Better-than-average and worse-than-average hospitals may not significantly differ from average hospitals: an analysis of Medicare Hospital Compare ratings

Paddock, Susan M.; Adams, John; Guardia, Fernando Hoces de la

doi:10.1136/bmjqs-2014-003405

Cited by 24 publications

(15 citation statements)

References 15 publications

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“…They concluded that these sets of measures make it difficult to distinguish among hospitals that patients are likely to choose from. Paddock et al 15 came to similar conclusions by using comparative rankings provided by the Hospital Compare website.…”

Section: Discussionmentioning

confidence: 69%

How well do subjective Hospital Compare metrics reflect objective outcomes in spine surgery?

Missios

Bekelis

2016

SPI

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OBJECTIVE The accuracy of public reporting in health care is an issue of debate. The authors investigated the association of patient satisfaction measures from a public reporting platform with objective outcomes for patients undergoing spine surgery. METHODS The authors performed a cohort study involving patients undergoing elective spine surgery from 2009 to 2013 who were registered in the New York Statewide Planning and Research Cooperative System database. This cohort was merged with publicly available data from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. A mixed-effects regression analysis, controlling for clustering at the hospital level, was used to investigate the association of patient satisfaction metrics with outcomes. RESULTS During the study period, 160,235 patients underwent spine surgery. Using a mixed-effects multivariable regression analysis, the authors demonstrated that undergoing elective spine surgery in hospitals with a higher percentage of patient-assigned high satisfaction scores was not associated with a decreased rate of discharge to rehabilitation (OR 0.77, 95% CI 0.57–1.06), mortality (OR 0.96, 95% CI 0.90–1.01), or hospitalization charges (β 0.04, 95% CI −0.16 to 0.23). However, it was associated with decreased length of stay (LOS; β −0.19, 95% CI −0.33 to −0.05). Similar associations were identified for hospitals with a higher percentage of patients who claimed they would recommend these institutions to others. CONCLUSIONS Merging a comprehensive all-payer cohort of spine surgery patients in New York state with data from the CMS Hospital Compare website, the authors were not able to demonstrate an association of improved performance in patient satisfaction measures with decreased mortality, rate of discharge to rehabilitation, and hospitalization charges. Increased patient satisfaction was associated with decreased LOS.

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Section: Discussionmentioning

confidence: 69%

How well do subjective Hospital Compare metrics reflect objective outcomes in spine surgery?

Missios

Bekelis

2016

SPI

View full text Add to dashboard Cite

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“…However, the utility of these measurements in generating hospital rankings has been debated. Paddock et al 17 used comparative rankings provided by the Hospital Compare Website and concluded that these sets of measures make it difficult to distinguish among hospitals that patients are likely to choose from. No prior study attempted to correlate subjective publicly reported measures with objective physician performance.…”

Section: Discussionmentioning

confidence: 99%

“…5,12 Some researchers 14 have demonstrated that improved patient satisfaction was associated with superior hospital-level outcomes in terms of mortality, length-of-stay, and discharge to rehabilitation for patients undergoing spine surgery. The same group 3 and others 17,20,22 failed to identify a similar relationship for different surgical procedures, raising questions about the reliability of this reporting platform. However, no previous study has investigated the correlation of hospital performance in patient satisfaction measures with the objective performance of the individual treating physicians, employed in these institutions.…”

Section: Introductionmentioning

confidence: 97%

Does Objective Quality of Physicians Correlate with Patient Satisfaction Measured by Hospital Compare Metrics in New York State?

et al. 2017

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Background It is unclear whether publicly reported benchmarks correlate with the quality of physicians and institutions. We investigated the association of patient satisfaction measures from a public reporting platform with the performance of neurosurgeons in New York State. Methods We performed a cohort study involving patients undergoing neurosurgical operations from 2009–2013, who were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. This cohort was merged with publicly available data from the CMS Hospital Compare website. A propensity adjusted regression analysis was used to investigate the association of patient satisfaction metrics with neurosurgeon quality, as measured by their individual rate of mortality and average length-of-stay (LOS). Results Overall, 166,365 patients underwent neurosurgical procedures during the study. Using a propensity adjusted multivariable regression analysis we demonstrated that undergoing neurosurgical operations in hospitals with a greater percentage of patient-assigned “high” score were associated with higher chance of being treated by a physician with superior performance in terms of mortality (OR 1.90; 95% CI, 1.86 to 1.95), and a higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (OR 1.24; 95% CI, 1.21 to 1.27). Similar associations were identified for hospitals with a higher percentage of patients, who claimed they would recommend these institutions to others. Conclusions Merging a comprehensive all-payer cohort of neurosurgery patients in New York State with data from the CMS Hospital Compare website, we observed an association of superior hospital-level patient satisfaction measures with the objective performance of individual neurosurgeons in the corresponding hospitals.

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“…This observation has led many scholars (e.g., Emmer and Schlesinger, 2016, Sinaiko et al, 2012) to conjecture that better presentation of medical quality information would cause patients to make more use of it in their decisions. A feature that is often cited as desirable is personalized information tailored to individual patients (Paddock et al, 2015, Sinaiko et al, 2012. The implication is that more usable information could make the outcomes in Table 6 possible.…”

Section: Numerical Analysesmentioning

confidence: 99%

Using Patient-Specific Quality Information to Unlock Hidden Healthcare Capabilities

Wang

Jun

Hopp

et al. 2019

M&SOM

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We document a wide variation in quality among 188 surgeons at 35 hospitals in New York state that perform mitral valve surgery. Our analysis shows that patients of different demographics and levels of acuity benefit differently from elite surgeons. However, existing healthcare provider quality information is based on population averages and so does not differentiate patients of different medical conditions. This implies that patient-centric quality information, which calibrates outcome statistics by patient demographics and acuity, can increase the ability of patients to choose the most appropriate surgeon. In this paper, we develop an approach for computing patient-centric information from outcome data and evaluate the potential health benefits from using such information to guide patients to surgeons. We estimate that the total societal benefits from using patient-centric information are comparable to those achievable by enabling the best surgeons to treat 40% more patients under population-average information.

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Better-than-average and worse-than-average hospitals may not significantly differ from average hospitals: an analysis of Medicare Hospital Compare ratings

Abstract: Our analyses illustrate the need for further innovations in the design of public report cards to enhance their salience for consumers.

Cited by 24 publications

References 15 publications

How well do subjective Hospital Compare metrics reflect objective outcomes in spine surgery?

How well do subjective Hospital Compare metrics reflect objective outcomes in spine surgery?

Does Objective Quality of Physicians Correlate with Patient Satisfaction Measured by Hospital Compare Metrics in New York State?

Using Patient-Specific Quality Information to Unlock Hidden Healthcare Capabilities

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