (individual or aggregate) to determine performance. A z-score is a standardized statistical test that compares the difference between the actual and predicted complication and mortality rates, taking into account patient variability and volume. A higher z-score means better performance.
A complete description of the methodology including risk factors, multivariate logistic regression model, and other relevant information is available in the Healthgrades Obstetrics and Gynecology Ratings 2022 Methodology. Patients were identified by their ICD-10 principal procedure for gynecologic surgeries and Diagnosis Related Groups (DRGs) for labor and delivery. A full list of ICD-10 codes can be found in Healthgrades ICD-10 Mapping Tool at https://icd10mappingtool.healthgrades.com/.
The second way Healthgrades communicates information on performance is by awards. Awards determine and communicate a hospital’s superior performance when compared to other eligible hospitals.
Each award has eligibility requirements specific to the nature and intent of the award. All awards require that a hospital receive a rating in the cohort(s) included in the determination of the award. Awards may reference a singular cohort or require the combination of a grouping of cohorts. Specific information on the cohorts included in each award is outlined in the sections below.
Labor and Delivery Excellence Award™ Methodology
The Labor and Delivery Excellence Award™ provides healthcare consumers with more transparency about hospitals that have exceptional clinical outcomes while caring for a patient during and immediately after childbirth. Patients and consumers benefit from this transparency because they will now have information to make informed decisions about the best hospitals to choose for their labor and delivery needs.
The Labor and Delivery Excellence Award recognizes the top 10% of hospitals in the country for clinical excellence in labor and delivery. While many hospitals have specific areas of expertise and high-quality outcomes in certain areas, these hospitals exhibit comprehensive high-quality care for patients during and after delivery. The award is based on complication outcomes for live-born single births delivered via vaginal delivery and live-born single and twin births delivered via C-section.
To help consumers assess and compare hospital performance relative to this award, Healthgrades uses a two-step methodology:
1. Evaluate hospital performance for two delivery types: C-section and vaginal births. Specifically:
- Live-born single births delivered via vaginal delivery
- Live-born single and twin births delivered via C-section
2. Identify the hospitals with superior performance overall for both delivery types using a volume-weighted z-score.
To be considered for an award in this specialty area, a hospital must be evaluated and categorized into one of three performance categories for both C-Section Delivery and Vaginal Delivery. We evaluate both procedures based on in-hospital complications. The Labor and Delivery Excellence Award is based on a volume-weighted average of the z-scores for these procedures.
After creating a list of hospitals that meet the above eligibility criteria, Healthgrades uses the following steps to determine recipients of the Labor and Delivery Excellence Award:
1. Determine an overall performance score: The overall performance score for each hospital is calculated using volume-weighted z-scores averaged across both cohorts. Volume weights represent the proportion of patients within a given cohort. The proportion is calculated as the ratio of patients in a cohort and outcome measure over total patients across both cohorts.
The final contribution of each cohort to the overall score will vary based on the mix of delivery types at each hospital.
2. Determine performance in sequential order: Hospitals are listed in descending order by their overall performance score.
3. Identify top 10% of all facilities: The top performers are selected from the above listing and receive the Labor and Delivery Excellence Award for 2022.
Gynecologic Surgery Excellence Award™ Methodology
The Gynecologic Surgery Excellence Award™ provides healthcare consumers with more transparency about hospitals that have exceptional clinical outcomes in procedures that treat diseases and conditions of the reproductive system and correct certain conditions of the urinary tract and rectum.
The Gynecologic Surgery Excellence Award recognizes the top 10% of hospitals in the country for clinical excellence. While many hospitals have specific areas of expertise and high-quality outcomes in certain areas, these hospitals exhibit comprehensive high-quality care for patients during gynecologic procedures.
To help consumers evaluate and compare hospital performance relative to this award, Healthgrades uses a two-step methodology:
1. Evaluate hospital performance for two types of procedures—hysterectomy and gynecologic procedures (other than hysterectomies).
2. Identify the hospitals with superior performance overall for both types of procedures using a volume-weighted z-score.
To be considered for an award in this specialty area, a hospital must be evaluated and categorized into one of three performance categories for both Hysterectomy and Gynecologic Procedures. We evaluate both procedures based on in-hospital complications. The Gynecologic Surgery Excellence Award is based on a volume-weighted average of the z-scores for these procedures.
