Romano P S, Rainwater J A, Antonius D
Department of Internal Medicine, and the Center for Health Services Research in Primary Care, University of California Davis School of Medicine, Sacramento 95817, USA.
Med Care. 1999 Mar;37(3):295-305. doi: 10.1097/00005650-199903000-00009.
Concerns about quality of care are increasing as hospitals struggle to lower costs. Hospital report cards are controversial, but little is known about their impact.
To determine whether recent hospital report cards are viewed more favorably than pioneering federal efforts; whether a report based on clinical data is viewed more favorably than one based on administrative data; and whether attitudes toward report cards are related to hospital characteristics.
Mailed survey of chief executives at 374 California hospitals and 31 New York hospitals listed in report cards on myocardial infarction and coronary bypass mortality.
Two-hundred-and-seventy-four hospitals in California (73.3% response) and 27 in New York (87.1% response). California hospitals were categorized on ownership, size, occupancy, risk-adjusted mortality, teaching status, patient volume, and surgical capability.
Number of hospital units that received or discussed the report card, ratings of its quality, perceptions of its usefulness, and knowledge of its methods.
In both states, report cards were widely disseminated within hospitals. The mean quality rating was higher (P = 0.0074) in New York than in California; New York respondents appeared to be more knowledgeable about key methods. One or more hospital characteristics was associated with each outcome measure. Leaders at high-mortality hospitals were especially critical and did not find the report useful, despite limited understanding of its methods.
Recent hospital report cards were rated better than pioneering federal efforts. A report based on clinical data was rated better, understood better, and disseminated more often to key staff than one that was based on administrative data. Barriers to constructive use of outcomes data persist, especially at high mortality hospitals.
随着医院努力降低成本，对医疗质量的担忧日益增加。医院报告卡存在争议，但对其影响知之甚少。
确定近期的医院报告卡是否比早期的联邦举措更受青睐；基于临床数据的报告是否比基于行政数据的报告更受青睐；以及对报告卡的态度是否与医院特征相关。
对加利福尼亚州374家医院和纽约州31家医院的首席执行官进行邮寄调查，这些医院被列入心肌梗死和冠状动脉搭桥死亡率报告卡。
加利福尼亚州的274家医院（回复率73.3%）和纽约州的27家医院（回复率87.1%）。加利福尼亚州的医院按所有权、规模、床位使用率、风险调整死亡率、教学状况、患者数量和手术能力进行分类。
收到或讨论报告卡的医院科室数量、对其质量的评分、对其有用性的看法以及对其方法的了解。
在两个州，报告卡在医院内部都得到了广泛传播。纽约州的平均质量评分高于加利福尼亚州（P = 0.0074）；纽约州的受访者似乎对关键方法了解得更多。每种结果指标都与一个或多个医院特征相关。高死亡率医院的领导尤其批评报告卡，并且认为它没有用处，尽管他们对其方法的了解有限。
近期的医院报告卡评分高于早期的联邦举措。基于临床数据的报告比基于行政数据的报告评分更高、理解得更好，并且更经常地分发给关键工作人员。建设性地使用结果数据仍然存在障碍，尤其是在高死亡率医院。
