Anyone familiar with U.S. News & World Report's annual hospital rankings knows that Houston facilities are repeat performers. The magazine's just-out 2010 list of the top 50 ranks M.D. Anderson as number one for cancer care; the Texas Heart Institute came in at number four for cardio care; and Texas Children's Hospital nabbed a bunch of pediatric top-tens. And that's just for starters.
But what's behind the rankings?
According to the Houston Business Journal's telling of it, "U.S. News said 4,852 hospitals were considered for their reputations, mortality rate, patient safety and care-related factors including nurse staffing and technology. Four specialties -- ophthalmology, psychiatry, rehabilitation and rheumatology -- were ranked on hospital reputation alone."
It's a bit of fine print that gets lost, and a point that Ashwini Sehgal, a nephrologist at MetroHealth Medical Center in Cleveland, analyzed for the April issue of the Annals of Internal Medicine.
According to Sehgal's study of just how much "reputation" figures into the rankings (he used the 2009 rankings), "little relationship exists between subjective reputation and objective measures of hospital quality among the top 50 hospitals." (Sehgal wasn't available for comment, so Hair Balls put on our academic-journal-thinkin'-cap and sifted through the study for the juicy parts).
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Strangely, according to Sehgal's study, ranking a hospital based on reputation -- i.e., judging by brand name, regardless of statistical data -- can have a negative impact on even good hospitals.
Because reputation can deteriorate quickly from a single negative event, even highly rated hospitals should be concerned about rankings based primarily on reputation. Moreover, reputation-based rankings may act as barriers to improving hospital quality, because even highly successful quality improvement programs are unlikely to enhance a hospital's ranking.
Sehgal writes that "the current rankings fall short of being an evidence-based system that data-conscious consumers, value-based purchasers, and reform-minded policymakers can rely on for health care decisions."
From what we can tell, it's not like Sehgal's saying M.D. Anderson, et al, are actually Third World death-mills, just that "reputation" might have some undue and unfortunate influence on the annual rankings. Not that this is any matter to Hair Balls; we still prefer to see the village shaman for all our health care needs.