It is time for hospitals to follow law and medical schools' example by withdrawing from U.S. News and World Report's rankings, two physicians wrote in an article published to Health Affairs.
The article's authors, Madeline Wozniak, MD, and Chinenyenwa Mpamaugo, MD, are both resident physicians at Seattle Children's. U.S. News' inequitable evaluations are visible in the weight they give different pediatric diseases, they write.
Children's hospitals are ranked across 10 subspecialties, and while cystic fibrosis falls under "pulmonology," there is no subsection for "hematology" in general nor sickle cell specifically. Nineteen of 42 achievable points are given for "success in managing cystic fibrosis patients." Hospitals can earn one point for having a formal sickle cell disease program.
However, sickle cell disease affects nearly three times as many people and causes 40 times more hospitalizations, according to the physicians — and sickle cell patients are usually Black.
Cystic fibrosis affects 1 in 3,500 white Americans and 1 in 17,000 Black Americans, while sickle cell disease affects 1 in 365 Black newborns and is incredibly rare among white newborns. Despite sickle cell's prevalence, it is considered less in U.S. News rankings. The lack of a separate hematology section is inappropriate, the physicians say.
The disproportionate amount of attention paid to both diseases in the rankings snowballs into funding opportunities, the physicians write. Cystic fibrosis receives nearly $2,000 more than sickle cell in federal funding per patient.
"If U.S. News more prominently featured SCD into its scoring mechanisms, hospitals might be more inclined to invest their finite resources in building staffing dedicated to excellence in SCD care or cultivating researchers who can compete for government research grants to advance novel therapies that will advance care for years to come," the physicians wrote.
They also addressed the equity, diversity and inclusion section recently added to hospital rankings. This section — which gives points for demographic information on patients and families and diversity training for leadership — only accounts for two points.
"These are certainly a step forward, but I would consider this to be one step forward, and the striking near-absence of SCD in the ranking methodology as two steps back," the article said.
"If, like universities, hospitals divorce themselves from ratings, we can refocus on the mission of treating our patients and communities equitably, and not being unduly influenced by flawed U.S. News incentives," the physicians concluded.
Read the full article here.