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Patient Confusion from Inconsistent Heart Surgery Ratings Study Finds

Public reporting of cardiac surgery ratings has been advocated to inform patient selection of hospitals. Although Society of Thoracic Surgeons (STS) ratings are based on risk-adjusted patient outcomes, other rating systems rely on administrative databases or factors such as reputation. A study published in the Journal of the American College of Surgeons evaluated the correlation among 4 widely used hospital rating systems for coronary artery bypass grafting (CABG) and aortic valve replacement (AVR). Researchers identified an initial cohort of 602 hospitals from US News & World Report’s (USN) listing of the 2016-17 “Best Hospitals for Heart Surgery.” From this cohort, current publicly available CABG and AVR ratings were collected from STS, USN, Centers for Medicare and Medicaid Services (CMS), and Healthgrades (HG). All 4 rating systems rated hospitals as high, average, or below average performers for each procedure. Researchers then determined the match rate between rating systems for individual hospitals and assessed interrater reliability with Cohen’s kappa. The study found that rating systems had different distributions of high and low performing ratings assigned. US News & World Report more frequently rated hospitals as high performing for both CABG and AVR when compared with STS, HG, and CMS. The study concluded that publicly reported cardiac surgery ratings have significant discrepancy and poor correlation. This may confuse rather than clarify public perception of hospital quality for cardiac surgery.

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