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The "Best" Hospitals May Be No Better Than the One around the Corner
Several well-known magazines publish their yearly "Top Hospitals" or "Best Doctors" issues every year. The biggest and best-known hospitals typically grace the tops of the lists, and these spots are often filled with the same hospitals from year to year. But a new study calls into question whether the hospitals in two popular rankings – U.S. News and World Report and the HealthGrades website – are really any better than others when it comes to cancer surgery success.
According to the study, ratings for U.S. News & World Report hospitals are based on the hospitals’ infrastructure, the reputation of subspecialists, and the hospitals’ 30-day mortality rate. HealthGrades bases their rankings on a particular equation, comparing expected outcomes to observed outcomes for 27 different procedures.
Using Medicare data, the research team looked at mortality rates after cancer surgeries for the 50 hospitals on each of the two lists vs. the hospitals that did not make either list, which included over 4,400. The 82,000 patients had all had one of three types of cancer surgery. The team tracked their mortality rates over 30 days post-surgery.
Initially, it looked like the U.S. News & World Report hospitals were clear winners, cutting death risk by up to 58%. HealthGrades top-rated hospitals only cut the risk for one of the surgeries, colectomy (removal of part of the colon). But when the researchers adjusted for the volume of patients treated in all of the hospitals, the U.S. News & World Report hospitals beat out others only in colectomy, and HealthGrades hospitals were no better than others in survival rate for any of the three procedures.
Millions of Americans look to each of the sources for information about the best hospitals. But the researchers conclude that patients may receive equally good treatment in a high-volume hospital near one’s home. Other studies have found that most people (about 75%) live within a 30-minute drive to a high-volume hospital.
Obviously the study has some limitations, including that the success of only three procedures was considered. And since these surgeries are often done in older people, who already have a lower success rate, other types of procedures should be studied in the future. In addition, the 30-day mortality rate was the only success measure taken into account. There are many other measures of a hospital’s success rate that could be considered, like readmission, complications, long term prognosis, and so on.
Still, the study suggests that revamping the way hospital rankings are done will be a necessary move. It also has some important implications for people who in search of a good hospital: the best hospital may be closer to home than you think.
The research was carried out by a team at the University of Michigan, Ann Arbor, and published in the May 5, 2011 issue of Archives of Surgery.
June 3, 2011