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Organ Transplants
In its role under the National Organ Transplant Act as the responsible steward of the program of solid organ transplantation in the United States, the Department of Health and Human Services has carried out analyses of the three critical issues in transplantation. These are: (1) What is the likelihood that, having been declared a transplant patient by being placed on a waiting list, the patient will actually receive an organ within a reasonable amount of time, say one year? (2) What is the likelihood that the patient will, instead, die while awaiting transplantation? (3) And what is the probability that the patient will still be alive one year after having been placed on the list, whether or not he or she received a transplant? The need for such analyses is highlighted by Figures A (for liver transplantation) and B (for heart transplantation). These figures present the fraction of centers (vertical axis) with actual transplant or waiting-list mortality rates (horizontal axes) and demonstrate the very wide variation among the centers in the rates of transplantation achieved for the patients within one year of being placed on the waiting list. In contrast, the variation in waiting-list mortality rates is much narrower and more clearly centered around an average or peak rate. This indicates that, unlike the probability of death, which is primarily but not solely determined by the clinical condition of the patient, many other considerations determine the probability of being transplanted. This point is brought out more clearly in Figures C (liver) and D (heart) and in more detail in Tables A (liver) and B (heart). These tables and figures present center-specific risk-adjusted rates of transplantation or of death on the waiting list and the probability of still being alive overall one year after being placed on the waiting list. The risk-adjustment corrects, as best the currently available data permit, for the disparities in the clinical conditions at the time of listing of the patients accepted as candidates by the various centers. Despite the risk-adjustment, a wide variation in center-specific outcomes is observed. In the case of liver transplantation, 10% of the centers have a standardized risk-adjusted rate of transplantation within one year of listing of 24.9% or less, and 10% have a rate of 71.2% or more. For the probability of dying within a year of listing while awaiting a liver transplant, the corresponding range is 7.7-22.3%, and for the probability of surviving one year as a candidate and/or recipient of the liver transplant the range is 65.3-85.9%. The ranges of standardized risk-adjusted probabilities for heart transplantation are: 35.8-71.8% (transplantation), 9.4-23.1% (death while awaiting a transplant), and 67.0-84.0% (one year survival). In both liver and heart transplantation, about two-thirds of the deaths within a year of listing occur while awaiting the transplant. The two measures of mortality are strongly correlated, with about 50% of the variation among centers in risk-adjusted survival accounted for by risk-adjusted mortality on the waiting list. In contrast, there is little correlation between the risk-adjusted rate of transplantation and risk-adjusted survival, none in the case of the liver. In other words, a more aggressive transplant policy does not necessarily achieve better ultimate results. This reinforces the point that the early performance of a transplant is not necessarily the best care that can be provided to a patient. The best care consists of a broad constellation of practices of the listing center and of other hospitals and care-givers to which the patient is subjected while awaiting transplantation, as well as during and after the transplantation itself. In carrying out these analyses, the Department identified gaps in the currently available data collected by the Scientific Registry. Some additional clinical details about the condition of the patient at the time of listing will be helpful in improving risk-adjustment. Moreover, death is not the sole outcome that must be addressed in the evaluation of transplantation because it is not the sole factor that drives the care of the patient. A clear understanding of the morbidity (clinical complications) and of the impairment of the patient's ability to function before and after transplantation is also indispensable. For this, the data are currently not available. The Department, to fulfill its responsibility for review and oversight of transplantation in the United States, is currently reevaluating the objectives and functions of the Scientific Registry. Its goal is to assure that the Registry carries out on an ongoing and timely basis the assessments of the effectiveness of the transplant program in sustaining the life, health and functional capacities of transplant patients, and of the burdens associated with their care, needed by the Department and by the transplantation community. How to Read the Tables The objective of the accompanying tables is to inform persons concerned with liver or heart transplantation, most particularly the patients, of the likelihood of three critical outcomes: (a) receiving a transplant within one year of being placed on the waiting list, (b) dying before receiving a transplant, and (c) most importantly, still being alive at least one year after being placed on the waiting list. This information, which applies to an average candidate, is contained in the columns labeled Survival, subheaded Alive (at one year), and Experience on the Waiting List with subheadings Transplanted or Died (within 1 year). The outcomes are presented in two forms, Actual and Adjusted. The term Adjusted refers to a method for correcting for the differences in the severity of the illness of the patients taken care of by the different centers by projecting the center's result, corrected for the severity of illness of its patients, on a standard population. If all patients received equally effective care, the centers' adjusted rates would be identical. The differences among the centers in the adjusted rates, therefore, reflect the differences in how well the patients were cared for by the listing center as well as by other hospitals and care givers who participated in the management of the patients' conditions. The first column in each Table identifies by a code number the Center at which the patients were registered as candidates for transplantation. The column labeled Patients gives number of persons listed and provides an indication of how active that center is. The next two columns report on the probability of surviving one year after listing, whether or not a transplant was received - the "bottom line". The remaining numerical columns provide information on the two principal alternative events that the patient may experience while awaiting a transplant - receipt of the transplant or death. A third alternative, which affects a very small proportion, removal from the waiting list, was also considered in the analyses. All the patients for whom data are displayed in these last columns were followed for at least a full year, hence the cutoff date of December 31, 1997 to permit follow up through 1998. Because of delays in reporting in the post-transplant period, an earlier cutoff date, December 31, 1996, was needed in the analysis of survival. The ranges listed beneath the US averages cover the middle 80% of the centers. Thus, 10% of the centers had rates below the lower end of the range and 10% had rates above the upper end of the range. In the evaluation of performance, attention should principally focus on the magnitude of the difference between the center=s result and the US average. The ranges are provided to help the reader assess how much the experience of the patients of that center differs from the average.
