UCLA Study Challenges Accuracy of U.S. News & World Report's Urology Care Rankings

a hand and medical records

A new study conducted by a team of UCLA Health urologists challenges the accuracy of the U.S. News & World Report (USNWR) hospital rankings for urology departments. 

The study, led by Dr. Kathy H. Huen, Dr. Mark S. Litwin, and Dr. Christopher S. Saigal with the Department of Urology at UCLA Health, examined the accuracy of the USNWR mortality and discharge-to-home measures for patients admitted or treated for urologic conditions. 

The USNWR Hospital Rankings have extensively promoted evaluations of hospital care quality, including specialty care rankings. The rankings use standardized Medicare codes to assign patients to different specialties. Some of these codes are considered "urology-related" by USNWR, even if the patient wasn't necessarily treated primarily by the urology department. So, the method USNWR uses to decide which patients count as "urology patients" doesn't necessarily match how hospitals themselves categorize their patients. 

The new study compared results from Medicare-generated data to data using electronic medical record (EMR) information and got different results.  

The authors used a reporting database to replicate USNWR’s method of assigning patients to a hospital’s urology service through Medicare Severity-Diagnosis Related Groups from January 2019 through December 2022. They compared it to outcomes among patients admitted or discharged by the urology department. They found significant differences in 30-day mortality rates between the two approaches. 

The USNWR-based analysis identified 13 patient deaths compared to three deaths in the primary urology group. Upon reviewing medical records, only four of the 13 deaths in the USNWR-based analysis group were "primarily associated" with urologic procedures or conditions. In contrast, all three deaths in the primary urology group were linked to urologic procedures or hospitalizations. 

During the analyzed time, home discharge rates were significantly lower in the USNWR-based analysis group compared to the patients in the primary urology group: 87% versus 95% in 2019 and 89% versus 94% in 2021. Further review of EMR data from selected patients not discharged to home identified some who had no or "minimal" contact with the urology service.