Do Hospital Rankings Mislead Patients? Variability Among National Rating Systems for Orthopaedic Surgery
Romil F Shah1, David W Manning, Bennet A Butler
1From the Department of Surgery (Dr. Shah, Dr. Bilimoria), Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, and Department of Orthopaedics (Dr. Shah, Dr. Manning, Dr. Butler), Northwestern University, Chicago, IL.
The Journal of the American Academy of Orthopaedic Surgeons
|October 10, 2019
Summary
Online hospital rating systems for orthopaedic surgery show little agreement. These conflicting ratings offer minimal guidance for patients, providers, and payers when choosing a hospital for orthopaedic care.
Area of Science:
- Health Services Research
- Orthopaedic Surgery Quality Assessment
Background:
- Multiple online hospital rating systems for orthopaedic surgery are available.
- Previous studies questioned the accuracy and consistency of these systems in other medical fields.
- No formal analysis of orthopaedic surgery rating systems had been conducted.
Purpose of the Study:
- To formally analyze the accuracy and consistency of online hospital rating systems for orthopaedic surgery.
- To assess the agreement and disagreement between different hospital rating systems.
- To identify hospital characteristics influencing ratings.
Main Methods:
- Examined five hospital rating systems (US News, HealthGrades, CareChex, Women's Choice, Hospital Compare) for orthopaedic surgery performance.
- Conducted descriptive analysis and assessed agreement/disagreement between ratings.
- Used Cohen's kappa and multinomial logistic regression to analyze agreement and influencing factors.
Main Results:
- No hospital was ranked as high-performing by all five systems; no hospital was ranked low-performing by all three systems that define low performance.
- Little agreement was found between any combination of rating systems regarding top-tier or bottom-tier performance (κ < 0.10).
- Hospitals were more likely to receive conflicting ratings (high-performing by one, low-performing by another) than consistent high-performance ratings.
Conclusions:
- There is a significant lack of agreement between hospital quality rating systems for orthopaedic surgery.
- Publicly available ratings provide conflicting information, offering little guidance for selecting orthopaedic surgery providers.
- Patients, providers, and payers receive inadequate guidance due to inconsistent hospital performance data.
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