US News & World Report’s influential “top 50” list of US hospitals is driven by subjective reputations of the institutions rather than objective measures of hospital quality, according to a study by Ashwini Sehgal of Case Western Reserve University.

To establish subjective reputations of US hospitals, US News surveys 250 board-certified physicians from around the country. US News also uses objective data including nurse-to-patient ratios, availability of specific medical technology, risk-adjusted mortality for Medicare patients, and teaching status.

In analyzing the relative contributions of subjective vs. objective measures in determining which hospitals made the coveted list, Sehgal “found little relationship between rankings and objective quality measures for most specialties.”

Specifically, he found a strong correlation between a hospital’s rank in the US News list and the hospital’s “reputation score” as measured in the survey. By contrast, a hospital’s rank was variably correlated with the objective scores used by US News.

For example, the top five heart and heart-surgery hospitals based on reputation score alone were the same as those of the US News top five heart hospitals (Cleveland Clinic, Mayo Clinic–Rochester, Johns Hopkins University, Massachusetts General Hospital, and the Texas Heart Institute).

“Because reputation score is determined by asking approximately 250 specialists to identify the five best hospitals in their specialty, only nationally recognized hospitals are likely to be named frequently,” Sehgal told MedScape. “Users should understand that the relative standings of US News & World Report’s top 50 hospitals largely indicate national reputation, not objective measures of hospital quality.”

“Being well-known may be the result of many factors that are unrelated to the quality of day-to-day care,” commented Harlan Krumholz of the Yale University School of Medicine.

The write-up is in the Annals of Internal Medicine.

Harvard scientists have found that as people age to a point where they become eligible for Medicare, the improved access to care it assures is associated with reductions in racial and socioeconomic disparities in health status.

That supports a contention made by many that universal coverage could narrow the US’ appalling gaps in the quality and outcomes of care for non-whites and the poor.
 
Before reaching these conclusions, John Ayanian and colleagues performed observational and quasi-experimental analyses of cross-sectional data from the National Health and Nutrition Examination Survey. Data had been collected between 1999 and 2006 from adults aged 40 to 85 years old.
 
The scientists found that measures of disease control improved significantly across all racial and socioeconomic subsets during the 7-year study period, which had the effect of preserving racial disparities noted at study onset…until that is, people reached an age where they qualified for Medicare.

That’s when the gaps narrowed dramatically.

Once people with hypertension enrolled in Medicare, Black vs. white disparities in systolic blood pressure dropped by 4.2 mm Hg, a 60% reduction.

Similarly, Medicare enrollment was associated with a 70% reduction in Black-white disparities for hemoglobin A1c levels, a measure of diabetes control. There were similar reductions in disparities when people were stratified according to educational status. 

“Universal health insurance may reduce persistent disparities we’ve seen for far too long in Americans from different racial or ethnic groups,” Ayanian told BurrillReport. He’s a professor of medicine and health care policy at Harvard Medical School and Brigham and Women’s Hospital.
 
The write-up is in the Annals of Internal Medicine.

“The results of this study make it clear that guaranteeing access to affordable insurance for all Americans is the essential first step toward…a healthier America,” said Karen Davis, president of the Commonwealth Fund, which funded the study.

Colonoscopy isn’t as good we thought as a screening test for colon cancer, but it’s a lot better than nothing and people ought to be getting it as per existing guidelines, according to a report in the Annals of Internal Medicine.

In a case-controlled study of 10,292 Canadians who died of colon cancer, scientists found that colonoscopy missed nearly all cancers of the right colon and a third of those on the left. Overall, it prevents 60-70% of colon cancer deaths.

Physicians usually tell patients the procedure prevents 90%.

For comparison’s sake, mammograms prevent 25% of breast cancer deaths and the PSA test has never been shown to reduce prostate cancer mortality.

Internists and family practitioners performed a third of the colonoscopies in this study. Many of them perform the procedure infrequently. The study did not compare their yields against gastroenterologists or those with more experience.

The study also did not address the role played by bowel preparation in determining colonoscopy yields.

Scientists attributed the near complete failure to detect right-sided cancer to location-specific attributes of colon polyps, the cancer-precursor lesions sought after and removed by colonoscopists. In the right colon, these polyps are flat and hard to see.

Left-sided polyps are easier to spot because they tend to be raised and have stalks.

After the study was published, the American Cancer Society said it will not alter its screening guidelines, adding that the procedure’s risk and cost mitigate against more frequent testing.

 “If I was to provide one main message, it would be that colonoscopies are the way that colon cancer mortality gets reduced,” David Ransohoff told the New York Times.

The UNC gastroenterologist added that “colonoscopy is a good test, but it isn’t completely effective. And you know what? We ought to be happy with that.”