An additional indication of the differences among the centers is given by the + and - signs to the right of the numbers that signify the rate. This indication addresses the statistical uncertainty about how precisely those differences can be measured. The uncertainty is greatest when few cases or patients are involved and smallest in the case of the high-volume centers. A single symbol indicates that the center=s outcome differs from what would be expected with reasonable certainty (less than 1 chance in 20 that the difference is due to chance only) and two symbols indicate considerable certainty (less than one chance in 100). A + sign indicates that the difference is in a favorable direction (higher probability of transplantation and of surviving at least one year, and lower probability of dying while awaiting a transplant), and a - sign indicates an unfavorable direction (lower than expected probability of transplantation, etc.). The difference between the result obtained at a center and the national average, taken together with this measure of uncertainty, is, therefore, an indication of how distinctively different the experience of the center's patients is from the national average. (Please note that the measures of uncertainty apply to a pattern rather than specifically to the data provided in the Tables. For example, in the case of Survival, the analyses addressed the pattern of survival for a period of up to three years, and that is what is reported by the measure of the level of uncertainty, not just the result at one year given in the Table.) How to Use the Tables We have produced the accompanying Tables to draw on recent experience in liver and heart transplantation to help clinicians to provide and patients to obtain the best care possible. By describing what happened to patients following their acceptance as candidates for transplantation by the more than 100 transplant centers in the US, we hope to enable (1) patients and their physicians to make more informed choices, and (2) the transplantation community to more effectively examine its practices and identify those that offer the greatest benefits to the patients. To compare the experiences of the patients of the various centers, attention should principally be given to the columns that contain the standardized, risk-adjusted data. The data for a particular center should be compared to the national average, given in the first line of each column, and to the range, given in the second line in each column. The range provides reference marks to calibrate the degree of concern with which a center's difference from the national average should be viewed by giving the results obtained by the middle 80% of the centers, with 10% of the centers having results below the low end of the range and 10% above the high end of the range. The columns with the pluses and minuses give an indication of how (un)likely it is that the deviation from the national norm could have been due purely to chance. The pluses and minuses arenot measures of how "good" or "bad" the centers are. A single plus or minus indicates a chance of less than one in 20 and two pluses or minus a chance of less than one in 100. But keep in mind that over 100 centers are listed in the Tables. That means that for 6 or 7 of them, the observed deviations could in fact be the result of statistical uncertainty at the 1 in 20 level, and for 1 or 2 at the 1 in 100 level. Therefore, although the data given in the Tables are suggestive, they do not provide definitive proof of superior or inferior performance. What the data do clearly demonstrate is that there is,for the very effective life-saving treatments of heart and liver transplantation, wide variation in the results achieved at different centers, even after variations in the severity of illness of the patients of these centers are corrected for. We began this note with the statement that the purpose of the Tables is to help us learn from experience. We must end with a word of caution. Whether we draw lessons correctly from experience depends entirely on how completely and accurately the patients, their severity of illness and what happened to them are known to us and on how good the analytic methods that we used are. We are confident about the methods because they have been well tested over the years. However, because the collection of the data about the patients and the clinical events they experience is a complex and arduous task, gaps do exist. In one extreme example, data on either the height or the weight of 80% of the patients of one center were unavailable, preventing the calculation in those cases of the body mass index, an important predictor in several analyses. Depending on how the missing data were handled in the analyses, the results at that center appeared either very good or just average. Therefore, the gaps in the data limit the accuracy of the assessments of performance that we can produce. We are confident about the pattern of variation that we observed, but less so about the position of any given center within that variation. We are currently working with the Scientific Transplant Registry to fill the gaps in the data and to further improve the analytic methods so that we may better determine what works best for patients.
