The values and preferences of the creators of overall hospital performance rating scores are inexorably infused into the ratings, but the researchers in a perspective article in the New England Journal of Medicine suggest that a flexible overall performance score that can be modified in real time by users may be the optimal method for generating relevant reviews for specific patient interests.

Researchers modified an original program used by the Centers for Medicare and Medicaid Services (CMS) to generate the Hospital Quality Star Ratings, enabling users to set their own weights to hospital performance ratings. Following modification, the program was then applied individually to measure scores from the 2016 Hospital Compare database. The investigators also created an Internet-based report card that allowed users to display customized overall hospital ratings with corresponding weights associated with the evaluation of the importance of 7 quality domains.

As an example of how this model would work in the real world, the researchers provided a hypothetical case study of a pregnant woman in Massachusetts who was trying to decide where to receive local obstetrical care. The Hospital Compare overall default ratings gave 4 stars to 2 nearby hospitals and 3 stars to another nearby hospital.

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The patient modified the scale, assigning no stars to mortality, efficient use of medical imaging, and readmissions — 3 of the 7 quality domains. Instead, the woman assigned 100 points to effectiveness, safety, and timeliness, and 50 points to patient experience. After implementing these weights into the system, the patient found 2 local options with 5-star ratings.

According to the creators of this hypothetical hospital rating system, “Overall hospital ratings are sensitive to the inherently subjective weights applied to the underlying performance measures.” Likewise, having a modifiable hospital rating system available online geared toward patients may be the next step in improving care in patients with specific health concerns and care values.


Rumball-Smith J, Gurvey J, Friedberg MW. Personalized hospital ratings — transparency for the internet age. N Engl J Med. 2018;379(9):806-807.