title: Public reporting of hospital quality shows inconsistent ranking results.
abstract: BACKGROUND
  Evidence from the US has demonstrated that hospital report cards might generate confusion for consumers who are searching for a hospital. So far, little is known regarding hospital ranking agreement on German report cards as well as underlying factors creating disagreement.
  
  
  OBJECTIVE
  This study examined the consistency of hospital recommendations on German hospital report cards and discussed underlying reasons for differences.
  
  
  METHODS
  We compared hospital recommendations for three procedures on four German hospital report cards. The agreement between two report cards was determined by Cohen's-Kappa. Fleiss' kappa was applied to evaluate the overlap across all four report cards.
  
  
  RESULTS
  Overall, 43.40% of all hospitals were labeled equally as low, middle, or top performers on two report cards (hip replacement: 43.2%; knee replacement: 42.8%; percutaneous coronary intervention: 44.3%). In contrast, 8.5% of all hospitals were rated a top performer on one report card and a low performer on another report card. The inter-report card agreement was slight at best between two report cards (κmax=0.148) and poor between all four report cards (κmax=0.111).
  
  
  CONCLUSIONS
  To increase the benefit of public reporting, increasing the transparency about the concept of - medical - "quality" that is represented on each report card seems to be important. This would help patients and other consumers use the report cards that most represent one's individual preferences.
authors.affiliation: Institute of Management (IFM), School of Business and Economics, Friedrich-Alexander-University Erlangen-Nuremberg, Health Services Management, Lange Gasse 20, 90403 Nuremberg, Germany. Electronic address: Martin.Emmert@fau.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Emmert
authors.affiliation: Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts Hannover, Hannover, Germany.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Taheri-Zadeh
authors.affiliation: Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts Hannover, Hannover, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kolb
authors.affiliation: Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts Hannover, Hannover, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Sander
mesh_terms: D003258:Consumer Behavior; D005858:Germany; D006761:Hospitals / Q000592:standards*; D006801:Humans; D011785:Quality Assurance, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data*
keywords: Healthcare quality; Hospital report cards; Internet; Public reporting