Table A. The Risk-Adjusted Experience of Patients Registered for Liver Transplantation Within One Year of Being Placed on the Waiting List
Survival Experience on the Waiting List (Listings, 4/94-12/96) (Listings, 4/94-12/97) Alive Transplanted Died (at 1 Year) (within 1 year) Patients/Actual%/Adjusted% Patients/Actual%/Adjusted%/Actual%/Adjusted%
-------------------------------------------------------------------------------- US 16,406 79.6% 79.6% 23,326 46.8% 46.8% 14.1% 14.1%
National Range [10-90%] 67.3-87.7 65.3-85.9 22.5-75.0 24.9-71.2 7.4-20.9 7.7-22.3)
University of Alabama Hospital, Birmingham, AL 249 85.8 79.6 + 375 74.4 71.9 ++ 11.2 12.1 ++
University Medical Center, Tucson, AZ 94 73.4 72.0 - 136 40.4 42.4 18.4 22.3 -
Cedars-Sinai Medical Center, Los Angeles, CA 177 78.6 85.2 250 65.6 65.6 ++ 9.2 7.6
Green Hospital of Scripps Clinic, La Jolla, CA 128 85.7 85.9 + 171 43.9 41.9 - 9.9 10.9
University of California-Irvine Medical Center, Orange, CA 58 78.0 79.7 102 47.1 43.8 9.8 7.2 ++
Loma Linda University Medical Center, Loma Linda, CA 112 87.3 86.7 143 39.9 41.2 - 10.5 9.9 +
California Pacific Medical Center, San Francisco, CA 356 87.7 83.6 ++ 493 22.5 24.2 -- 11.2 14.6 --
UCSD Medical Center, San Diego, CA 96 76.8 79.5 150 20.7 30.0 -- 18.7 18.3
UCSF Medical Center, San Francisco, CA 777 89.8 88.1 ++ 1024 21.2 25.1 -- 9.7 11.2 ++
University of California Davis Medical Center, Sacramento, CA 41 65.4 55.9 - 58 70.7 71.2 ++ 15.5 17.0 --
Stanford University Medical Center, Palo Alto, CA 374 87.3 81.9 + 547 26.0 28.8 -- 10.8 13.6 ++
St. Vincent Medical Center, Los Angeles, CA 28 70.8 76.8 56 26.8 31.0 - 19.6 19.3
UCLA Medical Center, Los Angeles, CA 720 79.3 82.9 ++ 1042 62.9 56.3 ++ 13.0 10.8
USC-University Hospital, Los Angeles, CA 47 58.3 63.9 -- 93 17.2 24.9 -- 20.4 16.5
The Children's Hospital, Denver, CO 32 93.7 95.0 + 39 56.4 41.1 7.7 8.9
Porter Memorial Hospital, CO 17 94.1 65.1 17 23.5 27.8 - 5.9 9.8
University Hospital, Denver, CO 268 83.2 78.3 364 34.9 37.9 -- 14.0 19.3
Hartford Hospital, Hartford, CT 26 61.5 60.8 - 37 59.5 52.8 24.3 25.5 -
Yale New Haven Hospital, New Haven, CT 100 75.2 73.5 150 21.3 22.9 -- 17.3 19.3
Howard University Hospital, Washington, DC 42 83.1 75.0 44 54.5 61.7 ++ 13.6 18.3 -
Jackson Memorial Hospital, Miami, FL 556 73.7 77.1 837 69.2 67.4 ++ 14.1 13.6 ++
Tampa General Hospital, Tampa, FL 8 62.5 67.2 46 65.2 62.2 + 21.7 18.8 -
Shands Hospital, Gainesville, FL 262 80.3 80.4 392 65.8 66.1 ++ 11.2 12.1 ++
Egleston Children's Hospital, Atlanta, GA 7 84.6 83.8 32 65.6 63.8 ++ 12.5 15.3 -
Emory University Hospital, Atlanta, GA 235 70.6 71.1 -- 296 75.3 73.7 ++ 18.2 18.7 --
St. Francis Medical Center, Honolulu. HI 18 77.6 76.7 27 40.7 45.7 18.5 22.7
University of Iowa Hospitals & Clinics, Iowa City, IA 118 76.8 76.9 147 77.6 76.4 ++ 11.6 11.6 ++
Northwestern Memorial Hospital, Chicago, IL 127 83.9 81.0 202 34.2 37.6 -- 10.9 11.6 +
Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 338 75.6 78.5 433 32.3 32.6 -- 18.5 14.9
University of Chicago Medical Center, Chicago, IL 457 77.2 77.1 646 37.9 39.8 -- 13.6 14.0 +
University of Illinois Hospital, Chicago, IL 128 77.0 77.2 231 20.3 23.1 -- 16.5 16.5 -
Methodist Hospital of Indiana, Indianapolis, IN 82 69.5 67.6 -- 111 36.0 40.4 18.9 24.5 -
Indiana University Hospitals, Indianapolis, IN 151 79.4 78.3 225 34.2 37.4 -- 16.4 17.3
University of Kansas Medical Center, Kansas City, KS 87 87.7 84.7 121 90.1 89.0 ++ 7.4 7.7 ++
