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In general this is a very good thing for patients, doctors and hospitals.  It is very important to measure the results one gets when serving the public, whether it be driving trains, flying airplanes and certainly going to the hospital for treatment.  Most hospitals and medical staffs have acknowledged that there can and should be improvement and that the only way to do that is to measure certain things such as outcome from particular treatments or results after procedures or even simply hospital admissions. 

Thus, there are a host of criteria and measures being used in this rating game.  The U.S. News and World Report has a simpler approach to its ratings.  Of the over 6,000 hospitals in the U.S. only 177 were of high enough quality to be ranked in even a single specialty this year.  (The Medical University Hospital was the only one in Coastal South Carolina).  The criteria used by U.S. News are: reputation with physicians randomly chosen around the country, care-related factors such as nursing to patient ratios, and a variety of patient services.  Risk adjusted mortality ratio is measured and this is counted in determining the score of a hospital.  (Risk adjustment takes into account the severity of illness of the patient on hospitalization – sicker patients are not expected to have as high a survival as those less sick.)  One problem with the U.S. News survey is that the reputation score tends to be high in places that have “names” this means that hospitals associated with major research universities tend to score very well and have higher scores. 

While the U.S. News tries to identify the very best hospitals, all the other rating agencies try to compare virtually all hospitals, often using the Medicare database for the source of information.  AHRQ relies on Patient Safety Indicators as measures of hospital performance.  Some are obviously proper such as how often is a “foreign body left in a patient after a procedure” that can only be the result of a mistake.  However, some are not so clearly hospital or doctor related safety issues such as “post-operative hemorrhage” since this can occur even when things are done perfectly in some patients and are what I call expected, but fortunately rare side effects of surgery.  Nevertheless these two and 18 other “indicators” are used to determine relative safety of hospitals, and then “Hospital Grades” are given out. 

The Joint Commission of Hospital Accreditation has defined a number of important patient groups, such as heart attack and heart failure, to study outcomes and compare hospital performance.  Again various criteria are used to compare hospitals and hospitals are categorized into three groups – meets, exceeds, or doesn’t meet the expected standards.  There are strengths and weaknesses to this rating system, as with the others.  For example, some of the criteria that count equally are whether there is documentation that patients were instructed to stop smoking that counts as much as other criteria such as whether patients were treated with appropriate medicine.  Admittedly, both are important, but one might argue that most patients know they should not smoke, but they might not be on the correct medication. 

What is the future going to bring.  I suspect the rating game will get more intense and more sophisticated.  Hopefully, there will be one or at most two rating groups (like the AP and UPI with sporting teams) rather than a myriad of ratings that do more to confuse the patients, hospitals and doctors.  After all, the name of this game is to promote healthy aging and to promote healthy hospitals.  We need good criteria to measure doctor and hospital performance.  This will improve performance and give patients greater confidence when choosing their hospital.