To the Editor.
—We echo and endorse Dr Green and colleagues'1 call for nationally representative databases with which to assess quality of care at American hospitals and an augmentation of funding for the provision of such data. Absent funding of the necessary magnitude, however, and believing that health consumers still need help in framing discussions with their physicians about quality issues, we have been compelled to forge ahead using a combination of secondary data sources and primary data collected from physicians.Green et al agree that our conceptual framework is solid, but they question the choices made in operationalizing some of our subconstructs. We wish to point out that some of the supposed inadequacies noted by Green and colleagues were in fact remedied in the 1996 edition or will be changed in the 1997 version.2 Specifically, we changed our incremental scoring method for the technology index, so that institutions are indeed
Hill CA, Comarow A. Are "America's Best Hospitals" America's Best?. JAMA. 1997;278(6):473. doi:10.1001/jama.1997.03550060049022