A relative dearth of relevant data hampers efforts to demonstrate a link between educational and clinical quality and may preclude residency applicants from identifying programs with the best clinical outcomes. Existing clinical rankings could fill this gap if they are based on sound judgments about quality.
To explore the potential of the U.S. News & World Report "America's Best Hospitals" clinical rankings in measuring the quality of clinical and learning environments, the author systematically reviewed the U.S. and Canadian literature for 1975 through 2007 regarding quality indicators and teaching hospitals. Individual data elements of the rankings were examined to assess the extent to which they included accepted measures of clinical performance.
A total of 187 articles met the inclusion criteria of addressing clinical quality criteria relevant to the rankings and quality assessment in teaching hospitals. Statistical examination of the data underlying the rankings and their relationship with measures of educational and clinical quality showed the rankings are largely based on institutional "prestige." Ranked clinical programs and institutions consistently outperform counterparts on available indices, suggesting that the data elements underlying the rankings may provide valid assessments about the quality of care in educational settings.
Data elements in the rankings can be used to assess clinical and, to a lesser extent, educational quality, but the number of specialties and ranked institutions is too small to have a significant effect on widespread clinical or educational quality, unless ranked institutions serve as sites for the development, study, and dissemination of best practices.
"Halasyamanti and Davis (2007) found an imperfect correlation for cardiac diagnoses and respiratory disorders between the highest-ranked hospitals in USNWR and those in ‗Hospital Compare'. Philibert's (2009) main criticisms of the USNWR rating are that prestigious institutions stand to gain the most; high-profile hospitals can attract more qualified clinicians and this does not necessarily translate into a better learning environment; and in the USNWR ranking too much emphasis is placed on specialised medical services instead of prevention and health maintenance (Philibert, 2009, p. 183). "
[Show abstract][Hide abstract] ABSTRACT: Although it has long been conjectured that having physicians in leadership positions is valuable for hospital performance, there is no published empirical work on the hypothesis. This cross-sectional study reports the first evidence. Data were collected on the top-100 U.S. hospitals in 2009, as identified by a widely-used media-generated ranking of quality, in three specialties: Cancer, Digestive Disorders, and Heart and Heart Surgery. The personal histories of the 300 chief executive officers of these hospitals were then traced by hand. The CEOs are classified into physicians and non-physician managers. The paper finds a strong positive association between the ranked quality of a hospital and whether the CEO is a physician or not (p < 0.001). This kind of cross-sectional evidence does not establish that physician-leaders outperform professional managers, but it is consistent with such claims and suggests that this area is now an important one for systematic future research.
Social Science [?] Medicine 08/2011; 73(4):535-9. DOI:10.1016/j.socscimed.2011.06.025 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We studied the impact of an 11-bed inpatient palliative care unit (PCU) on site of death and observed mortality in the health system, oncology, and palliative care units. Observers were concerned that an active PCU would attract dying patients and worsen comparative mortality rates for Medicare and U.S. News & World Report comparisons.
We reviewed 10 years of experience with all patients who died in the hospital before and after we opened our PCU in 2000.
The PCU concentrated dying patients on the PCU but total deaths did not change over 10 years and remained approximately 3% of admissions. Within 2 years, one quarter of all health system decedents died on the PCU. The proportion who died on the oncology floor and general units declined, but the number of intensive care unit deaths did not change.
An inpatient PCU did not increase the hospital-wide death rate. The PCU did change the site of death to a more appropriate venue for one quarter of patients.
Journal of palliative medicine 03/2010; 13(4):371-4. DOI:10.1089/jpm.2009.0372 · 1.91 Impact Factor
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