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June 26, 2002

Should Consumers Trust Hospital Quality Report Cards?—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(24):3206-3208. doi:10.1001/jama.287.24.3206

In Reply: Drs Finlayson and Birkmeyer suggest that some information, however imperfect, is better than no information because "more often than not, however, patients choosing 5-star hospitals will select a hospital with better performance." This perception is incorrect. We found that 1-star hospitals (the lowest rated) and 5-star hospitals (the highest rated) were statistically indistinguishable in 92% of pairwise comparisons, and 1-star hospitals had better risk-standardized mortality rates than 5-star hospitals in only 5% of comparisons. In fact, in only 3% of comparisons did the 5-star hospitals have significantly better outcomes than 1-star hospitals. Furthermore, Finlayson and Birkmeyer's concerns about direct hospital comparisons due to small sample sizes can be addressed by the use of multilevel models that "borrow" power across hospitals.

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