Jewish Hospital, Louisville, KY 83 67.3 69.0 - 121 75.2 74.8 ++ 14.0 13.8 ++
University of Kentucky Medical Center, Lexington, KY 49 72.7 75.2 91 57.1 57.7 ++ 24.2 24.5 --
Ochsner Foundation Hospital, New Orleans, LA 87 79.1 82.5 104 63.5 62.9 ++ 10.6 11.2
Southern Baptist Hopsital, LA 12 82.5 60.8 25 32.0 36.3 24.0 29.4
Tulane University Medical Center, LA 24 31.7 51.2 -- 30 60.0 57.6 + 26.7 24.6 --
Willis-Knighton Medical Center, Shreveport, LA 69 77.8 76.2 88 59.1 55.2 14.8 15.7
Beth Israel Hospital, MA 101 99.0 82.2 ++ 214 0.9 2.6 -- 1.9 4.7 ++
Children's Hospital, Boston, MA 32 87.0 85.2 35 28.6 17.3 -- 14.3 16.4
Beth Israel Deaconess Medical Center, Boston, MA 177 62.4 63.9 -- 208 35.1 34.7 32.2 33.1 --
Massachusetts General Hospital, Boston, MA 164 84.4 79.8 213 25.8 29.3 -- 15.5 18.1
New England Medical Center, Boston, MA 259 80.2 76.7 366 23.0 28.2 -- 13.4 17.0
University of Massachssetts Medical Center, MA 5 100.0 100.0 10 20.0 23.9 - 0.0 0.0 ++
Johns Hopkins Hospital, Baltimore, MD 340 79.2 76.6 - 469 19.4 23.3 -- 16.4 19.8
University of Maryland Medical System, Baltimore, MD 108 76.2 77.7 175 17.7 20.8 -- 20.0 21.3
Henry Ford Hospital, Detroit, MI 97 77.8 78.5 161 51.6 54.1 13.0 12.4
University of Michigan Medical Center, Ann Arbor, MI 348 76.7 78.9 -- 470 24.3 24.3 -- 20.0 17.5 --
Rochester Methodist Hospital, Rochester, MN 291 86.1 82.3 + 415 70.4 67.7 ++ 9.4 12.2 ++
St. Mary's Hospital, Rochester, MN 21 85.2 84.4 28 75.0 66.0 + 7.1 11.9
Fairview University Medical Center, Minneapolis, MN 94 79.6 77.3 130 63.8 63.1 ++ 13.8 14.4 -
Barnes-Jewish Hospital, St. Louis, MO 202 82.9 82.5 268 58.2 55.0 ++ 15.3 15.3 -
Cardinal Glennon Children's Hospital, St. Louis, MO 12 100.0 79.0 13 76.9 73.6 0.0 0.0 ++
St. Louis Children's Hospital, St. Louis, MO 25 87.8 83.8 31 41.9 32.5 9.7 11.8
The Children's Mercy Hospital, MO 6 83.3 86.4 14 78.6 67.5 0.0 0.0 ++
St. Louis University Hospital, St. Louis, MO 112 76.3 77.9 174 52.9 55.9 + 11.5 10.7
Carolinas Medical Center, Charlotte, NC 55 90.9 89.1 + 90 56.7 54.9 12.2 12.7
Duke University Medical Center, Durham, NC 156 80.0 73.4 220 53.2 57.2 ++ 11.4 14.7 -
University of North Carolina Hospitals, Chapel Hill, NC 160 82.8 83.1 + 269 40.5 39.0 -- 11.9 10.8 ++
University of Nebraska Medical Center, Omaha, NE 377 71.5 73.1 -- 524 46.6 43.2 20.4 22.1 --
University Hospital, Newark, NJ 113 83.7 84.3 173 81.5 79.7 ++ 8.7 8.5 ++
University Hospital, University of New Mexico, NM 47 68.5 58.1 -- 65 43.1 44.9 - 26.2 28.1 --
SYNU HC at Brooklyn, NY 6 50.0 74.6 20 40.0 54.3 15.0 12.3
Strong Memorial Hospital, Rochester, NY 126 84.6 81.1 189 47.1 52.6 10.6 10.3
Mount Sinai Medical Center, New York, NY 717 78.3 81.6 + 989 50.3 49.8 14.7 12.6
New York University Medical Center, New York, NY 266 86.7 85.6 ++ 391 33.5 40.5 -- 8.4 10.4 ++
Westchester County Medical Center, NY 12 83.3 72.0 70 32.9 42.1 11.4 11.4
Cleveland Clinic Foundation, Cleveland, OH 232 77.5 75.8 324 44.4 42.6 20.1 21.4 --
Children's Hospital Medical Center, Cincinnati, OH 45 72.6 79.4 66 68.2 58.5 + 15.2 14.8
Ohio State University Hospitals. Columbus, OH 97 72.9 68.9 - 168 57.7 54.9 ++ 11.9 14.8
University of Cincinnati Medical Center, Cincinnati, OH 108 80.2 78.3 157 48.4 46.5 10.8 10.6
University Hospital. Cleveland, OH 112 79.8 80.0 148 52.0 46.0 8.8 8.3 +
Integris Baptist Medical Center, Oklahoma City. OK 149 83.0 85.6 206 72.3 67.6 ++ 10.7 10.7
Oregon Health Sciences University Hospital, Portland, OR 190 79.3 76.7 258 50.8 50.5 13.2 14.6
