In Reply: Drs Finlayson and Birkmeyer suggest
that some information, however imperfect, is better than no information because
"more often than not, however, patients choosing 5-star hospitals will select
a hospital with better performance." This perception is incorrect. We found
that 1-star hospitals (the lowest rated) and 5-star hospitals (the highest
rated) were statistically indistinguishable in 92% of pairwise comparisons,
and 1-star hospitals had better risk-standardized mortality rates than 5-star
hospitals in only 5% of comparisons. In fact, in only 3% of comparisons did
the 5-star hospitals have significantly better outcomes than 1-star hospitals.
Furthermore, Finlayson and Birkmeyer's concerns about direct hospital comparisons
due to small sample sizes can be addressed by the use of multilevel models
that "borrow" power across hospitals.
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