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 Some people have been concerned that patient experience isn’t the
most important factor to measure, said coauthor Dr. Ashish K. Jha of
the Harvard T. H. Chan School of Public Health in Boston.
“Medicare has been putting a lot of data out for a long time, but
the broad consensus has been it’s very hard for consumers to use
this info,” Jha told Reuters Health by phone. “CMS responded by
giving out star ratings that consumers can understand easily.”
The five-star rating system is based on patients’ answers to 27
questions about a recent hospital stay. Questions cover
communication with nurses and doctors, the responsiveness of
hospital staff, the hospital's cleanliness and quietness, pain
management, communication about medicines, discharge information,
and would they recommend the hospital.
The survey is administered to a random sample of adult patients
between 48 hours and six weeks after hospital discharge. (Consumers
can compare their local hospitals online at
http://1.usa.gov/1Rt7DGW.)
For the new study, the researchers compared the CMS
patient-experience ratings at more than 3,000 hospitals in October
2015 to data from those hospitals on death or readmission within 30
days of discharge.
Patients in the study had been hospitalized for heart attack,
pneumonia or heart failure.
Of the 3,000 hospitals, 125 had five stars, more than 2,000 had
three or four stars, 623 had two stars, and 76 had only one star.
Four and five-star hospitals tended to be small rural nonteaching
hospitals in the Midwest.
Five-star hospitals had the lowest average patient death rate, 9.8
percent over the 30 days following discharge, while four three and
two-star hospitals all had just over 10 percent mortality rates and
one-star hospitals had an average 11.2 percent mortality rate, as
reported in JAMA Internal Medicine.
Five-star hospitals also readmitted less than 20 percent of patients
over the next month, while other hospitals all readmitted at least
that many.
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The data only included Medicare patients, who are older and may not
have the same results as younger patients, and there was not much
difference between two, three and four-star hospitals, the authors
note.
“If you use the star rating you’re more likely to end up at a high
quality hospital,” Jha said. “But I wouldn’t use only the star
rating to choose a hospital.”
“I don’t think these data are enough to by themselves to suggest
that (patients) should use the star rating as a single guide to
choose an institution,” agreed Dr. Joshua J. Fenton of the
University of California, Davis, who was not part of the new study.
No large hospitals had five stars, and more than half of the
five-star facilities didn’t have an intensive care unit, Fenton told
Reuters Health by phone.
“I can say from practicing in a rural hospital for a few years and
we did not have an ICU, when we hospitalized someone with pneumonia
or congestive heart failure, we would certainly not have kept them
there if we thought it was likely there would be a complication,” he
said.
Smaller rural hospitals “select” less acute patients, he said. The
authors of the new study tried to account for that, but it may still
have affected the results.
SOURCE: http://bit.ly/1WpE27e JAMA Internal Medicine, online April
10, 2016.
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