After creating a list of hospitals that meet the above eligibility criteria, Healthgrades uses the following steps to determine recipients of the Gynecologic Surgery Excellence Award:
1. Determine an overall performance score: The overall performance score for each hospital is calculated using volume-weighted z-scores averaged across both cohorts. Volume weights represent the proportion of patients within a given cohort. The proportion is calculated as the ratio of patients in a cohort and outcome measure over total patients across both cohorts.
The final contribution of each cohort to the overall score will vary based on the mix of hysterectomies and gynecologic procedures at each hospital.
2. Determine performance in sequential order: Hospitals are listed in descending order by their overall performance score.
3. Identify top 10% of all facilities: The top performers are selected from the above listing and receive the Gynecologic Surgery Excellence Award for 2022.
Obstetrics and Gynecology Excellence Award™ Methodology
The Obstetrics and Gynecology Excellence Award™ provides healthcare consumers with more transparency about hospitals that have exceptional clinical outcomes while caring for patients during and after childbirth and in procedures that treat diseases and conditions of the reproductive system.
The Obstetrics and Gynecology Excellence Award recognizes the top 10% of hospitals in the country for clinical excellence. While many hospitals have specific areas of expertise and high-quality outcomes in certain areas, these hospitals exhibit comprehensive high-quality care for patients during and after childbirth and across a range of gynecologic procedures.
To help consumers evaluate and compare hospital performance relative to this award, Healthgrades uses a two-step methodology:
1. Evaluate hospital performance for four types of procedures:
- C-Section Delivery
- Gynecologic Procedures (other than hysterectomies)
- Hysterectomy
- Vaginal Delivery
2. Identify the hospitals with superior performance overall in Obstetrics and Gynecology using a volume-weighted z-score.
To be considered for an award in this specialty area, a hospital must be evaluated and categorized into one of three performance categories for C-Section Delivery, Gynecologic Procedures, Hysterectomy, and Vaginal Delivery. We evaluate all four cohorts based on in-hospital complications. The Obstetrics and Gynecology Excellence Award is based on a volume-weighted average of the z-scores for these procedure groups.
After creating a list of hospitals that meet the above eligibility criteria, Healthgrades uses the following steps to determine recipients of the Obstetrics and Gynecology Excellence Award:
1. Determine an overall performance score: The overall performance score for each hospital is calculated using volume-weighted z-scores averaged across all four cohorts. Volume weights represent the proportion of patients within a given cohort. The proportion is calculated as the ratio of patients in a cohort and outcome measure over total patients across all four cohorts.
The final contribution of each cohort to the overall score will vary based on the mix of the four types of conditions and procedures at each hospital.
2. Determine performance in sequential order: Hospitals are listed in descending order by their overall performance score.
3. Identify top 10% of all facilities: The top performers are selected from the above listing and receive the Obstetrics and Gynecology Excellence Award for 2022.
Appendix A. All-Payer States Citations and Disclaimers
We respectfully list the following citations and disclaimers as requested from the following states that provide inpatient data.
Nevada: This information is from the records of the Nevada Division of Health Care Financing and Policy (DHCFP) and was released through the Center of Health Information Analysis (CHIA) of the University of Nevada, Las Vegas. Authorization to release this information does not imply endorsement of this study or its findings by either DHCFP or CHIA.
New York: This publication was produced from raw data purchased from or provided by the New York State Department of Health (NYSDOH). However, the conclusions derived, and views expressed herein are those of the author(s) and do not reflect the conclusions or views of NYSDOH. NYSDOH, its employees, officers, and agents make no representation, warranty or guarantee as to the accuracy, completeness, currency, or suitability of the information provided here.
Rhode Island: Rhode Island Hospital Discharge Data, Center for Health Data & Analysis, Rhode Island Department of Health
Virginia: Virginia Health Information (VHI) has provided non-confidential patient level information used in this file, report, publication, or database which it has compiled in accordance with Virginia law but which it has no authority to independently verify. By using this file, report, publication, or database, the user agrees to assume all risks that may be associated with or arise from the use of inaccurate data. VHI cannot and does not represent that the use of VHI’s data was appropriate for this file, report, publication, or database or endorse or support any conclusions of inferences that may be drawn from the use of VHI’s data.
Washington: Washington State Data is being made available from the Washington State Department of Health.
For a downloadable PDF, check out our Healthgrades Obstetric & Gynecology Excellence Awards 2022 Methodology.