by
Brendon Nafziger, DOTmed News Associate Editor | September 16, 2009
This is important, because poverty is linked with worse health outcomes. "Patients who don't have the same type of access to health care...are sicker," Dr. Origitano says.
And although it wasn't conclusive, the study did suggest that hospitals with more elective surgeries also had lower mortality rates, something Dr. Origitano believes is easy to predict, because patients needing optional or non-medically required surgeries are bound to be healthier than those undergoing a mandated or emergency procedure.
Dr. Origitano also takes issue with what he considers to be overly subjective markers of quality used by many ranking guides, such as reputation. "If you ask my mother," he says, "I have a great reputation. But how does it get carried forward?"
Avery Comarow, editor of U.S. News and World Report Best Hospitals, calls Dr. Origitano's study "provocative," but defends his publication's methods by saying he and his editors have already put in practice some of the things recommended by the study, such as excluding transfer patients and those on Medicaid from the scores used in the rankings, and taking into account whether a hospital is a certified stroke center.
"We're well aware of the problems with severity adjustment," he says, adding that though there is no "gold standard" for evaluating hospital quality; his publication gets "closer than many," and uses the tools relied on by the government and academia. He also adds that the reputation score given to hospitals, while admittedly somewhat subjective, is useful to consumers, and is computed from carefully weighted surveys sent only to board-certified doctors about departments in their area of expertise, so it amounts to a kind of "peer review" of hospitals.
Dr. Origitano still believes more work should be done. "We don't really know all the parameters of how to judge [hospital] quality," he says. "We need to get some parameters down that are durable and really reflect the hospital's ability to manage different populations of people."
Source: Journal of Neurosurgery, July 31, 2009
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