In search of America's best hospitals. The promise and reality of quality assessment
J. Green, N. Wintfeld, M. Krasner and C. Wells
Department of Clinical Evaluation and Outcomes Research, New York University Medical Center, New York, NY 10016, USA.
"America's Best Hospitals," by US News & World Report, is a
sophisticated and influential appraisal of hospital care. Using measures of
health care structure, process, and outcome, the report identifies
outstanding hospitals in 16 medical specialties through an overall "index
of hospital quality." This strong conceptual design, however, has not been
adequately implemented because national data sources for all 3 components
are severely limited. Most importantly, since there are no national data on
process of care, a reputation survey has been used to measure this
component of quality. One consequence of reliance on reputation is that a
small group of prominent hospitals in each specialty receives such high
scores that they automatically rise to the top of the rankings, regardless
of structure or outcome score. "America's Best Hospitals" identifies
America's best regarded hospitals, but provides limited additional insight
into quality. Adequate surveillance and protection of quality in an era of
managed care requires measurement systems beyond the scope of existing data
and methods.
