From the Department of Surgery (Dr. Shah, Dr. Bilimoria), Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, and Department of Orthopaedics (Dr. Shah, Dr. Manning, Dr. Butler), Northwestern University, Chicago, IL.
J Am Acad Orthop Surg. 2020 Sep 1;28(17):e766-e773. doi: 10.5435/JAAOS-D-19-00165.
A growing number of online hospital rating systems for orthopaedic surgery are found. Although the accuracy and consistency of these systems have been questioned in other fields of medicine, no formal analysis of these systems in orthopaedics has been found.
Five hospital rating systems (US News, HealthGrades, CareChex, Women's Choice, and Hospital Compare) were examined which designate "high-performing" and "low-performing" hospitals for orthopaedic surgery. Descriptive analysis was conducted for all hospitals defined as high- or low-performing in any of the five rating systems, and assessment for agreement/disagreement between ratings was done. A subsample of hospitals ranked by all systems was then created, and agreement between rating systems was investigated using a Cohen's kappa. Each hospital was included in a multinomial logistic regression model investigating which hospital characteristics increased the odds of being favorably/unfavorably rated by each system.
One thousand six hundred forty hospitals were evaluated by every rating system. Six hundred thirty-eight unique hospitals were identified as high-performing by at least 1 rating system; however, no hospital was ranked as high-performing by all five rating systems. Four hundred fifty-two unique hospitals were identified as low-performing; however, no hospital was ranked as low-performing by all the three rating systems which define low-performing hospitals. Within the study subsample of hospitals evaluated by each system, little agreement between any combination of rating systems (κ < 0.10) regarding top-tier or bottom-tier performance was found. It was more likely for a hospital to be considered high-performing by one system and low-performing by another (10.66%) than for the majority of the five rating systems to consider a hospital high-performing (3.76%).
Little agreement between hospital quality rating systems for orthopaedic surgery is found. Publicly available hospital ratings for performance in orthopaedic surgery offer conflicting results and provide little guidance to patients, providers, or payers when selecting a hospital for orthopaedic surgery.
Level 1 economic study.
越来越多的在线骨科手术医院评级系统被发现。尽管这些系统在医学的其他领域的准确性和一致性受到质疑，但在骨科领域尚未发现对这些系统的正式分析。
检查了五个医院评级系统（美国新闻、HealthGrades、CareChex、女性选择和医院比较），这些系统为骨科手术指定了“表现良好”和“表现不佳”的医院。对所有在五个评级系统中的任何一个中被定义为表现良好或表现不佳的医院进行描述性分析，并对评级之间的一致性进行评估。然后创建了一个由所有系统排名的医院子样本，并使用 Cohen 的 kappa 来研究评级系统之间的一致性。每个医院都被纳入一个多变量逻辑回归模型，该模型调查了哪些医院特征增加了每个系统有利/不利评级的可能性。
每个评级系统评估了 1640 家医院。有 638 家独特的医院至少被 1 个评级系统评为表现良好；然而，没有一家医院被所有五个评级系统评为表现良好。有 452 家独特的医院被评为表现不佳；然而，没有一家医院被定义为表现不佳的三个评级系统中的任何一个评为表现不佳。在所评估的医院子样本中，很少有任何组合的评级系统（κ<0.10）之间在顶级或底层表现方面达成一致。一个系统认为医院表现良好而另一个系统认为医院表现不佳的可能性（10.66%）大于五个评级系统中大多数系统认为医院表现良好的可能性（3.76%）。
骨科手术医院质量评级系统之间存在很少的一致性。可公开获得的骨科手术绩效医院评级提供了相互矛盾的结果，在选择骨科手术医院时，几乎不能为患者、提供者或支付者提供指导。
1 级经济研究。
