Hospital rating tools should allow patients to customize rankings

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Publicly available hospital ratings and rankings should be modified to allow quality measures to be prioritized according to the needs and preferences of individual patients, according to a new RAND Corporation analysis.

Writing in the Aug. 30 edition of the New England Journal of Medicine, researchers propose a new way of rating hospitals by creating tools that allow patients to decide which performance measures to prioritize. For example, researchers demonstrate how the different priorities of a pregnant woman and a middle-aged man needing knee surgery might change which of their local hospitals has the highest overall rating.

The research team created a web tool that demonstrates a way to create customized rankings. The tool, which allows users to create custom rankings of most hospitals in the nation, is based upon the 2016 version of the federal government's Hospital Compare star ratings.

"If the intent of hospital quality ratings is to inform patient choice, why not ask patients for their input?" said Dr. Mark Friedberg, senior author of the paper and a senior physician scientist at RAND, a nonprofit research organization. "We built a tool to show that it's possible to move beyond one-size-fits-all hospital ratings. In the internet era, there's no reason why these report cards can't be customized to each individual patient's needs and preferences."

Researchers demonstrate that a hospital quality report tailored to the "average" patient is likely not be a good fit for most patients with individual needs.

In one scenario modeled by the team, customizing hospital report cards to the needs of a pregnant woman who lives in the suburbs of Boston drives down the ranking of a large downtown medical center and boosts the ratings of two community hospitals that are closer to her home. In another scenario, the ranking of two hospitals in the Los Angeles suburbs reverses when a man needing elective knee surgery customizes rankings to reflect his own needs.

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Other authors of the analysis are Dr. Juliet Rumball-Smith and Jill Gurvey. Rumball-Smith worked on the project while she was a Commonwealth Fund Harkness Fellow at RAND. Development of the hospital tool was supported by RAND Ventures, which uses income from RAND's operations and unrestricted philanthropic gifts to support research.

RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality, and public health preparedness, among other topics.

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Warren Robak
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