Currently available public hospital quality rating systems frequently offer conflicting results, which may mislead stakeholders relying on the ratings to identify top-performing hospitals, according to an analysis published by NEJM Catalyst and reported by the American Hospital Association.
The authors evaluated the strengths and weaknesses of four public hospital quality rating systems based on their experience as physician scientists with methodological expertise in healthcare quality measurement: the Centers for Medicare & Medicaid Services' Hospital Compare overall star ratings; Healthgrades Top Hospitals; U.S. News & World Report Best Hospitals; and Leapfrog Hospital Safety Grade and Leapfrog Top Hospitals.
"Each rating system had unique weaknesses that led to potential misclassification of hospital performance, ranging from inclusion of flawed measures, use of proprietary data that are not validated, and methodological decisions," the authors said.
According to the analysis, no rating system received an A or an F. The highest grade received was a B by U.S. News & World Report. CMS Star Ratings received a C. The lowest grades were for Leapfrog, C-, and Healthgrades, D+. Each rating system had unique weaknesses that led to potential misclassification of hospital performance, ranging from inclusion of flawed measures, use of proprietary data that are not validated, and methodological decisions. Several issues that limited all rating systems examined included
· limited data and measures
· lack of robust data audits
· composite measure development
· measuring diverse hospital types together
· lack of formal peer review of their methods
The research concluded that,“ Opportunities to advance the field of hospital quality measurement include the need for better data subject to robust audits, more meaningful measures, and development of standards and robust peer review to evaluate rating system methodology.”
