Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Osborne, Nicholas H., Lauren Nicholas, Amir A. Ghaferi, Gilbert R. Upchurch , and Justin B. Dimick. 2010. "Do Popular Media and Internet-Based Hospital Quality Ratings Identify Hospitals with Better Cardiovascular Surgery Outcomes?" Journal of the American College of Surgeons, 210(1): 87-92.
Background Several popular media and Internet-based hospital quality rankings have become increasingly publicized as a method for patients to choose better hospitals. It is unclear whether selecting highly rated hospitals will improve outcomes after cardiovascular surgery procedures.
Study Design Using 2005 to 2006 Medicare data, we studied all patients undergoing abdominal aortic aneurysm repair, coronary artery bypass, aortic valve repair, and mitral valve repair (n = 312,813). Primary outcomes included risk-adjusted mortality, adjusting for patient characteristics and surgical acuity. We compared mortality at "Best Hospitals," according to US News and World Report and HealthGrades, with all other hospitals. We adjusted for hospital volume to determine whether hospital experience accounts for differences in mortality.
Results Risk-adjusted mortality was considerably lower in US News and World Report's "Best Hospitals" for abdominal aortic aneurysm repair only (odds ratio [OR] = 0.76; 95% CI, 0.61 to 0.94). Risk-adjusted mortality was considerably lower in HealthGrades' "Best Hospitals" after all 4 procedures: abdominal aortic aneurysm repair (OR = 0.75; 95% CI, 0.58 to 0.97), coronary artery bypass (OR = 0.78; 95% CI, 0.68 to 0.89), aortic valve repair (OR = 0.71; 95% CI, 0.59 to 0.85), and mitral valve repair (OR = 0.77; 95% CI, 0.61 to 0.99). Accounting for hospital volume, risk-adjusted mortality was not substantially lower at the US News and World Report's "Best Hospitals," while risk-adjusted mortality was lower at HealthGrades' "Best Hospitals" after coronary artery bypass and aortic valve repair mortality rates were adjusted for hospital volume (OR = 0.77; 95% CI, 0.64 to 0.92 and OR = 0.81; 95% CI, 0.71 to 0.94).
Conclusions Popular hospital rating systems identify high-quality hospitals for cardiovascular operations. However, patients can experience equivalent outcomes by seeking care at high-volume hospitals.
Country of focus: United States.