Importance:Hospital ratings including the US News & World Report's Best Hospitals rankings and the Centers for Medicare & Medicaid Services' (CMS') Overall Hospital Quality Star Rating (Overall Star Rating) measure different outcomes and are weakly correlated. Therefore, methods for defining and measuring reliable excellence, defined as consistently great performance across all quality measures, are needed. Objective:To assess a measure of reliable excellence using the 45 quality measures reported in the Overall Star Ratings. Design, Setting, and Participants:This cross-sectional study used hospital-level data from the 2023 and 2024 CMS Overall Star Ratings at all US hospitals with a 2023 and 2024 CMS Overall Star Rating. Exposures:The exposure was the CMS Overall Star Rating summary score, a continuous variable calculated from the weighted z scores of 45 quality measures used in the Overall Star Rating. A total of 100 000 simulations were run in which all US hospitals' CMS Overall Star Rating summary scores were calculated through summation of z scores from randomly generated measure weights, as opposed to the existing weights used in the Overall Star Rating method. Main Outcomes and Measures:Reliable excellence, defined as achieving a 90th percentile (or better) CMS Overall Star Rating summary score on at least 50 000 of 100 000 simulations. The percentage of hospitals achieving reliable excellence was calculated both overall and stratified by CMS Ovearll Star Ratings. Results:There were 2700 hospitals in the analysis, with 335 5-star hospitals (12.4%), 727 4-star hospitals (26.9%), 799 3-star hospitals (29.6%), 572 2-star hospitals (21.2%), and 267 1-star hospitals (9.9%) in the 2024 CMS Overall Star Rating. A total of 244 of 2700 hospitals (9.0%) met the study definition of reliable excellence, whereas 1287 of 2700 hospitals (47.7%) achieved excellence in at least 1 simulation. Conclusions and Relevance:This cross-sectional study of 2700 US hospitals found that only 244 hospitals (9.0%), including less than two-thirds of the CMS 5-star rated hospitals, were reliably excellent across 100 000 CMS Overall Star Rating scoring simulations using random measure weightings. These findings lend credence to the ubiquity of inconsistent greatness in health care quality and illuminate the need for methods to distinguish hospitals that provide reliably excellent care.

In this article, the authors discuss the creation of HealthLocator, a public, digital platform designed to address the confusion and inconsistencies between hospital rating systems. HealthLocator aims to empower patients with transparent, data-driven insights on more than 5,000 U.S. hospitals, helping them make informed decisions based on reliable metrics. Developed by the Mayo Clinic's Kern Center, HealthLocator integrates three core domains - quality outcomes, patient experience, and patient safety - into a single composite score. These domains draw from publicly available U.S. Centers for Medicare & Medicaid Services (CMS) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data, spanning measures of readmissions, mortality, timeliness of care, patient experience, and hospital-acquired conditions, subsequently transformed into percentiles to more clearly present and interpret performance. An unique complementary feature is the reliable excellence indicator, which identifies top-tier hospitals consistently scoring highly across all CMS measures through robust simulations. In addition, HealthLocator includes high-volume and high-6-month-survival indicators for surgeries and specialized care, using CMS claims data. The novel 6-month mortality model adjusts for patient risk while avoiding the potential for methodological manipulation through inappropriate use of observation stays that are excluded from mortality measurement in other rating and ranking systems. The Mayo Clinic plans to continually refine HealthLocator based on user feedback, with future updates focusing on personalization, outpatient and long-term care quality measures, expanded data sources, and broader stakeholder input via an external advisory board. The platform's goal is to become the definitive, patient-centered resource for hospital performance - advancing transparency, trust, and clinical quality across the U.S. health care system. In essence, HealthLocator is not just another ranking system - it is a public service initiative rooted in peer-reviewed methods and designed to help patients find high-quality care while promoting accountability and improvement in health care delivery.

Despite significant advancements in Generative Artificial Intelligence (GenAI), practical adoption in healthcare, particularly patient safety, remains challenging due to concerns regarding data privacy, model transparency, clinical relevance and user engagement. We present LLaMPS (Large Language Model for Patient Safety), a locally deployed GenAI platform designed to enhance patient safety event management and reporting. LLaMPS integrates automated incident classification, harm-level prediction, intelligent search, and an interactive chatbot. The system employs a Retrieval-Augmented Generation (RAG) approach, leveraging secure, institutionally hosted large language models (LLMs) and a vector database to ensure data privacy and regulatory compliance. Developed iteratively with direct input from clinicians and patient safety experts, LLaMPS demonstrates high classification accuracy and improved user satisfaction, underscoring the potential of locally controlled AI solutions to enhance patient safety workflows.

