• Bo Shi, Christopher J King, and Sean Shenghsiu Huang.
• Department of Accounting and Finance, Elmer R Smith College of Business and Technology, Morehead State University, Morehead, Kentucky.
• J Hosp Med. 2020 Oct 1; 15 (10): 588-593.

IntroductionThe Centers for Medicare & Medicaid Services (CMS) publishes hospital quality ratings to provide more transparent and useable quality information to patients and stakeholders. However, there is a gap in the literature regarding the geographic distribution of the hospitals with higher star ratings. In this paper, we focus on the associations between star ratings and community characteristics, including racial/ethnic mix, household income, educational attainment, and regional difference.MethodsA retrospective study and cross-sectional logistic and multinomial logistic regression analyses.ResultsAccording to the multivariate regression results, hospitals in areas with lower income, lower educational attainment, and higher minority population shares have lower quality ratings (lower income: odds ratio [OR] 0.67; 95% CI, 0.49-0.91; lower education: OR 0.66; 95% CI, 0.51-0.85; higher minority: OR 0.52; 95% CI, 0.40-0.69). Compared with hospitals in the Midwest, hospitals in Northeast, South, and West regions have lower quality ratings (Northeast: OR 0.37; 95% CI, 0.25-0.56; South: OR 0.68; 95% CI, 0.51-0.91; West: OR 0.69; 95% CI, 0.49-0.97).Discussion And ConclusionOverall, our results show that hospitals with higher star ratings are less likely to be located in communities with higher minority populations, lower income, and lower levels of educational attainment. Findings contribute to the discussion of integrating social factors in hospital quality star rating calculation methodologies.

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