Rosenthal Gary E, Sarrazin Mary Vaughan, Harper Dwain L, Fuehrer Susan M
Division of General Internal Medicine, Iowa City VA Medical Center, Iowa City, Iowa, USA.
J Gen Intern Med. 2003 Aug;18(8):601-8. doi: 10.1046/j.1525-1497.2003.11209.x.
To compare severity-adjusted in-hospital mortality and length of stay (LOS) in a Veterans Administration (VA) hospital and private sector hospitals serving the same health care market.
Retrospective cohort study.
A large VA hospital and 27 private sector hospitals in the same metropolitan area.
Consecutive VA (N = 1,960) and private sector (N = 157,147) admissions in 1994 to 1995 with 9 high-volume diagnoses.
Severity of illness was measured using validated multivariable models that were based on data abstracted from medical records. Outcomes were adjusted for severity and compared in VA and private sector patients using multiple logistic or linear regression analysis.
Unadjusted mortality was similar in VA and private sector patients (5.0% vs 5.6%, respectively; P =.26), although mean LOS was longer in VA patients (12.7 vs 7.0 days; P <.001). Adjusting for severity, the odds of death in VA patients was similar (odds ratio [OR] 1.07; 95% confidence interval [95% CI], 0.74 to 1.54; P =.73). However, a larger proportion of deaths in VA patients occurred later during hospitalization (P <.001), and the odds of death in VA patients were actually lower (P <.05) in analyses limited to deaths during the first 7 (OR, 0.56) or 14 (OR, 0.63) days. Adjusted LOS was longer (P <.001) in VA patients for all 9 diagnoses.
If the current findings generalizable to other markets, hospital mortality, a widely used performance measure, may be similar or lower in VA and private sector hospitals serving the same markets. The longer LOS of VA patients may reflect differences in practice patterns and may be an important source of bias in comparisons of VA and private sector hospitals.
比较退伍军人事务部（VA）医院与服务于同一医疗市场的私立医院中经病情严重程度调整后的住院死亡率和住院时间（LOS）。
回顾性队列研究。
一家大型VA医院和同一大都市地区的27家私立医院。
1994年至1995年连续收治的VA患者（N = 1960）和私立医院患者（N = 157147），诊断疾病有9种且病例数多。
使用基于从病历中提取的数据经过验证的多变量模型来测量疾病严重程度。对病情严重程度进行调整后，采用多元逻辑回归或线性回归分析对VA患者和私立医院患者的结局进行比较。
VA患者和私立医院患者未调整的死亡率相似（分别为5.0%和5.6%；P = 0.26），尽管VA患者的平均住院时间更长（12.7天对7.0天；P < 0.001）。经病情严重程度调整后，VA患者死亡的几率相似（优势比[OR]为1.07；95%置信区间[95%CI]为0.74至1.54；P = 0.73）。然而，VA患者中较大比例的死亡发生在住院后期（P < 0.001），并且在仅限于前7天（OR，0.56）或14天（OR, 0.63）内死亡的分析中，VA患者死亡的几率实际上更低（P < 0.05）。对于所有9种诊断，VA患者调整后的住院时间更长（P < 0.001）。
如果当前的研究结果可推广到其他市场，那么在服务于相同市场的VA医院和私立医院中，广泛使用的绩效指标——医院死亡率可能相似或更低。VA患者较长的住院时间可能反映了医疗实践模式的差异，并且可能是VA医院与私立医院比较中偏差的一个重要来源。
