tag:blogger.com,1999:blog-4968787219619380438.post2519343051325783643..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Hospital and Doctor Ratings: Junk Science? No, No Science at AllSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-4968787219619380438.post-47766147641853330502012-07-16T06:01:40.995-04:002012-07-16T06:01:40.995-04:00@uretericbud, thanks for the interesting comment. ...@uretericbud, thanks for the interesting comment. I agree there has to be a better way to rate hospitals and doctors. Unfortunately, I am not sure how that can be done to everyone's satisfaction.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-65398380480830207762012-07-15T19:51:22.368-04:002012-07-15T19:51:22.368-04:00SS, indeed..
The effort was motivated by reviewin...SS, indeed..<br /><br />The effort was motivated by reviewing the annual rankings of Urology departments by the U.S. News and World Report (USNWR) Magazine. As you know the rankings are legitimized by heavy hospital advertising, but as you note in your piece above the methodology used for generating the lists is questionable at best. In fact, of the three “quality domains” the magazine uses to generate hospital rankings – structure, process, and outcomes – the process domain has had a tremendous dominating effect on the final rankings. <br /><br />This process domain overwhelmingly measures the hospital’s reputation score [ very nicely shown in the Sehgal Ann Int Med 2010 manuscript you mention]. As such, the rankings in U.S. News & World Report essentially reflects a hospital’s supposed national reputation -- a characteristic that is only further reinforced by the magazine’s rankings. Indeed, nearly perfect correlation exists between the reputation score and the final hospital ranking for all specialties [Sehgal 2010]. For example, in urology 100% of top 10 hospitals and 95% of top 20 hospitals are ordered identically by reputation score and overall ranking. <br /><br />Since the reputation score has been the lynchpin of the U.S. News and World Report Rankings one would assume that rigorous methodology underlies this metric. Yet, when one drills down into the details of how the reputation score is obtained, it becomes apparent that the measure is entirely subjective and is largely a reflection of historical biases. In fact, the metric is derived from asking 250 physicians to list 5 “best” hospitals with only 40 to 50% of those surveyed responding.<br /><br />As such, a department’s recent academic contribution reflects the thought leadership of existing faculty and, thus, arguably better measures that department’s prominence than a subjective historical reputation score.<br /><br />The way I see it, we in the medical community can either accept the assessments of these third-party rankings or attempt to develop new metrics that are objective, reproducible, current, and are void of subjective bias. The manuscript we put together is just one step in that direction.<br /><br />Clearly, thought leadership is not a perfect surrogate for clinical excellence, and the proposed metric should be a component of a larger more comprehensive ranking system that incorporates other objective measures such as standardized reporting of specific patient outcomes and morbidity, adherence to practice guidelines and clinical pathways, process performance, and peer reviewed departmental funding (just to name a few). <br /><br />Enjoy your blogs/tweets very much.<br /><br />Best,<br /><br />@uretericbudAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9076315016522327092012-07-14T20:23:30.361-04:002012-07-14T20:23:30.361-04:00Anon, thanks for the interesting link. It's a ...Anon, thanks for the interesting link. It's a novel way to rate a program. But there's more to it than just academics, isn't there?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-50410274760587585392012-07-14T20:07:39.706-04:002012-07-14T20:07:39.706-04:00This is a follow-up to the Annals of Internal Medi...This is a follow-up to the Annals of Internal Medicine study. If reputation score in USNWR drives the overall ranking, does it at least reflect thought leadership within a field? Not so much: http://www.europeanurology.com/article/S0302-2838(11)01131-6/fulltextAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-35165732655140238032011-02-11T09:28:05.783-05:002011-02-11T09:28:05.783-05:00I encourage you both to look at section 4.2.5 in t...I encourage you both to look at section 4.2.5 in the following wikipedia entry: http://en.wikipedia.org/wiki/Gender-neutral_pronoun<br /><br />It seems you actually have many options! Which one is your favorite?Vickie@Demand_Euphoriahttps://www.blogger.com/profile/17706946767924290485noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9686515442767245372011-02-10T17:18:31.322-05:002011-02-10T17:18:31.322-05:00I feel your pain and love the accurate phrase &quo...I feel your pain and love the accurate phrase "...at least during daylight hours." I used the pronoun "her" on purpose just to tweak my readers. Unfortunately, "them" is just wrong and there is no singular pronoun that is gender-neutral. I hate "his/her."Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-19398182073204614232011-02-10T14:59:17.334-05:002011-02-10T14:59:17.334-05:00I risk appearing to be an old frump, but I mourn t...I risk appearing to be an old frump, but I mourn the passing of the common gender. I realize that a physician today is perforce more likely to be a female in the US, at least during daylight hours. Still the pharma commercial commonplace, "I asked my doctor, and she said..", strikes me as closely related to the he/she, his/her of the sixties. <br /><br />Oh well. Never mind. This rant is just for you. No use kicking the hornets' nest.busysynch machttps://www.blogger.com/profile/09523931675451213342noreply@blogger.com