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Study gives mediocre grades to some health-care report cards

CHICAGO (AP) _ Some health-care ``report cards'' designed to make hospitals and doctors more accountable get only mediocre grades themselves.

Researchers examined one such Internet-based rating service and said that it and others that grade hospitals solely on death rates and other patient outcomes can be misleading and unfair.

For example, a hospital may treat patients who are much sicker and thus may have a much higher death rate, even though the treatment there may be superior, said Dr. Harlan Krumholz of Yale University, who led the study.

``The risk is that a lot of hospitals may appear to be doing worse than they actually are. The public may lose confidence in local hospitals when they don't truly deserve it,'' Krumholz said.

The study looked at, a publicly traded company that provides free information on hospitals nationwide. relies in part on billing records and other publicly available administrative data.

The researchers examined how ranked hospitals on a five-star system based on their heart attack death rates.

But the researchers looked instead at detailed medical records not readily available to grading companies, and focused on how well doctors followed the accepted guidelines for heart attack treatment, including use of anti-clotting drugs, aspirin and beta blockers.

The researchers found lower rates of aspirin and beta blocker use at one-, two- and three-star hospitals than at five-star hospitals. They also found big differences between hospitals given the same grade. Also, some hospitals with fewer stars had better mortality rates than those rated higher.

The system provides ``little meaningful discrimination between individual hospitals' performance,'' the researchers said.

The study appears in Wednesday' Journal of the American Medical Association. called the study fatally flawed.

Chief executive Kerry Hicks said that the study looked at outdated ratings and that the Web site has more up-to-date rankings. ``We've improved our methodologies'' since the study period, Hicks said.'s ratings are made with input from doctors, statisticians and other health-care experts, Hicks said.

Hicks said the rankings are still valuable for consumers.
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