New measures did little to change the grade distribution in the Leapfrog Group’s fall 2016 Hospital Safety Scores report.

Out of the 2,633 hospitals included in the report, “C” was the most common grade, given to 954 hospitals. An "A" was awarded to 844, 658 a “B,” 157 a “D,” and only 20 received failing grades.

The grades were in the same order in the fall 2015 and spring 2016 reports, despite the scoring methodology being updated in the spring to include data on two new infection measures (MRSA Bacteremia and C.difficile) and new patient experience measures like communication about medicines, communication about discharge, nurse communication, doctor communication and responsiveness of hospital staff.

There were changes, however, particularly at the state level, when judging by percentage of hospitals earning an “A.” North Carolina improved from No. 19 in the spring 2013 grades to No. 5 in this report, while Idaho has advanced to No. 2 from No. 45 in the same time frame.

“In the fast-changing healthcare landscape, patients should be aware that hospitals are not all equally competent at protecting them from injuries and infections,” said Leapfrog President and CEO Leah Binder. “We believe everyone has the right to know which hospitals are the safest and encourage community members to call on their local hospitals to change, and on their elected officials to spur them to action. States that put a priority on safety have shown remarkable improvements."

The top ranked state was Hawaii, while the bottom-ranked states, each with no "A" hospitals, were Alaska, Delaware and North Dakota, along with Washington, D.C.

Other states were able to climb up from that bottom rung, like Vermont, which was one of those no “A” hospital states in 2015, but was ranked eighth in this report.