Researchers question rankings’ validity

Some use reputation to measure quality

When the influential U.S. News & World Report published its annual "America’s Best Hospitals," a list identifying outstanding hospitals in 16 medical specialties including cardiology, an article in the Journal of the American Medical Association (JAMA) disputed the list’s accuracy.¹ Because there are no national data on process of care, the report states, a reputation survey was used to measure this component of quality.

"One consequence of reliance on reputation," warned the JAMA authors, "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. Adequate surveillance and protection of quality in an era of managed care requires measurement systems beyond the scope of existing data and methods."

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1. Green J, Wintfeld N, Krasner M, et al. In search of America’s best hospitals: The promise and reality of quality assessment. JAMA 1997; 277:1,152-1,155.