THIS Institute, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
Epidemiology of Cancer Healthcare Outcomes, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
JAMA Health Forum. 2022 May 13;3(5):e221006. doi: 10.1001/jamahealthforum.2022.1006. eCollection 2022 May.
The Centers for Medicare & Medicaid Services (CMS) Hospital Compare star ratings are widely used summaries of hospital quality that can influence patient choice and organizational reputation.
To identify the changes in hospital ratings and rankings associated with alternative methodological choices in the calculation of the 2021 CMS Hospital Compare star ratings.
This cross-sectional study used publicly available 2021 Hospital Compare data for 3339 US hospitals from the October 2020 data release. Change in apparent hospital performance was assessed, arising when plausible alternatives to current methods are used for calculating star ratings in relation to individual measure standardization, domain derivation, and domain weighting. Three example changes were examined in detail, with more comprehensive changes considered using Monte Carlo simulation. Changes in centile of hospital ranks and in star rating overall were examined, as well as separately in CMS peer groupings defined by the number of reported quality domains.
Proportion of hospitals receiving a different star rating under the alternative technical specifications than under the current (2021) CMS approach and mean absolute change in centile rank of hospitals under alternative technical specifications compared with the current (2021) CMS approach.
A total of 3339 US hospitals were included in the analysis. Of the specific changes to current specifications considered, the alternative method of standardization was associated with the most substantial changes, with 55.4% (95% CI, 53.7%-57.1%) of hospitals having their star rating reclassified. The change in domain weights was associated with the smallest differences, but even that resulted in reclassification of the star rating in approximately 1 in 4 (24.5%; 95% CI, 23.0%-26.0%) hospitals. In the simulation study, which covered a range of possible changes, on average half of hospitals (51.8%; IQR, 44.2%-59.7%) were assigned a different star rating from that produced by the current specification, usually into an adjacent star category.
In this cross-sectional study of data on US hospitals, CMS Hospital Compare star ratings were found to be highly sensitive to how performance ratings are calculated, demonstrating the need for transparent justification of the technical approaches used in calculating composite performance ratings.
医疗保险和医疗补助服务中心（CMS）医院比较星级评定是广泛使用的医院质量摘要，可以影响患者选择和组织声誉。
确定与计算 2021 年 CMS 医院比较星级评定的替代方法相关的医院评级和排名变化。
设计、设定和参与者：本横断面研究使用了 2021 年 10 月发布的公共可用的 3339 家美国医院的 2021 年 CMS 医院比较数据。通过对个体测量标准化、域推导和域加权相关的星级评定当前方法的合理替代方法，评估了明显的医院绩效变化。详细检查了三个示例更改，并使用蒙特卡罗模拟考虑了更全面的更改。检查了医院等级百分位的变化和星级评定的整体变化，以及根据报告的质量域数量由 CMS 同行分组定义的星级评定的单独变化。
在替代技术规范下，而不是在当前（2021 年）CMS 方法下，获得不同星级评定的医院比例，以及在替代技术规范下，与当前（2021 年）CMS 方法相比，医院百分位排名的平均绝对变化。
共纳入 3339 家美国医院进行分析。在所考虑的当前规范的具体更改中，标准化的替代方法与最显著的更改相关，55.4%（95%CI，53.7%-57.1%）的医院的星级评定被重新分类。域权重的变化导致的差异最小，但即使如此，也会导致大约 1/4（24.5%；95%CI，23.0%-26.0%）的医院的星级评定重新分类。在涵盖各种可能更改的模拟研究中，平均一半的医院（51.8%；IQR，44.2%-59.7%）被分配了不同于当前规范产生的星级评定，通常是相邻的星级类别。
在这项对美国医院数据的横断面研究中，发现 CMS 医院比较星级评定对绩效评分的计算方法非常敏感，这表明需要透明地证明计算综合绩效评分所使用的技术方法的合理性。
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