Objective To assess whether the US News and World Report (USNWR) Urology specialty ranking methodology accurately captures and classifies complications following elective outpatient urology procedures. Methods We conducted electronic health record chart review of n = 80 elective, outpatient urology procedures with complications from 2019-2023 across 4 hospitals in our integrated US health system. We used the Solventum AM-PPC software and USNWR methodology to determine eligibility and measure complications. For each complication identified by the software, we assessed: (1) whether the procedure was performed by a urologist; (2) whether the adjudicator agreed with the complication type; and (3) whether the complication was a clinically related sequelae of the index procedure. We reported Clavien-Dindo severity of each complication. Results Our adjudication agreed on complication type in 62/80 (78%) complications, and 64/80 (80%) complications were clinically related to the index urology procedure. Combined, 57/80 (71%) complications were concordant on both complication type and clinical relatedness. However, 38/80 (48%) index procedures were conducted by interventional radiologists, not urologists. Furthermore, 11/80 (13.8%) complications were false positive urinary tract infections (UTIs). Conclusion The USNWR methodology for elective outpatient urology procedural complications showed reasonable clinical validity but detected several false positive UTIs. Further, USNWR should clarify the extent to which procedures performed by interventional radiologists belong in urology rankings.

Objectives In the USA and UK, pandemic-era outcome data have been excluded from hospital rankings and pay-for-performance programmes. We assessed the relationship between US hospitals’ pre-pandemic Centers for Medicare and Medicaid Services (CMS) Overall Hospital Star ratings and early pandemic 30-day mortality among both patients with COVID and non-COVID to understand whether pre-existing structures, processes and outcomes related to quality enabled greater pandemic resiliency.Design and data source A retrospective, claim-based data study using the 100% Inpatient Standard Analytic File and Medicare Beneficiary Summary File including all US Medicare Fee-for-Service inpatient encounters from 1 April 2020 to 30 November 2020 linked with the CMS Hospital Star Ratings using six-digit CMS provider IDs.Outcome measure The outcome was risk-adjusted 30-day mortality. We used multivariate logistic regression adjusting for age, sex, Elixhauser mortality index, US Census Region, month, hospital-specific January 2020 CMS Star rating (1–5 stars), COVID diagnosis (U07.1) and COVID diagnosis×CMS Star Rating interaction.Results We included 4 473 390 Medicare encounters from 2533 hospitals, with 92 896 (28.2%) mortalities among COVID-19 encounters and 387 029 (9.3%) mortalities among non-COVID encounters. There was significantly greater odds of mortality as CMS Star Ratings decreased, with 18% (95% CI 15% to 22%; p<0.0001), 33% (95% CI 30% to 37%; p<0.0001), 38% (95% CI 34% to 42%; p<0.0001) and 60% (95% CI 55% to 66%; p<0.0001), greater odds of COVID mortality comparing 4-star, 3-star, 2-star and 1-star hospitals (respectively) to 5-star hospitals. Among non-COVID encounters, there were 17% (95% CI 16% to 19%; p<0.0001), 24% (95% CI 23% to 26%; p<0.0001), 32% (95% CI 30% to 33%; p<0.0001) and 40% (95% CI 38% to 42%; p<0.0001) greater odds of mortality at 4-star, 3-star, 2-star and 1-star hospitals (respectively) as compared with 5-star hospitals.Conclusion Our results support a need to further understand how quality outcomes were maintained during the pandemic. Valuable insights can be gained by including the reporting of risk-adjusted pandemic era hospital quality outcomes for high and low performing hospitals.

