Report Cards for Hospitals May Be Misleading

FRIDAY Sept. 11, 2009 -- A new study questions the value of hospital report cards and national rankings when it comes to neurology and neurosurgery.

Researchers with Loyola University Health System in Chicago say the mortality index, a statistic to gauge the number of deaths a facility has in a given area of medical care, may be inflated -- indicating a higher-than-normal death rate -- at hospitals that specialize in severe traumas, have busy emergency departments or have high numbers of patients on government-subsidized Medicaid.

"A hospital with a lower mortality index may not be a better hospital for patient care, but rather a place where the patient mix has been refined or limited," study senior author Dr. Thomas Origitano, chairman of the Loyola medical school's department of neurological surgery, said in a university news release.

The study authors, whose findings are available online in advance of publication in an upcoming print issue of the Journal of Neurosurgery, say their review of neurosurgical deaths at 103 academic medical centers shows that the mortality index skews against hospitals that do the following:

  • Take on complex cases transferred from other hospitals.
  • Perform non-elective surgery, such as spine infections, more often than elective surgeries, such as decompression of a pinched nerve. Elective surgeries, they note, are only done when a patient is considered healthy enough for the procedure while non-electives tend to be for more severe cases and must be performed regardless of other health factors.
  • Operate Level 1 trauma centers, which specialize in handling the most severe cases of emergency medicine, such as gunshot wounds or accident-related head and neck injuries.
  • Treat a large Medicaid population, a group the researchers noted typically has "poor access to medical care, are poorly educated in health and hygiene, are uninsured and present only once their symptoms have become severe."

The researchers also said that using a facility's reputation as a key ranking criteria, which many national evaluation systems do, "is at best subjective" and may mislead patients.

There is no "definitive or reliable source for rating the quality of overall neurosurgical care," the researchers concluded.

More information

The U.S. Department of Health and Human Services has more about comparing hospitals.

Posted: September 2009


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