Halasyamani Lakshmi K, Davis Matthew M
Department of Internal Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan 48197, USA.
J Hosp Med. 2007 May;2(3):128-34. doi: 10.1002/jhm.176.
In April 2005 the Centers for Medicare and Medicaid Services launched "Hospital Compare," the first government-sponsored hospital quality scorecard. We compared the ranking of U.S. News and World Report's "Best Hospitals" with Hospital Compare performance ratings.
We examined Hospital Compare scores for core measures related to care for acute myocardial infarction (AMI), congestive heart failure (CHF), and community-acquired pneumonia (CAP). We calculated composite scores for the disease-specific sets of core measures and a composite combined score for the 14 core measures (across 3 diseases) and determined national score quartile cut points for each set. We then characterized the quartile distribution of Hospital Compare scores for the Best Hospitals for care of cardiac conditions and respiratory disorders in each year, as well as for the Best Hospital "Honor Roll" institutions.
AMI scores were available for 2165 hospitals, CHF scores for 3130, and CAP scores for 3462. In both 2004 and 2005, fewer than 50% of the Best Hospitals for cardiac care rated in the top quartile of Hospital Compare scores for AMI and CHF. Among the Best Hospitals for care of respiratory disorders, fewer than 15% scored in the top Hospital Compare quartile for CAP. Among Honor Roll institutions, only 5 (of 14 hospitals in 2004; of 16 in 2005) ranked in the top quartile for the combined core measure score.
Hospital Compare scores are frequently discordant with Best Hospital rankings, which is likely attributable to the markedly different methods each rating approach employs. Such discordance between major quality rating systems paints a conflicting picture of institutional performance for the public to interpret.
2005年4月，医疗保险和医疗补助服务中心推出了首个政府资助的医院质量记分卡“医院比较”。我们比较了《美国新闻与世界报道》“最佳医院”排名与“医院比较”的绩效评级。
我们检查了“医院比较”中与急性心肌梗死（AMI）、充血性心力衰竭（CHF）和社区获得性肺炎（CAP）护理相关的核心指标得分。我们计算了特定疾病核心指标集的综合得分以及14项核心指标（涵盖3种疾病）的综合合并得分，并确定了每组指标的全国得分四分位数切点。然后，我们描述了每年心脏疾病和呼吸系统疾病最佳医院以及最佳医院“荣誉榜”机构在“医院比较”得分方面的四分位数分布情况。
有2165家医院提供了AMI得分，3130家提供了CHF得分，3462家提供了CAP得分。在2004年和2005年，心脏护理最佳医院中，在“医院比较”中AMI和CHF得分处于前四分位数的医院均不到50%。在呼吸系统疾病护理最佳医院中，在“医院比较”中CAP得分处于前四分位数的医院不到15%。在“荣誉榜”机构中，只有5家（2004年为14家医院中的5家；2005年为16家医院中的5家）在综合核心指标得分方面排名前四分位数。
“医院比较”得分与最佳医院排名常常不一致，这可能是由于每种评级方法所采用的方法明显不同。主要质量评级系统之间的这种不一致给公众呈现出一幅相互矛盾的机构绩效图景以供解读。