Objective To evaluate whether hospital re-accreditation improves quality, patient safety and reliability over three accreditation cycles by testing the accreditation life cycle model on quality measures. Design The validity of the life cycle model was tested by calibrating interrupted time series (ITS) regression equations for 27 quality measures. The change in the variation of quality over the three accreditation cycles was evaluated using the Levene’s test. Setting A 650-bed tertiary academic hospital in Abu Dhabi, UAE. Participants Each month (over 96 months), a simple random sample of 10% of patient records was selected and audited resulting in a total of 388 800 observations from 14 500 records. Intervention(s) The impact of hospital accreditation on the 27 quality measures was observed for 96 months, 1-year preaccreditation (2007) and 3 years postaccreditation for each of the three accreditation cycles (2008, 2011 and 2014). Main outcome measure(s) The life cycle model was evaluated by aggregating the data for 27 quality measures to produce a composite score (YC) and to fit an ITS regression equation to the unweighted monthly mean of the series. Results The results provide some evidence for the validity of the four phases of the life cycle namely, the initiation phase, the presurvey phase, the postaccreditation slump and the stagnation phase. Furthermore, the life cycle model explains 87% of the variation in quality compliance measures (R2=0.87). The best-fit ITS model contains two significant variables (β1 and β3) (p≤0.001). The Levene’s test (p≤0.05) demonstrated a significant reduction in variation of the quality measures (YC) with subsequent accreditation cycles. Conclusion The study demonstrates that accreditation has the capacity to sustain improvements over the accreditation cycle. The significant reduction in the variation of the quality measures (YC) with subsequent accreditation cycles indicates that accreditation supports the goal of high reliability.

Background: Developing countries frequently use hospital accreditation to guarantee quality and patient safety. However, implementation of accreditation standards is demanding on organisations. Furthermore, the empirical literature on the benefits of accreditation is sparse and this is the first empirical interrupted time series analysis designed to examine the impact of healthcare accreditation on hospital quality measures.Methods: The study was conducted in a 150-bed multispecialty hospital in Abu Dhabi, United Arab Emirates. The quality performance outcomes were observed over a 48 month period. The quality performance differences were compared across monthly intervals between two time segments, 1 year pre-accreditation (2009) and 3 years post-accreditation (2010, 2011 and 2012) for the twenty-seven quality measures. The principal data source was a random sample of 12,000 patient records drawn from a population of 50,000 during the study period (January 2009 to December 2012). Each month (during the study period), a simple random sample of 24 percent of patient records was selected and audited, resulting in 324,000 observations. The measures (structure, process and outcome) are related to important dimensions of quality and patient safety.Results: The study findings showed that preparation for the accreditation survey results in significant improvement as 74% of the measures had a significant positive pre-accreditation slope. Accreditation had a larger significant negative effect (48% of measures) than a positive effect (4%) on the post accreditation slope of performance. Similarly, accreditation had a larger significant negative change in level (26%) than a positive change in level (7%) after the accreditation survey. Moreover, accreditation had no significant impact on 11 out of the 27 measures. However, there is residual benefit from accreditation three years later with performance maintained at approximately 90%, which is 20 percentage points higher than the baseline level in 2009.Conclusions: Although there is a transient drop in performance immediately after the survey, this study shows that the improvement achieved from accreditation is maintained during the three year accreditation cycle.

ObjectiveTo evaluate whether accredited hospitals maintain quality and patient safety standards over the accreditation cycle by testing a life cycle explanation of accreditation on quality measures. Four distinct phases of the accreditation life cycle were defined based on the Joint Commission International process. Predictions concerning the time series trend of compliance during each phase were specified and tested.DesignInterrupted time series (ITS) regression analysis of 23 quality and accreditation compliance measures.SettingA 150-bed multispecialty hospital in Abu Dhabi, UAE.ParticipantsEach month (over 48 months) a simple random sample of 24% of patient records was audited, resulting in 276 000 observations collected from 12 000 patient records, drawn from a population of 50 000.Intervention(s)The impact of hospital accreditation on the 23 quality measures was observed for 48 months, 1 year preaccreditation (2009) and 3-year postaccreditation (2010–2012).Main outcome measure(s)The Life Cycle Model was evaluated by aggregating the data for 23 quality measures to produce a composite score (YC) and fitting an ITS regression equation to the unweighted monthly mean of the series.ResultsThe four phases of the life cycle are as follows: the initiation phase, the presurvey phase, the postaccreditation slump phase and the stagnation phase. The Life Cycle Model explains 87% of the variation in quality compliance measures (R2=0.87). The ITS model not only contains three significant variables (β1, β2and β3) (p≤0.001), but also the size of the coefficients indicates that the effects of these variables are substantial (β1=2.19, β2=−3.95 (95% CI −6.39 to −1.51) and β3=−2.16 (95% CI −2.52 to −1.80).ConclusionsAlthough there was a reduction in compliance immediately after the accreditation survey, the lack of subsequent fading in quality performance should be a reassurance to researchers, managers, clinicians and accreditors.

