Faculty Collaboration Database

Do popular media and internet-based hospital quality ratings identify hospitals with better cardiovascular surgery outcomes? J Am Coll Surg 2010 Jan;210(1):87-92

Date

02/04/2010

Pubmed ID

20123337

DOI

10.1016/j.jamcollsurg.2009.09.038

Scopus ID

2-s2.0-72049093199 (requires institutional sign-in at Scopus site)   31 Citations

Abstract

BACKGROUND: Several popular media and Internet-based hospital quality rankings have become increasingly publicized as a method for patients to choose better hospitals. It is unclear whether selecting highly rated hospitals will improve outcomes after cardiovascular surgery procedures.

STUDY DESIGN: Using 2005 to 2006 Medicare data, we studied all patients undergoing abdominal aortic aneurysm repair, coronary artery bypass, aortic valve repair, and mitral valve repair (n = 312,813). Primary outcomes included risk-adjusted mortality, adjusting for patient characteristics and surgical acuity. We compared mortality at "Best Hospitals," according to US News and World Report and HealthGrades, with all other hospitals. We adjusted for hospital volume to determine whether hospital experience accounts for differences in mortality.

RESULTS: Risk-adjusted mortality was considerably lower in US News and World Report's "Best Hospitals" for abdominal aortic aneurysm repair only (odds ratio [OR] = 0.76; 95% CI, 0.61 to 0.94). Risk-adjusted mortality was considerably lower in HealthGrades' "Best Hospitals" after all 4 procedures: abdominal aortic aneurysm repair (OR = 0.75; 95% CI, 0.58 to 0.97), coronary artery bypass (OR = 0.78; 95% CI, 0.68 to 0.89), aortic valve repair (OR = 0.71; 95% CI, 0.59 to 0.85), and mitral valve repair (OR = 0.77; 95% CI, 0.61 to 0.99). Accounting for hospital volume, risk-adjusted mortality was not substantially lower at the US News and World Report's "Best Hospitals," while risk-adjusted mortality was lower at HealthGrades' "Best Hospitals" after coronary artery bypass and aortic valve repair mortality rates were adjusted for hospital volume (OR = 0.77; 95% CI, 0.64 to 0.92 and OR = 0.81; 95% CI, 0.71 to 0.94).

CONCLUSIONS: Popular hospital rating systems identify high-quality hospitals for cardiovascular operations. However, patients can experience equivalent outcomes by seeking care at high-volume hospitals.

Author List

Osborne NH, Nicholas LH, Ghaferi AA, Upchurch GR Jr, Dimick JB

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cardiovascular Surgical Procedures
Female
Hospitals
Humans
Internet
Male
Mass Media
Quality Assurance, Health Care
Risk Assessment
Survival Analysis
Treatment Outcome
United States