Information technology is a key component to reaching Leapfrog's top 45 best hospitals for quality - a list the watchdog organization released Thursday.

Leapfrog added a new efficiency standard to its quality criteria and also introduced a category for top rural hospitals.

Thirty-four urban, eight children's and three rural hospitals have been named 2009 Leapfrog Top Hospitals, based on results from The Leapfrog Hospital Survey. The survey is the only national, public comparison of hospitals on key issues including mortality rates for certain common procedures, infection rates, safety practices, and measures of efficiency.

Qualifying criteria for Leapfrog's Top Hospital Award list remain virtually the same as 2008, with one added dimension: Once hospitals demonstrate top quality, they must also rise to the top of the list on efficiency.

"This year's class of top hospitals not only hits the mark in areas such as medication error prevention and preventing ICU deaths, but they also use their resources wisely, providing excellent and efficient outcomes for patients," said Leah Binder, CEO of The Leapfrog Group. "Regardless of what happens to healthcare reform, these hospitals are the future."

The award winners in the 2009 rural hospital category scored in the top decile nationally for efficiency and are located in Georgia and Maine.

"Rural hospitals should be especially recognized as they often have higher hurdles to clear than their larger, urban counterparts in terms of access to capital and other resources," said Binder, a former administrator of a rural hospital.

In 2009, top hospitals in urban settings fulfill the following criteria:

• Fully meet Leapfrog standards for implementing computer physician order entry (CPOE) systems (that have been shown to reduce medication errors by up to 85 percent), and for passing Leapfrog's test of their system;
• Fully meet stringent performance standards for complex, high-risk procedures (such as heart bypass surgery) done in that particular hospital;
• Fully meet standards for staffing the ICU, shown to reduce mortality by 40 percent or more;
• Score in the top decile in the country for efficiency - scored by the Leapfrog Hospital Recognition Program incorporating quality outcomes, length of stay, readmission rates, and incidence of hospital acquired conditions and infections. The efficiency standard applies to heart bypass surgery, heart angioplasty, heart attack and pneumonia patients.

"We know from research that Leapfrog-reporting hospitals are among the best in the country, and they demonstrate through Leapfrog that they set ambitious goals for their performance," said Binder, pointing to a study by Ashish Jha, MD,  at Harvard Medical School, published in the peer-reviewed Journal of the Joint Commission in 2008, concluding that Leapfrog hospitals have lower mortality and better quality of care than those that don't report to Leapfrog.

"Not all hospitals make the top hospital list, but every hospital that participates in Leapfrog deserves credit," said David Knowlton, chairman of The Leapfrog Group and president and CEO of the New Jersey Health Care Quality Institute. "They are fundamentally changing the hospital market into one that is highly responsive to the quality, cost and value needs of consumers and large buyers of healthcare."

For the full list of the 45 top hospitals by category, please click on next page.