How Good Is Your Hospital?

Do you want to read an online "report card" for your local hospital? Would you consider shopping around for "the best" hospital in town? If so, then read on.

It is increasingly common for consumers to access the Internet for healthcare information and advice, and physicians are being bombarded with questions raised by Web searches. In particular, some consumers go online to compare "Hospital A" with "Hospital B." But just how accurate is this comparison information gleaned from Web sites?

HealthGrades.com is one such commercial Web site. With over 1 million visitors last year, it has been featured in USA Today and the Los Angeles Times. The site uses a star system to rate hospitals -- five-star hospitals are the best, three-star hospitals are average and one-star hospitals are poor. Ratings are also available for nursing homes and home health agencies.

Dr. Harlan Krumholz, from the Yale University School of Medicine, compared ratings given by HealthGrades.com with his own research. The findings were just published in the Journal of the American Medical Association.

Dr. Krumholz and colleagues looked at data collected by the Cooperative Cardiovascular Project on patients hospitalized for heart attacks. They reviewed over 200,000 separate hospital admissions at 3,363 hospitals. Researchers looked at whether an important treatment such as clot-busting drugs or bypass surgery was used. They also compared mortality and checked if the appropriate discharge medications, including aspirin, beta-blockers and ACE inhibitors, were given.

Dr. Krumholz found that, as a group, five-star hospitals had lower mortality rates than one-star hospitals and were more likely to use aspirin and beta-blockers. However, there was a wide range of quality for hospitals within each rating group. This means that some of the five-star hospitals had higher mortality then some of the three-star hospitals. Therefore, consumers looking to find the hospital with the lowest mortality cannot rely on the star rating system.

The authors concluded, "The ratings poorly discriminated between any two individual hospitals' process of care or mortality rates during the study period. Limitations in discrimination may undermine the value of health care quality ratings for patients or payers and may lead to misperceptions of hospitals' performance."