VA Hospital, Portland, OR 92 75.8 73.1 117 40.2 39.7 - 14.5 13.6
Albert Einstein Medical Center, Philadelphia, PA 154 78.1 78.4 261 34.9 44.8 10.3 9.6 +
Children's Hospital, Pittsburgh, PA 156 74.3 73.6 208 37.0 27.2 -- 21.6 21.8
Children's Hospital. Philadelphia. PA 33 84.1 86.2 51 62.7 50.9 5.9 6.7
Milton S. Hershey Medical Center. Hershey, PA 41 73.2 65.3 68 20.6 21.7 -- 17.6 21.4
University of Pittsburgh Medical Center, Pittsburgh, PA 673 80.1 79.3 854 48.0 47.0 12.5 11.7 +
St. Christopher's Hospital for Children, Philadelphia. PA 51 82.7 89.2 + 73 46.6 37.1 9.6 7.3 +
Thomas Jefferson University Hospital, Philadelphia, PA 196 75.2 77.3 250 33.6 27.8 -- 20.0 16.0 -
Hospital of University of Pennsylvania, Philadelphia, PA 247 72.9 79.2 409 36.4 37.6 -- 18.3 15.4
Oakland VA Medical Center, Pittsburgh, PA 128 71.5 77.2 158 34.2 30.3 -- 20.9 16.4
Medical University of South Carolina. Charleston, SC 118 59.9 63.5 -- 171 64.3 61.2 ++ 22.8 24.7 --
Le Bonheur Children's Medical Center, Memphis, TN 10 50.0 55.9 - 11 54.5 48.1 ++ 45.5 51.9
University of Tennessee Medical Center, Memphis, TN 101 60.6 66.3 -- 150 66.0 70.8 ++ 18.7 15.1 --
Vanderbilt University Medical Center, Nashville, TN 93 79.4 79.8 153 75.8 72.9 ++ 15.7 17.0 --
University Hospital. San Antonio, TX 120 83.0 81.2 211 46.4 53.0 + 14.7 14.8
Children's Medical Center, Dallas, TX 41 85.3 89.6 53 84.9 72.8 + 5.7 6.4
Hermann Hospital, Houston. TX 136 76.4 75.3 206 59.7 57.2 ++ 17.0 18.9 --
St. Luke's Episcopal Hospital, Houston; TX 32 75.0 71.4 45 68.9 65.6 ++ 20.0 21.4 --
Texas Children's Hospital, Houston, TX 33 84.8 85.3 41 65.9 51.6 7.3 9.3
Baylor University Medical Center, Dallas, TX 490 79.3 83.8 + 655 58.5 54.1 ++ 15.9 13.8
Latter-Day Saints Hospital, Salt Lake City, UT 108 81.0 82.9 148 62.2 58.3 ++ 12.2 12.7
Primary Children's Medical Center, Salt Lake City, UT 7 71.4 69.8 16 56.2 55.0 12.5 15.8
Inova Fairfax Hospital, Falls Church, VA 145 83.8 81.0 199 52.8 51.7 12.1 12.1
Medical College of Virginia Hospitals, Richmond, VA 178 81.4 78.3 267 54.7 58.3 ++ 10.9 13.1
University of VA Health Science Center, Charlottesville, VA 186 78.7 79.1 226 55.3 52.1 11.1 10.7
Children's Hospital & Medical Center, Seattle, WA 16 86.2 85.7 29 37.9 35.5 13.8 12.1
University of Washington Medical Center, Seattle, WA 280 78.6 82.8 355 44.5 51.3 16.6 14.1
Children's Hospital of Wisconsin, Milwaukee, WI 11 100.0 91.3 16 75.0 60.9 0.0 0.0 ++
Froedtert Memorial Lutheran Hospital, Milwaukee, WI 68 70.4 71.9 - 100 84.0 82.9 ++ 14.0 15.5 --
University of Wisconsin Hospital and Clinics, Madison, WI 225 80.7 82.1 308 68.8 65.2 ++ 10.1 10.8
Table B.The Risk-Adjusted Experience of Patients Registered for Heart Transplantation Within One Year of Being Placed on the Waiting List
Survival Experience on the Waiting List (Listings, 4/94-12/96) (Listings, 4/94-12/97) Alive Transplanted Died (at 1 Year) (within 1 year) Patients / Actual%/Adjusted% Patients / Actual%/Adjusted% / Actual%/Adjusted%
-------------------------------------------------------------------------------- 10,034 75.8% 75.8% 13,448 53.7% 53.7% 16.5% 16.5% National Range[10-90%] 64.4-83.5 67.0-84.0 35.0-72.7 35.8-71.8 10.0-24.7 9.4-23.1)
University of Alabama Hospital, Birmingham, AL 148 74.9 74.1 203 71.4 71.8 ++ 17.7 18.8 --
University Medical Center, Tucson, AZ 153 89.4 82.7 + 223 43.0 43.9 -- 11.2 15.6 +
Baptist Medical Center, Little Rock, AR 35 74.3 75.5 48 70.8 74.4 ++ 18.8 18.6 --
