Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Osborne, Nicholas H., Amir A. A. Ghaferi, Lauren Nicholas, and Justin B. Dimick. 2011. "Evaluating Popular Media and Internet-Based Hospital Quality Ratings for Cancer Surgery." Archives of Surgery, 146(5): 600-604.
Objective: We sought to determine whether "best hospitals," as defined by the US News & World Report or HealthGrades, have lower mortality rates than all other American hospitals for cancer surgery.
Design: Retrospective cross-sectional study.
Setting: Medicare database (2005-2006).
Patients: All patients with a diagnosis of malignancy who underwent pancreatectomy, esophagectomy, and colectomy (n=82 724).
Main Outcomes Measures: Risk-adjusted mortality rates at best hospitals according to both the US News & World Report and HealthGrades, was compared with all other US hospitals, adjusting for differences in patient factors and surgical acuity. Risk-adjusted mortality rates between best hospitals and all other hospitals was compared after controlling for differences in hospital volume.
Results: Risk-adjusted mortality was significantly lower in US News & World Report best hospitals for all 3 procedures: pancreatectomy (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.30-0.58), esophagectomy (OR, 0.48; 95% CI, 0.37-0.62), and colectomy (OR, 0.69; 95% CI, 0.55-0.86). Risk-adjusted mortality was significantly lower in HealthGrades best hospitals for colectomy (OR, 0.79; 95% CI, 0.65-0.95). However, after accounting for hospital volume, risk-adjusted mortality was only significantly lower at the US News & World Report best hospitals for colectomy (OR, 0.79; 95% CI, 0.62-0.99) and was not significantly lower at HealthGrades best hospitals for any of the 3 oncologic procedures.
Conclusions: Publicly marketed hospital rating systems of surgical quality such as the US News & World Report " America's Best Hospitals" and HealthGrades " Best Hospitals" may identify high-quality hospitals for some oncologic surgeries. However, these ratings fail to identify other high-volume hospitals of equal quality.
Country of focus: United States.