![]() Are academic medical centers really worse? The authors argue that small community hospitals are still ranking better than many esteemed academic medical centers.While this could be useful for quality measurement, it would not be helpful for patient or physician decision-making where rank-ordering is better. Absolute scores could result in a majority of hospitals receiving 5 stars or receiving 1 stars. The authors argue for an absolute scale, but implementing this in practice may be difficult. An alternative approach would be to measure quality on an absolute scale. Hospital Compare in essence ranks hospitals by quality meaning that only about 1 in 7 hospitals receives a 5-star rating. While this may not be statistically ideal, it is more transparent. To address this, Medicare has revised the star ratings in 2020 so that all measures are equally weighted. Likely few hospital administrators are familiar with k-means clustering or latent variable models. However, the authors have a fair point that quality metrics are only actionable if they can be clearly understood by the people being evaluated. The k-means clustering approach does seem reasonable and may be useful for retrospective analysis. It could be the case that PSI-90 was the key differentiator across hospitals and hospital quality was similar across the other measures. One measure, the AHRQ PSI-90 complication composite, counted for up to 90% of performance in the safety of care measure group, with the 6 other measures in the group carrying much smaller weights.” This does not mean that the approach was wrong. The authors write that “the latent variable model weighting approach was complex, opaque, and resulted in skewed measure weights. CMS has updated the Hospital Compare so that only hospitals with a minimum number of measures are scored. The authors also note that empirically, “the more measures a hospital reported, the less likely it was to receive 5 stars.” As smaller hospitals have less reporting requirements, it’s not clear if smaller hospitals are providing better care, or if this is a statistical anomaly. While this is sensible from a feasibility standpoint–you can only measure quality for the patients a hospital treats–the comparisons may not be fully comparable. ![]() In practice, however, the authors note that these hospitals often report different numbers and types of measures. In theory, if these hospitals are in the patient/physicians choice set for potential places to be hospitalized, they should be compared. The authors claim that comparing a small 20-bed critical access hospitals to say a specialty orthopedic hospital is not really a useful comparison. Comparison against non comparable hospitals.What are the key challenges with Hospital Compare’s star ratings? A ViewPoint in JAMA by Bilimoria and Barnard (2021) list five key limitations: These star ratings are based on 64 metrics across 7 measure categories: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging. The results are presented on Hospital Compare. The Centers for Medicare and Medicaid Services aimed to summarize hospital quality using a star rating system, where hospitals can receive between 1 and 5 stars (5 is better). Does it have low readmission rates? Low rates of mortality? Do they follow clinical guidelines? Are patients satisfied? Are they good at cardiology care? What about cancer treatment?Ĭombining all these different dimensions of quality is a complex task. Is your hospital high quality? Well, this depends on what quality means.
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