Patients — especially those living in poverty — see better surgical outcomes when treated at a hospital ranked by U.S. News & World Report, according to a recent study in the American Journal of Surgery.
Researchers at the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center in Columbus studied the cases of 916,164 Medicare beneficiaries who underwent abdominal aortic aneurysm repair, coronary artery bypass grafting, colectomy or lung resection. They used multivariable logistic regression to evaluate the relationship between care at U.S. News-ranked hospitals, county-level duration of poverty and risk-adjusted 30-day mortality.
Mortality was lowest at ranked hospitals across all poverty levels — but the most impoverished patients saw the greatest benefit from care at ranked facilities, according to the report. Patients living in neighborhoods of "persistent poverty" saw the lowest mortality rates when treated at U.S. News-ranked hospitals: 5.89%, compared to 8.89% at unranked hospitals.
The surgies studied by Ohio State researchers are among the 21 procedures and conditions U.S. News publishes rankings for — so although the publication had no role in the study, the findings weren't a major shock to Ben Harder, U.S. News' managing editor and chief of health analysis.
"The initial finding that ranked hospitals are better than unranked hospitals is not a surprise to us," Mr. Harder told Becker's.
However, the magnitude of the difference in mortality was "quite stunning" to Mr. Harder — and it illustrates the importance of expanding care access, he said.
"For the healthcare system as a whole, the study highlights how important it is that we ensure that poorer patients have the same access as wealthier patients enjoy to top ranked hospitals," Mr. Harder said. "And in fact, their data suggests that it would actually be beneficial to society if poor patients had better access to the top-rated hospitals, because they get more incremental benefit in terms of better outcomes than patients from wealthier backgrounds."
U.S. News has been working to roll out its own health equity scales, including access measures that gauge whether hospitals are serving patient populations racially representative of their communities.
Despite these efforts — slow-moving due to a lack of available data, experts told Becker's last October — the publication's esteemed lists came under scrutiny this year. Law and medical schools alleged that the rankings hindered diversity measures by prioritizing prestige; some health systems followed in questioning the "best hospitals" methodology, which weighs physician opinion scores. In July, U.S. News responded with a number of changes to the rating system, including the elimination of ordinal rankings on the hospital honor roll.
The Ohio State study encourages U.S. News to continue publishing data, specifically health equity measurements, Mr. Harder said.
"It validates our decision to work on that [health equity] metric portfolio over the last few years. We're not done. That continues to be a work in progress," Mr. Harder said. "So there may be opportunities that emerge out of studies like this one around ways that we can better assess which hospitals are using their expertise to the maximum."
"But I'd say that there's a great deal that you can learn from looking up ranked hospitals on U.S. News right now and studying the access measures and the outcome disparity measures that we've published, about whether [these hospitals are] doing as much as they can to help with populations that have been historically disadvantaged," he said.