U.S. News and World Report publish an annual ranking of the top 50 American hospitals which is purportedly based upon the quality of care they provide. The issue is well read and used by the public, health care providers and policymakers alike and thus should provide an unbiased and accurate assessment of the hospitals. In reality, however, it appears that a subjective evaluation of the hospitals reputation plays too strong a role in the final decision based upon a study recently published in the Annals of Internal Medicine (A Sehgal, The Role of Reputation in US News & World Report’s Rankings of the Top 50 American Hospitals. 20 April 2010 Annals of Internal Medicine Vol. 152, No. 8 pp. 521-525.
US News & World Report claims that the rankings are based upon 3 quality domains: structure, process and outcomes. Structure and outcomes are based upon objective criteria such as staffing, patient volume, patient safety, adverse events and mortality. Process, however, is based upon a subjective measure of reputation. These three domains are to be weighted equally. In reality, however,reputation appears to have a greater influence.
For its 2009 rankings, US News & World Report looked at 1859 American hospitals based upon their number of beds, teaching status, available technologies, risk adjusted mortality, patient safety index and number of discharges, etc. Subjective reputation was assessed based upon surveys from approximately 250 board certified physicians who were randomly selected for target conditions. Within the top rated institutions, the scores based upon the objective criteria were very similar. Reputation on the other hand showed a high degree of variation, giving it a greater value in the final evaluation and led to a disproportionate influence of reputation on the overall findings, and one that did not always correlate with mortality and patient safety scores.
The author felt that this reliance on reputation could harm top performing hospitals if they experience even a single negative event, and could result in less focus on quality improvement programs since they do not necessarily equate with a hospitals reputation or ranking.
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