Grading the Graders

BACKGROUND: Concerns about quality of care are increasing as hospitals struggle to lower costs. Hospital report cards are controversial, but little is known about their impact. OBJECTIVES: To determine whether recent hospital report cards are viewed more favorably than pioneering federal efforts; whether a report based on clinical data is viewed more favorably than one based on administrative data; and whether attitudes toward report cards are related to hospital characteristics. DESIGN: Mailed survey of chief executives at 374 California hospitals and 31 New York hospitals listed in report cards on myocardial infarction and coronary bypass mortality. SUBJECTS: Two-hundred-and-seventy-four hospitals in California (73.3% response) and 27 in New York (87.1% response). California hospitals were categorized on ownership, size, occupancy, risk-adjusted mortality, teaching status, patient volume, and surgical capability. MEASURES: Number of hospital units that received or discussed the report card, ratings of its quality, perceptions of its usefulness, and knowledge of its methods. RESULTS: In both states, report cards were widely disseminated within hospitals. The mean quality rating was higher (P = 0.0074) in New York than in California; New York respondents appeared to be more knowledgeable about key methods. One or more hospital characteristics was associated with each outcome measure. Leaders at high-mortality hospitals were especially critical and did not find the report useful, despite limited understanding of its methods. CONCLUSIONS: Recent hospital report cards were rated better than pioneering federal efforts. A report based on clinical data was rated better, understood better, and disseminated more often to key staff than one that was based on administrative data. Barriers to constructive use of outcomes data persist, especially at high mortality hospitals.