Insurance organizations, policy and healthcare consumers rely heavily on hospital ranking reports, but how accurate are they? Do differences in patient preferences for life-sustaining treatments that exist between different hospitals affect how hospitals are ranked?
Researchers from Boston University School of Medicine (BUSM) examined how hospital differences in patient preferences for life-sustaining treatments (do not resuscitate, or DNR, orders) affected hospital rankings for pneumonia. They found that including patient decisions about life-sustaining treatments in the statistical models used to determine hospital mortality rankings resulted in substantial changes to hospital rankings that could affect hospital ratings, and reimbursements and financial penalties. This study appears in the JAMA Internal Medicine.
"Our findings suggest that current methods of comparing hospitals, which do not account for patient DNR status, penalize potentially high-quality hospitals admitting a larger proportion of patients who had chosen to forego resuscitation. Therefore, accounting for DNR status in programs that compare hospital mortality outcomes may substantially affect publicly reportable hospital rankings and hospital reimbursements," explained corresponding author Allan Walkey, MD, MSc, assistant professor of medicine at Boston University School of Medicine and a pulmonary, allergy, sleep & critical care physician at Boston Medical Center.