Introduction: Quality of care in pediatric cardiology and cardiovascular surgical programs is highly valued by the public, but the most common method for assessing quality is published rankings, such as those by US News and World Report (USNWR). Whether there is significant correlation between USNWR rankings of pediatric cardiology and cardiovascular surgical programs and clinical measures of outcome, such as severity-adjusted cardiovascular surgical mortality rates is unknown.
Hypothesis: USNWR rankings are reliable surrogate for risk-adjusted surgical outcomes.
Methods: We used the 2015 USNWR website to define institutional rankings for Pediatric Cardiology and Cardiovascular Surgery programs. Clinical assessments of outcome were derived from 2011-2014 Society of Thoracic Surgeons (STS) risk-adjusted mortality rates for participating programs. Rank correlations were performed between USNWR ratings and each of the STS mortality ratings (Spearman’s testing). Subanalysis was done within STS defined groups (STAT1-5) representing broad spectrum of surgical complexity. Of 50 programs highest ranked by USNWR, 39 had complete, and 41 near-complete STS data; 9 were excluded.
Results: Correlation between USNWR rank vs. STS adjusted mortality rate rank was insignificant for the sample as a whole (rho=0.179, p=0.275), and when individual STAT groups analyzed separately. There were significant correlations between reputation rank and surgical volume rank (rho=0.747, p<0.001) and between overall program rank and surgical volume rank (rho=0.758, p<0.001) derived from USNWR. Institutional volume rank correlated with adjusted mortality rank only in STAT4 (rho=0.349, p=0.025). Institutional reputation rank did not correlate with adjusted mortality rank in general or in any STAT group (p>0.05).
Conclusions: Although mortality outcomes and multifactorial programmatic rankings are two somewhat different standards by which a program caring for children with heart disease might be judged, it is expected that these ought to correlate. The lack of reliable association between STS derived mortality rates and USNWR rankings illustrate that better methods for informing the public about the quality of pediatric cardiovascular programs are needed.