Arkansas Children's Hospital, Little Rock, AR 21 68.1 84.6 40 62.5 72.4 ++ 25.0 20.2 --
UCSD Medical Center, San Diego, CA 43 82.0 82.0 66 65.2 63.2 13.6 12.1
California Pacific Medical Center, San Francisco, CA 80 80.7 75.3 113 43.4 45.8 16.8 19.6
Sharp Memorial Hospital, San Diego. CA 60 85.0 81.8 83 42.2 43.0 - 19.3 21.5
Sutter Memorial Hospital, Sacramento, CA 10 69.3 67.2 18 61.1 63.3 16.7 20.0
UCLA Medical Center, Los Angeles, CA 338 76.7 78.3 509 55.8 57.8 14.9 14.2
Loma Linda University Medical Center, Loma Linda, CA 105 71.5 80.6 + + 146 66.4 67.9 ++ 17.8 14.8 ++
Stanford University Medical Center, Palo Alto, CA 139 78.0 77.5 190 61.6 60.5 + 15.3 14.8
UCSF Medical Center, San Francisco, CA 46 84.7 80.5 68 52.9 58.1 10.3 11.1
St. Vincent Medical Center, Los Angeles, CA 41 79.7 78.2 60 71.7 73.8 + 13.3 8.1
Cedars-Sinai Medical Center, Los Angeles, CA 86 87.2 83.0 110 77.3 75.8 ++ 10.0 10.8
USC-University Hospital, Los Angeles, CA 35 81.5 81.3 51 45.1 44.5 - 15.7 14.0
Children's Hospital, Los Angeles, CA 31 62.9 80.2 40 35.0 26.6 -- 32.5 15.6 +
University Hospital, Denver, CO 69 78.1 76.8 92 68.5 64.9 ++ 16.3 18.1
The Children's Hospital, Denver, CO 59 75.8 80.0 80 85.0 83.3 + 12.5 11.2
Yale New Haven Hospital, New Haven, CT 54 72.0 68.7 83 50.6 48.3 19.3 19.5
Hartford Hospital, Hartford, CT 64 65.5 70.3 79 63.3 62.6 + 20.3 18.4
Washington Hospital Center, Washington, DC 55 68.2 65.4 72 58.3 56.0 15.3 19.6
Children's National Medical Center, Washington, DC 13 53.9 69.3 15 26.7 17.4 -- 33.3 20.6
Jackson Memorial Hospital, Miami, FL 112 70.2 72.8 166 60.2 58.6 16.9 15.0
Shands Hospital, Gainesville, FL 138 81.0 80.3 192 68.8 69.6 ++ 9.4 9.4
Tampa General Hospital, Tampa, FL 121 79.5 75.6 169 60.4 59.8 12.4 13.0
Tallahassee Memorial Reg. Med. Ctr., Tallahassee, FL 34 57.7 58.8 - 45 57.8 54.9 22.2 23.0
All Children's Hospital, FL 11 81.8 87.4 19 84.2 89.7 ++ 15.8 10.3
Emory University Hospital, Atlanta, GA 146 89.4 87.4 + 195 40.0 45.5 -- 10.8 14.6 +
St. Joseph's Hospital, Atlanta, GA 70 75.7 68.3 88 51.1 51.1 18.2 22.8
Egleston Children's Hospital, Atlanta, GA 46 74.1 81.6 62 74.2 65.6 12.9 9.1
Evanston Hospital. Evanston, IL 29 93.1 87.9 34 35.3 38.9 -- 8.8 9.2 +
OSF St. Francis Medical Center, Peoria, IL 68 79.4 82.4 93 45.2 45.6 -- 14.0 11.2 ++
University of Chicago Medical Center, Chicago, IL 24 66.7 68.4 37 48.6 48.2 27.0 23.7
Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 141 76.7 79.1 162 50.6 51.1 14.2 12.9
University of Illinois Hospital, Chicago, IL 21 60.5 62.6 24 37.5 35.2 - 20.8 16.9
Loyola University Medical Center, Maywood, IL 111 75.0 73.5 146 56.2 53.3 15.1 16.7
Children's Memorial Hospital, Chicago, IL 19 78.6 85.4 28 57.1 47.3 25.0 15.6
The Lutheran Hospital of Ft. Wayne, Fort Wayne, IN 40 79.9 70.9 49 44.9 50.6 12.2 17.3
Indiana University Hospitals, Indianapolis, IN 41 69.9 73.8 55 67.3 64.7 + 18.2 16.4
Methodist Hospital of Indiana, Indianapolis, IN 60 73.3 73.0 93 54.8 53.6 16.1 19.9
St. Vincent Hospital & Health Center, Indianapolis, IN 70 76.6 73.0 97 42.3 42.7 -- 15.5 14.8 +
University of Iowa Hospitals & Clinics, Iowa City, IA 56 81.9 78.5 68 38.2 47.0 - 11.8 12.9
Mercy Hospital Medical Center, Des Moines, IA 18 69.1 81.2 25 48.0 50.7 16.0 12.3
Via Christi Regional Medical Center, Wichita, KS 96 81.1 71.2 123 29.3 38.2 -- 13.0 21.0
Jewish Hospital, Louisville, KY 117 74.3 70.4 141 41.1 41.2 -- 18.4 22.8
University of Kentucky Medical Center, Lexington, KY 49 74.6 62.0 70 55.7 60.5 12.9 13.8
