Given the potential range of scores for a hospital best at everything and a hospital worst at everything, how different are hospitals from each other?.However, serious morbidity for colorectal surgery and 30-day post-PCI readmission rate were lower at high-star hospitals compared with low-star hospitals. 10 On the other hand, no significant associations were found between Star Ratings and mortality in laparoscopic abdominal surgeries, serious morbidity for bariatric or hiatal hernia surgeries, or 30-day risk-standardized mortality after PCI. For example, Star Ratings seemed to be significantly associated with cancer surgery outcomes, 8-10 although the efficiency, effectiveness, and feasibility of patients’ use of Star Ratings to identify high-quality hospitals for complex cancer surgeries was questioned. Available data on the small amount of correlation among specific Hospital Compare measures 7 suggest that an overall rating may not be informative about relative hospital performance for specific conditions or procedures.Įxisting literature examining associations between Star Ratings and outcomes of cancer surgery, 8-10 advanced laparoscopic abdominal surgery, 11 and percutaneous coronary intervention (PCI) 12 demonstrates mixed results. In this case, the value of any overall rating system can be questioned because it inevitably includes information on aspects of care that are not relevant to the patient’s specific condition. 6Īn overall rating system could also be used by individual patients or consumers for choices of hospitals for specific needs-elective surgical procedures being a common example. An overall rating that brings together scores on multiple individual measures of quality simplifies the decision about inclusion in the network, and it allows a plan or purchaser or patient advocacy group to make recommendations to its members or clients about “good” vs “bad” hospitals for purposes of their choices. It can be used by purchasers or health plans that are designing limited provider networks and whose interest in hospital quality spans the entire range of clinical specialties and programs. 5Īn overall hospital rating or ranking system could be used in either of 2 ways. Although concerns have been raised about technical aspects of the Star Ratings 3 and the accuracy and fairness of the ratings, 4 a variety of consumer advocacy and large purchaser groups have reported that they find the Star Ratings useful. Scores are calculated using a statistical model for each of the 7 groups and are weighted and combined to yield an overall hospital rating of 1 to 5 stars. 2 Under the current method, a set of 57 individual measures of quality are categorized into 7 quality groups or domains. The CMS Overall Hospital Quality Star Ratings 1 (referred to subsequently as the “Star Ratings”) were created to provide consumers with a simple, easy-to-understand summary of the measures available in the Hospital Compare measure set. These 2 observations suggest that the Star Ratings are of limited value to consumers choosing hospitals for specific care needs. The Star Ratings did not predict hospital quality scores for separate quality measures related to specific medical conditions or health care needs. No significant associations were found between hospitals’ overall Star Ratings and their performance on a set of condition-specific quality measures for hospitals in California and New York State.Ĭonclusions: Hospitals’ overall scores clustered in the middle of the potential distribution of scores no hospitals were either best at everything or worst at everything. On average, for a given quality measure included in the Star Rating program, 12% of 1-star hospitals received top-quartile scores and 16% of 5-star hospitals received bottom-quartile scores. Hospitals did not consistently perform well or poorly across the range of measures and quality groups included in the Star Ratings. Results: The distribution of hospitals’ Star Rating summary scores was tightly compressed, with no hospitals at or near the scores that would be obtained if a hospital were either best or worst across all quality domains. Methods: Hospital Star Rating data reported in February 2019 and additional quality data from California and New York were used, with a mix of analytical approaches including descriptive statistics, correlational analysis, and Poisson regression models. Study Design: Observational study using secondary data analyses. Objectives: To examine characteristics of the CMS Overall Hospital Quality Star Ratings related to their use by consumers for choosing hospitals.
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