ArticleBMJ open2021
Multicentre methodological study to create a publicly available score of hospital financial standing in the USA.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- Operational Efficiency and Liquidity Within Hurricane Prone Hospitals in the United States: A Regional Study.International journal of financial research · 2026Article
- Hospital Financial Health and Provision of Obstetric and Neonatal Intensive Care Unit Services.JAMA network open · 2025Article
- Financial performance of hospitals in Europe - a scoping review.BMC health services research · 2025Article
- Hospitals' financial performance across European countries: a scoping review protocol.BMJ open · 2024Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectivesTo create a straightforward scoring procedure based on widely available, inexpensive financial data that provides an assessment of the financial health of a hospital.
designMethodological study.
settingMulticentre study.
participantsAll hospitals and health systems reporting the required financial metrics in the USA in 2017 were included for a total of 1075 participants.
interventionsWe examined a list of 232 hospital financial indicators and used existing models and financial literature to select 30 metrics that sufficiently describe hospital operations. In a set of hospital financial data from 2017, we used principal coordinate analysis to assess collinearity among variables and eliminated redundant variables. We isolated 10 unique variables, each assigned a weight equal to the share of its coefficient in a regression onto Moody's Credit Rating, our predefined gold standard. The sum of weighted variables is a single composite score named the Yale Hospital Financial Score (YHFS). PRIMARY OUTCOME MEASURES: Ability to reproduce both financial trends from a 'gold-standard' metric and known associations with non-fiscal data.
resultsThe validity of the YHFS was evaluated by: (1) cross-validating it with previously excluded data; (2) comparing it to existing models and (3) replicating known associations with non-fiscal data. Ten per cent of the initial dataset had been reserved for validation and was not used in creating the model; the YHFS predicts 96.7% of the variation in this reserved sample, demonstrating reproducibility. The YHFS predicts 90.5% and 88.8% of the variation in Moody's and Standard and Poor's bond ratings, respectively, supporting its validity. As expected, larger hospitals had higher YHFS scores whereas a greater share of Medicare discharges correlated with lower YHFS scores.
conclusionsWe created a reliable and publicly available composite score of hospital financial stability.
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