National Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity

Abstract

Attempts to assess the quality and safety of hospitals have proliferated, including a growing number of consumer-directed hospital rating systems. However, relatively little is known about what these rating systems reveal. To better understand differences in hospital ratings, we compared four national rating systems. We designated "high" and "low" performers for each rating system and examined the overlap among rating systems and how hospital characteristics corresponded with performance on each. No hospital was rated as a high performer by all four national rating systems. Only 10 percent of the 844 hospitals rated as a high performer by one rating system were rated as a high performer by any of the other rating systems. The lack of agreement among the national hospital rating systems is likely explained by the fact that each system uses its own rating methods, has a different focus to its ratings, and stresses different measures of performance.

En ubehagelig sannhet

“…Nylig publiserte studier fra USA viser at rangeringer av sykehus varierer stort. Ved å sammenligne resultater fra fire nasjonale system fant en at ingen sykehus fikk høy rangering på alle systemene, kun ti prosent av de som ble høyt rangert i ett system fikk tilsvarende høy rangering i ett annet system (9). Tilsvarende finner man i internasjonale målesystemer, hvor rangeringen fra CMW Fund ((10)) viser at kvaliteten på norske helsetjenester er av de dårligste blant de landene som deltok, mens OECD sin rangering på kvalitetsområdet viser at Norge skårer bra.…”

Legal and Policy Interventions to Improve Patient Safety

“…Confronted with a battery of metrics and no guidance about which are most important, providers and patients may be none the wiser about which institutions provide the best care. 30 To address these concerns, measures are sometimes retired once performance "tops off" (ie, when most providers are scoring near or at 100%), on the basis that the value in ongoing measurement will be limited. 31,32 For example, CMS has started retiring a number of heart failure and heart attack measures such as the prescribing of β-blockers at discharge for patients with a myocardial infarction.…”

A Methodological Critique of the ProPublica Surgeon Scorecard

“…[5][6][7][8] Conversely, methodologically flawed, inconsistent, or invalid report cards might cause substantial harm by misleading or confusing patients and incorrectly classifying providers. [9][10][11][12][13][14][15][16] Such reports could lead patients to choose or avoid providers based on inaccurate information. Patients are thereby harmed in the short term by making worse choices of providers and in the long term by misinformed or inappropriately incentivized providers, who might fail to make necessary improvements or might avoid patients who are appropriate for a surgical procedure but who pose a greater risk of generating a poor reported outcome.…”