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Area of Science:

  • Endocrinology
  • Medical Quality Assessment
  • Health Services Research

Background:

  • Hospital rankings, such as those by US News and World Report (USNWR), influence patient choices and institutional reputation.
  • The USNWR Diabetes & Endocrinology specialty ranking methodology is not transparent regarding mortality attribution.
  • Accurate mortality attribution is crucial for evaluating healthcare quality and patient outcomes.

Purpose of the Study:

  • To assess the accuracy of mortality attributions made by US News and World Report (USNWR) for the Diabetes & Endocrinology specialty.
  • To compare USNWR's attributed causes of death with clinician-adjudicated causes in a real-world patient cohort.

Main Methods:

  • Retrospective review of consecutive Medicare fee-for-service inpatients at Mayo Clinic, Florida, with mortality within 30 days of admission.
  • Inclusion criteria focused on patients within Medicare Severity Diagnosis Related Groups relevant to the USNWR Diabetes & Endocrinology cohort (November 2018 - April 2022).
  • A clinician adjudicated the primary cause of death, classifying it as diabetes/endocrine, cancer, failure to thrive, or other.

Main Results:

  • Of 49 deceased patients, only 7 (14.3%) had a primary cause of death related to diabetes or endocrine conditions.
  • Cancer was the leading cause of death (49.0%), followed by failure to thrive (30.6%).
  • A significant discrepancy of 86% was observed between USNWR's implied attributions and actual causes of death.

Conclusions:

  • The USNWR methodology for attributing mortality in the Diabetes & Endocrinology specialty appears inaccurate, with a high rate of misattribution.
  • This discrepancy raises concerns about the reliability of USNWR rankings for assessing the quality of diabetes and endocrinology care.
  • Misleading hospital rankings could negatively impact patient decision-making and institutional reputation.