Study: Transferred patients hurt big hospitals' rankings

ANN ARBOR, MI In an era when hospital rankings, report cards and quality surveys steer the nation's health care decisions, a new study finds that major medical centers may be getting penalized on those measures for doing what they do best: taking care of the patients that no other hospital can or will treat.

The study, based on four years of data from the University of Michigan Health System's unique repository of clinical patient information, found that patients transferred to a major center from other hospitals are sicker and more likely to die than others, and that this "transfer effect" is not accounted for by hospital-rating tools.

The effect has long been suspected by large, referral private, public and university-affiliated medical centers, but was never fully quantified until now.

The new results, published by a UMHS team in the June 3 issue of the Annals of Internal Medicine, show the effect is enough to damage a hospital's score on measures that patients, insurers, employers and the government use to make health care choices.

The authors call upon those who prepare hospital rankings and reports to either include a hospital's transfer rate in the statistical analysis of its patient outcomes, or to analyze outcomes with and without transfer patients included. This, they say, will improve the representation of hospital quality that patients and their families can use to guide their health care decisions.

"Hospitals are now asked to prove the quality of their care through hard numbers, and the results are used in everything from advertising to contract negotiations with major employers," says lead author Andrew Rosenberg, M.D., assistant professor of anesthesiology and internal medicine at UMHS. "But we find that such assessments may be biased against the most advanced medical centers, because they're the hospital of last resort for patients with the most complex and severe problems. That means quality models need to c

Contact: Kara Gavin
University of Michigan Health System

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