Abstract
BackgroundPatients’ choices of providers when undergoing elective surgeries significantly impact both perioperative outcomes and costs. There exist a variety of approaches that are available to patients for evaluating between different hospital choices.ObjectiveThis paper aims to compare differences in outcomes and costs between hospitals ranked using popular internet-based consumer ratings, quality stars, reputation rankings, average volumes, average outcomes, and precision machine learning–based rankings for hospital settings performing hip replacements in a large metropolitan area.MethodsRetrospective data from 4192 hip replacement surgeries among Medicare beneficiaries in 2018 in a the Chicago metropolitan area were analyzed for variations in outcomes (90-day postprocedure hospitalizations and emergency department visits) and costs (90-day total cost of care) between hospitals ranked through multiple approaches: internet-based consumer ratings, quality stars, reputation rankings, average yearly surgical volume, average outcome rates, and machine learning–based rankings. The average rates of outcomes and costs were compared between the patients who underwent surgery at a hospital using each ranking approach in unadjusted and propensity-based adjusted comparisons.ResultsOnly a minority of patients (1159/4192, 27.6% to 2078/4192, 49.6%) were found to be matched to higher-ranked hospitals for each of the different approaches. Of the approaches considered, hip replacements at hospitals that were more highly ranked by consumer ratings, quality stars, and machine learning were all consistently associated with improvements in outcomes and costs in both adjusted and unadjusted analyses. The improvement was greatest across all metrics and analyses for machine learning–based rankings.ConclusionsThere may be a substantive opportunity to increase the number of patients matched to appropriate hospitals across a broad variety of ranking approaches. Elective hip replacement surgeries performed at hospitals where patients were matched based on patient-specific machine learning were associated with better outcomes and lower total costs of care.
Highlights
Patients undergoing elective surgeries often seek information at different levels of granularity when choosing providers, ranging from institutions to practices to individual physicians
Patients who underwent surgeries at hospitals that were ranked as top hospitals according to the Centers for Medicare & Medicaid Services emergency department (ED) (CMS) quality stars, Yelp, the average volume, the average outcome rate, and the precision navigation–based approaches were associated with substantially better outcomes than the population averages
The percentage of patients who underwent surgery at a hospital ranked as a top hospital by each ratings approach varied from 27.6% (1159/4192) for the precision navigation–based rankings to 49.6% (2078/4192) for the average volume–based rankings
Summary
Patients undergoing elective surgeries often seek information at different levels of granularity when choosing providers, ranging from institutions to practices to individual physicians. Objective: This paper aims to compare differences in outcomes and costs between hospitals ranked using popular internet-based consumer ratings, quality stars, reputation rankings, average volumes, average outcomes, and precision machine learning–based rankings for hospital settings performing hip replacements in a large metropolitan area. Methods: Retrospective data from 4192 hip replacement surgeries among Medicare beneficiaries in 2018 in a the Chicago metropolitan area were analyzed for variations in outcomes (90-day postprocedure hospitalizations and emergency department visits) and costs (90-day total cost of care) between hospitals ranked through multiple approaches: internet-based consumer ratings, quality stars, reputation rankings, average yearly surgical volume, average outcome rates, and machine learning–based rankings. Elective hip replacement surgeries performed at hospitals where patients were matched based on patient-specific machine learning were associated with better outcomes and lower total costs of care
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