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Hospital ratings miss many high performers: study
May 18, 2011 / 9:36 PM / in 6 years

Hospital ratings miss many high performers: study

NEW YORK (Reuters Health) - Looking for hospital ratings on the internet or in magazines may not serve patients’ best interests, suggests a study of HealthGrades and U.S. News & World Report.

It shows that for three types of cancer surgery, “America’s 50 Best Hospitals” as ranked by internet-based HealthGrades are no better than the other hospitals once the number of patients they treat is taken into account.

Based on the U.S. News & World Report ratings, the top-50 hospitals trumped the rest on just one of the surgeries -- removal of the colon or part of it.

“Our findings show that both ratings fail to identify equally well-performing hospitals of similar volume,” Dr. Nicholas Osborne, of the University of Michigan in Ann Arbor, and colleagues write in the Archives of Surgery.

“Because these ratings list only a selected number of best hospitals,” the researchers add, “these consumer aids may dissuade patients from seeking care at closer high-volume, equal-quality hospitals.”

Millions of Americans use the rating systems, according to the report, and HealthGrades bills itself as the country’s “leading healthcare ratings organization.”

HealthGrades did not respond to an emailed request for comments.

The new study examined how many patients died within 30 days of cancer surgery, comparing the top-50 hospitals from the two ratings to other hospitals across the nation.

The researchers made sure to adjust for differences between patients, including income and sickness. Their analysis is based on Medicare data -- limiting it to people over 65 -- and they didn’t look at other important outcomes, such as complications and cost.

At first glance, U.S. News & World Report’s best hospitals led the pack on all three surgeries, cutting the risk of death by between 31 and 58 percent.

But when the researchers adjusted the numbers for how many patients were treated -- something the ratings don’t consider -- the top-ranking hospitals had better results only in colon surgery.

HealthGrades’ top-50 hospitals did better on just one type of surgery to begin with, but that advantage disappeared completely after taking patient volume into account.

In an editorial, Dr. David Linehan and Dr. David Jaques, both surgeons at Washington University School of Medicine, St. Louis, said the findings show the shortcomings of commercially available hospital rankings.

“A physician colleague just emailed one of us for a recommendation for care of a family member with a complex cancer problem,” they write.

“Some things we did not do: (1) go to or (2) drop down to the magazine section in our hospital gift shop. But we did know where the patient lived and had first-hand knowledge of the quality of the hospital and the surgeon that we recommended. That insider information is both priceless and not easily available to the general public.”

They conclude: “For now, we have imperfect, profit-driven hospital ratings fueled by the perceived marketing advantage by those at the top of the list.”

SOURCE: Archives of Surgery, May 17, 2011.

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