Pollock Benjamin D, Ubl Daniel S, Devkaran Subashnie, Dowdy Sean C
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, Florida.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
JAMA Netw Open. 2025 Jul 1;8(7):e2519029. doi: 10.1001/jamanetworkopen.2025.19029.
Hospital ratings including the US News & World Report's Best Hospitals rankings and the Centers for Medicare & Medicaid Services' (CMS') Overall Hospital Quality Star Rating (Overall Star Rating) measure different outcomes and are weakly correlated. Therefore, methods for defining and measuring reliable excellence, defined as consistently great performance across all quality measures, are needed.
To assess a measure of reliable excellence using the 45 quality measures reported in the Overall Star Ratings.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used hospital-level data from the 2023 and 2024 CMS Overall Star Ratings at all US hospitals with a 2023 and 2024 CMS Overall Star Rating.
The exposure was the CMS Overall Star Rating summary score, a continuous variable calculated from the weighted z scores of 45 quality measures used in the Overall Star Rating. A total of 100 000 simulations were run in which all US hospitals' CMS Overall Star Rating summary scores were calculated through summation of z scores from randomly generated measure weights, as opposed to the existing weights used in the Overall Star Rating method.
Reliable excellence, defined as achieving a 90th percentile (or better) CMS Overall Star Rating summary score on at least 50 000 of 100 000 simulations. The percentage of hospitals achieving reliable excellence was calculated both overall and stratified by CMS Ovearll Star Ratings.
There were 2700 hospitals in the analysis, with 335 5-star hospitals (12.4%), 727 4-star hospitals (26.9%), 799 3-star hospitals (29.6%), 572 2-star hospitals (21.2%), and 267 1-star hospitals (9.9%) in the 2024 CMS Overall Star Rating. A total of 244 of 2700 hospitals (9.0%) met the study definition of reliable excellence, whereas 1287 of 2700 hospitals (47.7%) achieved excellence in at least 1 simulation.
This cross-sectional study of 2700 US hospitals found that only 244 hospitals (9.0%), including less than two-thirds of the CMS 5-star rated hospitals, were reliably excellent across 100 000 CMS Overall Star Rating scoring simulations using random measure weightings. These findings lend credence to the ubiquity of inconsistent greatness in health care quality and illuminate the need for methods to distinguish hospitals that provide reliably excellent care.
医院评级，包括《美国新闻与世界报道》的最佳医院排名以及医疗保险和医疗补助服务中心（CMS）的医院总体质量星级评定（总体星级评定），衡量的是不同的结果，且相关性较弱。因此，需要有方法来定义和衡量可靠卓越性，即所有质量指标都始终表现出色。
使用总体星级评定中报告的45项质量指标来评估可靠卓越性的一种衡量方法。
设计、设置和参与者：这项横断面研究使用了2023年和2024年所有获得CMS总体星级评定的美国医院的医院层面数据。
暴露因素是CMS总体星级评定汇总分数，这是一个连续变量，由总体星级评定中使用的45项质量指标的加权z分数计算得出。总共进行了100000次模拟，在这些模拟中，所有美国医院的CMS总体星级评定汇总分数是通过将随机生成的指标权重的z分数相加来计算的，而不是使用总体星级评定方法中现有的权重。
可靠卓越性定义为在100000次模拟中的至少50000次模拟中达到第90百分位（或更高）的CMS总体星级评定汇总分数。计算了总体上以及按CMS总体星级评定分层的达到可靠卓越性的医院百分比。
分析中有2700家医院，在2024年CMS总体星级评定中，有335家五星级医院（12.4%）、727家四星级医院（26.9%）、799家三星级医院（29.6%）、572家二星级医院（21.2%）和267家一星级医院（9.9%）。2700家医院中有244家（9.0%）符合可靠卓越性的研究定义，而2700家医院中有1287家（47.7%）在至少1次模拟中达到了卓越。
这项对2700家美国医院的横断面研究发现，在使用随机指标权重进行的100000次CMS总体星级评定评分模拟中，只有244家医院（9.0%）是可靠卓越的，其中包括不到三分之二的CMS五星级评级医院。这些发现证实了医疗质量中不一致的卓越性普遍存在，并表明需要有方法来区分提供可靠卓越医疗服务的医院。