Ochsner Foundation Hospital, New Orleans, LA 255 72.0 73.5 - 314 47.8 47.7 -- 15.0 14.7 ++
Willis-Knighton Medical Center, Shreveport, LA 157 72.0 64.8 - - 206 33.0 38.8 -- 20.9 26.9
Tulane University Medical Center, New Orleans, LA 38 49.7 57.2 - - 40 50.0 50.8 30.0 24.0
University of Maryland Medical System, Baltimore, MD 43 70.5 76.0 52 42.3 46.9 23.1 20.7
Johns Hopkins Hospital, Baltimore, MD 86 83.2 75.2 113 44.2 50.6 9.7 13.5
Massachusetts General Hospital, Boston, MA 55 87.1 86.4 83 67.5 67.1 + 6.0 5.3
Brigham & Women's Hospital, Boston, MA 89 80.2 83.6 120 78.3 72.1 ++ 10.0 11.0
New England Medical Center, Boston, MA 32 65.6 63.9 46 65.2 65.3 10.9 10.2
Children's Hospital, Boston, MA 29 68.3 79.8 43 81.4 74.9 9.3 6.8
University of Michigan Medical Center, Ann Arbor, MI 116 66.0 69.0 155 51.6 51.8 21.9 21.4
Henry Ford Hospital, Detroit, MI 59 74.4 71.4 78 67.9 68.4 ++ 11.5 14.0
William Beaumont Hospital, Royal Oak, MI 28 69.9 59.7 31 32.3 34.3 22.6 29.4
St. Mary's Hospital, Rochester, MN 92 80.3 74.8 125 34.4 39.0 -- 17.6 23.1
Fairview University Medical Center, Minneapolis, MN 99 84.4 78.3 123 28.5 31.9 -- 12.2 16.2 ++
Abbott-Northwestern Hospital, Minneapolis, MN 64 78.1 73.9 91 23.1 25.3 -- 19.8 18.5 -
University of Missippi Medical Center, Jackson, MS 38 77.6 71.3 58 60.3 62.6 + 19.0 18.0
Barnes-Jewish Hospital, St. Louis, MO 109 80.5 76.0 137 47.4 49.4 - 13.1 12.9 +
St. Louis University Hospital, St. Louis, MO 89 76.3 79.5 + 112 51.8 52.6 14.3 18.4
St. Luke's Hospital, Kansas City, MO 71 83.0 75.4 88 64.8 67.4 ++ 10.2 13.7
University of Missouri Hospital & Clinic, Columbia, MO 33 74.9 74.5 42 71.4 70.0 + 14.3 16.2
Cardinal Glennon Children's Hospital, St. Louis, MO 9 55.6 71.7 15 66.7 50.0 26.7 16.6
St. Louis Children's Hospital, St. Louis, MO 70 63.9 72.1 89 67.4 62.9 24.7 18.5
Bryan Memorial Hospital, Lincoln, NE 52 80.6 74.6 64 48.4 48.8 17.2 17.9
University of Nebraska Medical Center, Omaha, NE 23 73.9 75.9 32 68.8 69.3 9.4 6.9
Newark Beth Israel Medical Center, Newark, NJ 66 70.5 69.2 82 74.4 71.4 ++ 18.3 19.3 --
Presbyterian Hospital, Albuquerque,NM 42 73.7 72.9 52 55.8 55.7 17.3 18.8
Buffalo General Hospital, Buffalo, NY 54 65.1 53.3 - - 65 24.6 30.5 - 20.0 28.7
Presbyterian Hospital in NY City, New York. NY 342 74.4 73.3 479 48.6 44.7 -- 19.0 17.3 --
Mount Sinai Medical Center, New York, NY 196 76.4 73.1 249 31.3 35.0 -- 18.1 21.0
Duke University Medical Center, Durham, NC 91 74.3 76.5 119 68.1 67.1 ++ 16.8 17.5 -
North Carolina Baptist Hospital, Winston-Salem, NC 44 75.9 73.8 59 49.2 51.8 25.4 23.5
University of North Carolina Hospitals, Chapel Hill, NC 73 75.1 78.9 98 44.9 41.9 17.3 17.0
Carolinas Medical Center, Charlotte, NC 72 75.5 69.5 101 58.4 56.6 13.9 16.1
University of Cincinnati Medical Center, Cincinnati, OH 92 74.9 69.7 119 56.3 56.0 14.3 16.4
Medical College Hospitals, Toledo, OH 42 80.9 80.5 54 51.9 51.9 11.1 11.4
Ohio State University Hospitals. Columbus, OH 46 83.5 83.1 60 43.3 43.5 16.7 19.4
Cleveland Clinic Foundation, Cleveland, OH 317 79.3 81.4 + + 449 56.1 53.3 14.9 14.2
Integris Baptist Medical Center, Oklahoma City. OK 106 79.1 78.5 134 43.3 45.7 - 18.7 19.4
University Hospital. Oklahoma City, OK 34 69.2 68.5 38 57.9 59.7 18.4 18.6
Saint Francis Hospital, Tulsa. OK 62 75.8 73.9 80 41.2 41.2 -- 18.8 18.7
Oregon Health Sciences University Hospital, Portland, OR 78 73.8 70.8 91 67.0 62.4 + 17.6 20.2 -
Temple University Hospital. Philadelphia, PA 247 80.0 78.8 327 74.6 71.1 ++ 10.1 10.1
