18 May Hospitals With Rigorous Quality Improvement Programs Penalized In Star Ratings
MedicalResearch.com Interview with:
John Oliver DeLancey, MD, MPH
Resident, Department of Urology
Research Fellow, Surgical Outcomes and Quality Improvement Center
Northwestern University Feinberg School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We initially looked at the star ratings for hospitals that we considered to provide excellent care, and it did not seem that this was reflected in the star ratings. Therefore, we sought to examine which factors were associated with the likelihood of receiving a high or low star rating.
When we examined these associations, we found that academic and community hospitals, who reported nearly all of the measures included, had disproportionally lower star ratings than Critical Access or Specialty hospitals, who reported on average about half of the measures used to generate the star ratings.
MedicalResearch.com: What should readers take away from your report?
Response: As with any rating system, there is potential for bias to affect the ratings, and many of the measures used in the Star Ratings are subject to surveillance bias, which means that hospitals with rigorous quality improvement programs to detect events are penalized in the Star Ratings simply because they are more actively searching to identify these events. Readers should first consider what specific information they are seeking when looking at these ratings systems. The CMS star ratings system does specifically allow consumers to search for hospital performance on each of the specific measures included in their ratings system, which may be useful for consumers who are looking for information regarding specific aspects of care that they may be seeking. Unfortunately, the combination of different types of hospitals into a summary rating system may limit the ability of the rating system to provide useful information to patients.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We believe that when rating hospitals in particular, ratings systems should account for, or separate hospitals that care for meaningful different populations of patients. In doing this, ratings may be able to be assigned on a more equitable basis to allow the public to evaluate comparable hospitals and inform their care decisions.
This work is supported by grant funding from the Agency for Healthcare Research and Quality
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DeLancey JO, Softcheck J, Chung JW, Barnard C, Dahlke AR, Bilimoria KY. Associations Between Hospital Characteristics, Measure Reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings. JAMA. 2017;317(19):2015-2017. doi:10.1001/jama.2017.3148
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