Needleman Jack, Buerhaus Peter I, Mattke Soeren, Stewart Maureen, Zelevinsky Katya
Department of Health Services, UCLA School of Public Health, 90095-1772, USA.
Health Serv Res. 2003 Dec;38(6 Pt 1):1487-508. doi: 10.1111/j.1475-6773.2003.00189.x.
To assess whether adverse outcomes in Medicare patients can be used as a surrogate for measures from all patients in quality-of-care research using administrative datasets.
Patient discharge abstracts from state data systems for 799 hospitals in 11 states. National MedPAR discharge data for Medicare patients from 3,357 hospitals. State hospital staffing surveys or financial reports. American Hospital Association Annual Survey.
We calculate rates for 10 adverse patient outcomes, examine the correlation between all-patient and Medicare rates, and conduct negative binomial regressions of counts of adverse outcomes on expected counts, hospital nurse staffing, and other variables to compare results using all-patient and Medicare patient data.
DATA COLLECTION/EXTRACTION: Coding rules were established for eight adverse outcomes applicable to medical and surgical patients plus two outcomes applicable only to surgical patients. The presence of these outcomes was coded for 3 samples: all patients in the 11-state sample, Medicare patients in the 11-state sample, and Medicare patients in the national Medicare MedPAR sample. Logistic regression models were used to construct estimates of expected counts of the outcomes for each hospital. Variables for teaching, metropolitan status, and bed size were obtained from the AHA Annual Survey.
For medical patients, Medicare rates were consistently higher than all-patient rates, but the two were highly correlated. Results from regression analysis were consistent across the 11-state all-patient, 11-state Medicare, and national Medicare samples. For surgery patients, Medicare rates were generally higher than all-patient rates, but correlations of Medicare and all-patient rates were lower, and regression results less consistent.
Analyses of quality of care for medical patients using Medicare-only and all-patient data are likely to have similar findings. Measures applied to surgery patients must be used with more caution, as those tested only in Medicare patients may not provide results comparable to those from all-patient samples or across different samples of Medicare patients.
评估在使用行政数据集的医疗质量研究中，医疗保险患者的不良结局是否可作为所有患者指标的替代指标。
来自11个州799家医院的州数据系统中的患者出院摘要。来自3357家医院的医疗保险患者的全国医疗住院费用偿付数据。州医院人员配置调查或财务报告。美国医院协会年度调查。
我们计算了10种不良患者结局的发生率，检查了所有患者和医疗保险患者发生率之间的相关性，并对不良结局计数与预期计数、医院护士人员配置及其他变量进行负二项式回归，以比较使用所有患者和医疗保险患者数据的结果。
数据收集/提取：为适用于内科和外科患者的8种不良结局以及仅适用于外科患者的2种结局制定了编码规则。对3个样本的这些结局的存在情况进行编码：11个州样本中的所有患者、11个州样本中的医疗保险患者以及全国医疗保险医疗住院费用偿付样本中的医疗保险患者。使用逻辑回归模型构建每家医院结局预期计数的估计值。教学、大都市地位和床位规模的变量来自美国医院协会年度调查。
对于内科患者，医疗保险患者发生率始终高于所有患者发生率，但两者高度相关。回归分析结果在11个州所有患者样本、11个州医疗保险患者样本和全国医疗保险患者样本中是一致的。对于外科患者，医疗保险患者发生率通常高于所有患者发生率，但医疗保险患者与所有患者发生率的相关性较低，且回归结果不太一致。
使用仅医疗保险患者和所有患者数据对内科患者医疗质量进行分析可能会有相似的结果。应用于外科患者的指标必须更加谨慎地使用，因为仅在医疗保险患者中测试的指标可能无法提供与所有患者样本或不同医疗保险患者样本可比的结果。