Allegheny General Hospital, Pittsburgh. PA 77 71.4 74.6 95 25.3 27.5 -- 22.1 22.5
Allegheny University Hospital-Center City. Philadelphia, P 155 76.0 76.7 198 56.6 55.3 19.7 19.0 -
Hospital of University of Pennsylvania, Philadelphia, PA 119 80.3 77.0 180 58.3 56.6 16.1 16.0
University of Pittsburgh Medical Center, Pittsburgh, PA 204 72.8 73.4 260 35.8 35.8 -- 20.8 21.4
Milton S. Hershey Medical Center. Hershey, PA 97 70.1 75.7 136 54.4 49.5 24.3 19.8
St. Christopher's Hospital for Children, Philadelphia. PA 18 55.6 70.8 22 72.7 69.9 18.2 16.7
Children's Hospital, Pittsburgh, PA 57 80.2 84.2 + 78 39.7 33.8 -- 17.9 12.0 ++
Children's Hospital. Philadelphia. PA 39 55.8 77.7 62 48.4 37.0 -- 30.6 14.4 +
Medical University of South Carolina. Charleston, SC 61 80.0 81.8 88 72.7 76.0 ++ 13.6 13.0 +
Vanderbilt University Medical Center, Nashville, TN 129 64.4 67.1 - 162 56.2 56.6 + 24.1 22.7 --
Baptist Memorial Hospital, Memphis. TN 66 60.6 67.5 97 49.5 46.6 32.0 31.1 --
St. Thomas Hospital, Nashville, TN 100 80.9 74.5 126 47.6 56.2 14.3 16.2
University of Texas Medical Branch, Galveston, TX 47 82.8 87.3 58 60.3 64.1 8.6 10.0
Baylor University Medical Center, Dallas, TX 54 65.6 59.1 - 88 43.2 44.8 19.3 23.9
St. Paul Medical Center, Dallas, TX 62 79.0 79.1 101 62.4 60.3 14.9 15.1
Methodist Medical Center, Dallas, TX 23 73.8 84.3 + + 26 42.3 39.1 - 15.4 8.8 +
Seton Medical Center, Austin, TX 49 73.4 74.3 - 68 73.5 73.1 ++ 17.6 19.2 --
St. Luke's Episcopal Hospital, Houston; TX 172 72.5 76.7 228 53.1 51.7 18.0 16.3
University Hospital. San Antonio, TX 31 74.1 69.2 32 71.9 76.9 ++ 21.9 18.3 -
The Methodist Hospital, Houston, TX 76 74.9 75.8 115 64.3 62.7 ++ 18.3 17.0
San Antonio Community Hospital, San Antonio, TX 54 63.7 63.3 59 62.7 60.1 + 22.0 23.5 -
Columbia Hospital at Medical City Dallas, Dallas, TX 58 93.1 92.1 + + 94 89.4 84.8 ++ 3.2 3.6
Brooke Army Medical Center, Fort Sam Houston, TX 14 71.4 69.4 18 66.7 61.6 22.2 23.5
Children's Medical Center, Dallas, TX 15 66.7 79.7 22 72.7 66.3 13.6 7.4
University of Utah Medical Center, Salt Lake City, UT 51 81.1 77.3 71 64.8 67.2 + 8.5 10.2
Latter-Day Saints Hospital, Salt Lake City, UT 32 84.4 84.7 46 71.7 66.0 8.7 10.9
Primary Children's Medical Center, Salt Lake City, UT 23 69.2 80.0 + 30 76.7 68.4 13.3 9.3
Sentara Norfolk General, Norfolk, VA 63 74.5 75.1 86 65.1 65.7 + 17.4 15.2
University of VA Health Science Center, Charlottesville, V 110 71.3 68.5 - - 133 39.1 44.2 - 21.1 20.2
Medical College of Virginia Hospitals, Richmond, VA 34 70.4 67.7 40 32.5 33.5 -- 22.5 19.8
Inova Fairfax Hospital, Falls Church, VA 74 67.5 64.2 97 39.2 42.1 23.7 28.0
McGuire VA Medical Center, Richmond, VA 41 78.0 75.7 51 29.4 35.7 -- 13.7 17.7
Columbia Henrico Doctor's Hospital, Richmond, VA 55 64.5 72.8 71 45.1 39.0 - 31.0 23.3
University of Washington Medical Center, Seattle, WA 75 89.2 79.6 116 63.8 70.7 ++ 6.0 7.5
Sacred Heart Medical Center, Spokane, WA 40 95.0 93.9 + + 50 62.0 64.8 4.0 6.5
Children's Hospital & Medical Center, Seattle, WA 13 76.9 75.0 15 66.7 55.3 20.0 14.4
University of Wisconsin Hospital and Clinics, Madison, WI 171 83.1 84.0 + 225 68.9 71.0 ++ 12.0 12.3
St. Luke's Medical Center, Milwaukee, WI 146 77.9 76.0 198 40.9 41.3 -- 15.7 20.0
Froedtert Memorial Lutheran Hospital, Milwaukee, WI 18 82.5 77.1 40 40.0 39.9 17.5 21.3
Children's Hospital of Wisconsin, Milwaukee, WI 13 32.6 73.0 15 40.0 ... 33.3 ...
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