Hospital comparison web sites can be misleading

A review of six publicly available hospital comparison Web sites suggests that they display inconsistent results and use inappropriate or incomplete standards to measure quality, according to a report in the September issue of Archives of Surgery.

A total of 113 million Americans searched for health information on the Internet in 2006, according to background information in the article. Of those, 29 percent searched for information on specific hospitals and physicians. At the same time, pressure from insurance companies and the public for transparency and accountability in health care continues to increase. Data on hospital performance is frequently made available through Web sites aimed at patients, but few researchers have examined these sites and their content.

Michael J. Leonardi, M.D., and colleagues at the David Geffen School of Medicine at UCLA, Los Angeles, performed a systematic Internet search in September 2006 to identify publicly available hospital quality comparison sites. Six sites were identified and rated on accessibility, transparency of the data and statistical calculations, appropriateness, consistency and timeliness.

Of the six sites identified, one was government-run (Hospital Compare from the Centers for Medicare and Medicaid Services), two were non-profit (Quality Check from the Joint Commission on Accreditation of Healthcare Organizations and the Leapfrog Group's Hospital Quality and Safety Survey Results), and three were private and proprietary.

“For accessibility and data transparency, the government and non-profit Web sites were best,” the authors write. “For appropriateness, the proprietary Web sites were best, comparing multiple surgical procedures using a combination of process, structure and outcome measures. However, none of these sites explicitly defined terms such as complications.” All data on the sites were at least one year old, and most were two or more years old.

To determine consistency, sample searches were conducted on the three proprietary Web sites comparing four Los Angeles–area hospitals on three common procedures (laparoscopic gall bladder removal, hernia repair and colon removal). The searches demonstrated significant inconsistencies—for example, for colon removal, one hospital was ranked best by two sites but worst by the other site, and the hospital ranked best on that site was ranked worst on another.

“Further work is needed to improve these issues, particularly the accessibility by patients, the quality and type of data reporting, the statistical method and the criteria by which hospitals and specific operations are compared. It is probably important that surgeons be involved with the development of such reporting Web sites so that the comparisons accurately and appropriately reflect the quality of surgical care.”

http://archsurg.ama-assn.org/