ImportanceDespite widespread use to guide patients to hospitals providing the best care, it remains unknown whether Centers for Medicare & Medicaid Services (CMS) hospital star ratings are a reliable measure of hospital surgical quality.ObjectiveTo examine the CMS hospital star ratings and hospital surgical quality measured by 30-day postoperative mortality, serious complications, and readmission rates for Medicare beneficiaries undergoing colectomy, coronary artery bypass graft, cholecystectomy, appendectomy, and incisional hernia repair.Design, Setting, and ParticipantsThis cohort study evaluated 100% Medicare administrative claims for nonfederal acute care hospitals with a CMS hospital star rating for calendar years 2014-2018. Data analysis was performed from January 15, 2022, to April 30, 2023. Participants included fee-for-service Medicare beneficiaries aged 66 to 99 years who underwent colectomy, coronary artery bypass graft, cholecystectomy, appendectomy, or incisional hernia repair with continuous Medicare coverage for 3 months before and 6 months after surgery.ExposureCenters for Medicare & Medicaid Services hospital star rating.Main Outcomes and MeasuresRisk- and reliability-adjusted hospital rates of 30-day postoperative mortality, serious complications, and 30-day readmissions were measured and compared across hospitals and star ratings.ResultsA total of 1 898 829 patients underwent colectomy, coronary artery bypass graft, cholecystectomy, appendectomy, or incisional hernia repair at 3240 hospitals with a CMS hospital star rating. Mean (SD) age was 74.8 (7.0) years, 50.6% of the patients were male, and 86.5% identified as White. Risk- and reliability-adjusted 30-day mortality rate decreased in a stepwise fashion from 6.80% (95% CI, 6.79%-6.81%) in 1-star hospitals to 4.93% (95% CI, 4.93%-4.94%) in 5-star hospitals (adjusted odds ratio, 1.86; 95% CI, 1.73-2.00). There was wide variation in the rates of hospital mortality (variation, 1.89%; range, 2.4%-16.2%), serious complications (variation, 1.97%; range, 5.5%-45.1%), and readmission (variation, 1.27%; range, 9.1%-22.5%) across all hospitals. After stratifying hospitals by their star rating, similar patterns of variation were observed within star rating groups for 30-day mortality: 1 star (variation, 1.91%; range, 3.6%-12.0%), 2 star (variation, 1.86%; range, 2.8%-16.2%), 3 star (variation, 1.84%; range, 2.9%-12.3%), 4 star (variation, 1.76%; range, 2.9%-11.5%), and 5 star (variation, 1.79%; range, 2.4%-9.1%). Similar patterns were observed for serious complications and readmissions.Conclusion and RelevanceAlthough CMS hospital star rating was associated with postoperative mortality, serious complications, and readmissions, there was wide variation in surgical outcomes within each star rating group. These findings highlight the limitations of the CMS hospital star rating system as a measure of surgical quality and should be a call for continued improvement of publicly reported hospital grade measures.

中文翻译：

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联邦指定医院星级的术后结果差异


重要性尽管广泛用于引导患者前往提供最佳护理的医院，但医疗保险和医疗中心是否能够提供最佳护理仍不得而知。医疗补助服务 (CMS) 医院星级评定是医院手术质量的可靠衡量标准。目的通过接受结肠切除术、冠状动脉切除术的医疗保险受益人的 30 天术后死亡率、严重并发症和再入院率来衡量 CMS 医院星级评定和医院手术质量旁路移植术、胆囊切除术、阑尾切除术和切口疝修补术。设计、设置和参与者这项队列研究评估了 2014-2018 历年 CMS 医院星级非联邦急症护理医院的 100% 医疗保险行政索赔。数据分析于2022年1月15日至2023年4月30日进行。参与者包括年龄在66至99岁的按服务收费医疗保险受益人，他们接受了结肠切除术、冠状动脉旁路移植术、胆囊切除术、阑尾切除术或切口疝修补术并接受连续医疗保险承保手术前 3 个月和手术后 6 个月。ExposureCenters for Medicare &医疗补助服务医院星级评级。主要结果和措施测量并比较不同医院和星级评级的 30 天术后死亡率、严重并发症和 30 天再入院的风险和可靠性调整住院率。结果共有 1 898 829 名患者接受了治疗3240 家 CMS 医院星级医院提供结肠切除术、冠状动脉旁路移植术、胆囊切除术、阑尾切除术或切口疝修补术。平均 (SD) 年龄为 74.8 (7.0) 岁，50.6% 的患者为男性，86.5% 为白人。经过风险和可靠性调整后的 30 天死亡率从 6.80% 逐步下降（95% CI，6.79%-6.一星级医院的这一比例为 81%），五星级医院的比例为 4.93%（95% CI，4.93%-4.94%）（调整后的比值比，1.86；95% CI，1.73-2.00）。医院死亡率（变异，1.89%；范围，2.4%-16.2%）、严重并发症（变异，1.97%；范围，5.5%-45.1%）和再入院率（变异，1.27%；范围，5.5%-45.1%）存在很大差异。范围，9.1%-22.5%）所有医院。按星级对医院进行分层后，在星级评级组中观察到 30 天死亡率的相似变化模式：1 星（变化，1.91%；范围，3.6%-12.0%）、2 星（变化，1.86%；范围） ，2.8%-16.2%）、3 星（变异，1.84%；范围，2.9%-12.3%）、4 星（变异，1.76%；范围，2.9%-11.5%）和 5 星（变异，1.79%） ；范围，2.4%-9.1%）。严重并发症和再入院也观察到类似的模式。 结论和相关性尽管 CMS 医院星级评级与术后死亡率、严重并发症和再入院相关，但每个星级评级组内的手术结果存在很大差异。这些发现凸显了 CMS 医院星级评级系统作为手术质量衡量标准的局限性，并应呼吁继续改进公开报告的医院等级衡量标准。