We all like lists. US News & World Report has told us for years which colleges are considered the top in the nation. Castle Connolly tells us which are the “Top Doctors” in our community and Car & Driver gives us a ranking of cars by type.
In The Order of Things (New Yorker February 14, 2011) Malcolm Gladwell pokes serious holes in some of our most revered rankings and lists. If you ever glanced at the US News rankings in high school when considering colleges to attend, you owe it to yourself to read the article. Lists are fine as long as you know full well how they were prepared and understand that it’s almost impossible for a list to be both comprehensive and heterogeneous as Gladwell says.
HealthGrades just released their Top 50 Cities for Hospital Care. While they are relatively clear about the methodology used to create the list (comprehensive study of patient death and complication rates at the nation’s nearly 5,000 hospitals) it still creates a misleading impression for most consumers. In fact, HealthGrades unashamedly list statistics showing how much these lists influence consumer decision-making. Here are a few they list:
* 83.4% of consumers are very or somewhat concerned about hospital quality in their community.
* Almost all patients surveyed, 93.8%, reported being willing to go out of their way (drive further, reschedule appointments) to seek care at a more highly rated hospital. The majority of health care consumers surveyed, 64.9%, also stated that they would be willing to pay more out of pocket to seek care at a top-rated hospital.
* Over half, 57.0%, believe online hospital quality ratings are a trustworthy source of information.
To HealthGrade’s credit, their computations are not pulled out of thin air. They site some very valid statistics:
* Distinguished Hospitals for Clinical Excellence (Top 5% in the nation) outperform all other hospitals across all of the 17 mortality cohorts and six of nine complication cohorts studied from 2007 through 2009.
* Specifically, Distinguished Hospitals for Clinical Excellence had a 29.82% lower risk-adjusted in-hospital mortality rate and a 1.91% lower risk-adjusted in-hospital complication rate among Medicare beneficiaries compared to all other hospitals.
I am going to offer an admittedly anecdotal reaction based on my experience interacting with thousands of physicians and a great number of hospitals from all over the country. Based on what I know from first-hand experience in the following cities, I’d far sooner prefer to have to undergo a hospital stay in Seattle, Palo Alto, CA, Houston, TX or Westchester NY than I would half of the cities listed in the HealthGrades Top 20.
Does this mean the HealthGrades list is worthless? No. It means it probably has too much influence over a consumer population with little ability to assess its relative merits. It’s also great marketing for HealthGrades.
Do you work for a hospital in a city not listed? If so, should your city be on the list? Or, is your city on the list? Is it justified?