Hospitals' star ratings and clinical outcomes: ecological study

The English Department of Health is developing global measures of the performance of all NHS bodies, including 166 acute hospital trusts. Since 2000-1, the trusts get zero, one, two, or three stars to indicate performance.1 This rating may not reflect the effectiveness of clinical care measured in patient outcomes because of the lack of accurate routine data.2 One exception is in adult critical care3; we checked whether a hospital's rating provided an indication of its clinical outcomes. We compared the 2001-2 rating of 102 acute hospital trusts for which we had validated data for that year. We calculated each patient's predicted risk of death before discharge from hospital4 and compared it with actual mortality for all admissions in 2001-2 for each unit. We compared rating with crude mortality at the patient level rather than aggregated by hospital; our sample …