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July 27, 2020

National Hospital Quality Rankings: Improving the Value of Information in Hospital Rating Systems

Author Affiliations
  • 1Department of Medicine, Duke University School of Medicine, Durham, North Carolina
  • 2Duke University Health System, Durham, North Carolina
  • 3Department of Population Health Sciences, Duke University, Durham, North Carolina
  • 4Duke Clinical Research Institute, Durham, North Carolina
JAMA. Published online July 27, 2020. doi:10.1001/jama.2020.11165

Every year, hospitals are ranked or rated by public and private organizations that aim to identify centers that provide high-quality health care. Although the reports are intended to help guide consumers in determining where to seek care, these ranking systems often yield conflicting information or, worse, misinformation for patients and their clinicians.1 As an example, the US News & World Report Best Hospitals rankings correlate poorly with the Leapfrog Hospital Safety Grades (spearman correlation, 0.28) and the Centers for Medicare & Medicaid Services (CMS) Star Ratings (spearman correlation, 0.33).1 This conflicting information may lead hospitals and health systems to misdirect resources toward improving rankings on a particular measure and potentially miss opportunities to improve health and health care delivery.

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    2 Comments for this article
    Ranking Versus Rating Hospital Quality
    Michael McAleer, PhD(Econometrics),Queen's | Asia University, Taiwan
    Any academic who has been associated with ranking or interpreting ranking systems of individual research output, academic standards of research journals, and associated departments, faculties, and universities, is well aware that measuring quality, efficacy, impact, importance, and influence is based on numerous arbitrary factors that are not necessarily widely accepted.

    The same argument applies to annual rankings of departments, faculties, colleges, business schools, and universities in an endeavour to attract prospective students.

    Whichever rankings or ratings methods are used, it is critical that any factors that are presented are simple, identifiable, convincing, transparent, balanced, informative, useful, easily interpretable, rigorous,
    measurable, accountable, reproducible and, most of all, accurate.

    As analyzed in the excellent Viewpoint, hospital rankings and ratings can reduce misinformation in the process of expanding and explaining information about public health care delivery outcomes.  

    It is recognized that there can be significant differences across large geographic, financial affordability, socioeconomic environment, racial and ethnic composition, among other pervasive disparities, so any informative ranking or rating system would be more helpful if the healthcare boundaries were localized.

    Measuring health care quality and outcomes provided by hospitals is subject to numerous arguable and arbitrary factors, such that creating qualitative and quantitative tiers and group ratings might be preferable to numerical rankings that are statistically problematic in the absence of meaningful confidence intervals.
    Hospitals -- Unlike Major Universities -- Serve Local Populations
    Brad Davis |
    @Michael McAleer you state that "The same argument applies to [hospitals as to] the annual rankings of departments, faculties, colleges, business schools, and universities . . . ."

    No. The entire point of this article is that local populations disproportionately impact rankings with respect to major hospitals vs. major universities, which can be selective about their faculty and student populations. Hospitals serve primarily local populations, and so any "rankings" measure that does not include local health graphics is misleading.