Vitamin D deficiency has been linked to chronic diseases among different populations worldwide. However, these relationships are still unclear and have not been explored within the United Arab Emirates (UAE) population. In this study, the relationship between vitamin D, risk for depression symptoms, and sun avoidance inventory was explored. The prevalence of vitamin D deficiency among a sample of employees working in Abu Dhabi (the capital of UAE) was first assessed and then the influence of demographic factors (age, gender and ethnicity) on vitamin D status was examined. A random sample of 141 employees from two different major oil companies within Abu Dhabi was selected and tested for vitamin D deficiency. All participants worked indoors and reflected the multi-ethnic nature of Abu Dhabi residents. Serum levels of vitamin D [25(OH)D] were measured and depression was assessed using the Beck Depression Inventory version 2. Moreover, the sun avoidance inventory (SAI) was used to assess attitudes towards sun avoidance in the context of vitamin D deficiency. There was a significant negative correlation between vitamin D levels and sun avoidance scores (r=-0.45, p<0.0001). Sun avoidance scores were also significantly positively correlated with depression symptoms scores (r=0.33, p<0.001). This study demonstrated that sun avoidance behaviors were the major risk factor for vitamin D deficiency among Abu Dhabi employees and that these were also positively associated with depressive symptoms. Key words: Vitamin D deficiency, United Arab Emirates, indoor employees, sun avoidance inventory, Beck depression inventory.

Distinguishing bacterial from viral meningitis helps prevent unnecessary use of antibiotics and decreases the length of stay. The distinction may often be blurred by the typical textbook description of viral meningitis which states that mononuclear cells predominate in the cerebrospinal fluid (CSF). The aim of the work is to accurately describe the CSF response in a group of children with enteroviral meningitis proven by the gold standard, polymerase chain reaction (PCR). A cross sectional study was performed at Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates (UAE). We examined retrospectively all children (< 12 years as per hospital definition) who tested PCR positive for enterovirus in the CSF from January 2005 to January 2007. 53 patients with mean age (SD) of 74.8 months (37.8) were included. There was a statistically significant dominance in polymorphnuclear cells (PMN) in both the CSF (Chi Square statistic 28.78, P < 0.001) and serum, which persisted after 24 h with mononuclear cells and PMN equally represented. A correlation between CSF and serum PMN% was also detected (Pearson's r = 0.447, P=0.001, 95% CI = 0.196 to 0.643). Our peak season was in spring, there was a male predominance and the median (IQR) length of stay was 48 h (48 -72). The majority of children with aseptic meningitis had PMN predominance in both CSF and serum, which is not limited to the first 24 h. This finding differs from most standard textbook descriptions and may have relevance in using PMN counts to distinguish bacterial from viral meningitis. Key words: Enterovirus, viral meningitis, PCR, polymorphnuclear cells, length of stay, children.

Background Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and morbidity. |The study objective was to determine the impact of a fast track area (FTA) on both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. LWBS rates and mortality rates) in non-urgent patients. The secondary objective was to assess if a FTA negatively impacted on urgent patients entering the ED. Methods The study took place in a 500 bed, urban, tertiary care hospital in Abu Dhabi, United Arab Emirates. This was a quasi-experimental, which examined the impact of a FTA on a pre-intervention control group (January 2005) (n = 4,779) versus a post-intervention study group (January 2006) (n = 5,706). Results Mean WTs of Canadian Triage Acuity Scale (CTAS) 4 patients decreased by 22 min (95% CI 21 min to 24 min, P < 0.001). Similarly, mean WTs of CTAS 5 patients decreased by 28 min (95% CI 19 min to 37 min, P < 0.001) post FTA. The mean WTs of urgent patients (CTAS 2/3) were also significantly reduced after the FTA was opened ( P < 0.001). The LWBS rate was reduced from 4.7% to 0.7% (95% CI 3.37 to 4.64; P < 0.001). Opening a FTA had no significant impact on mortality rates ( P = 0.88). Conclusion The FTA improved ED effectiveness (WTs and LOS) and quality measures (LWBS rates) whereas mortality rate remained unchanged.