Pandey V A, Kerle M I, Jenkins M P, Wolfe J H N
Regional Vascular Unit, St Mary's Hospital, London, UK.
Ann R Coll Surg Engl. 2007 May;89(4):384-8. doi: 10.1308/003588407X183445.
The publication of interpretable performance data for hospitals is an important service. In November 2002, the medical benchmarking company Dr Foster published a league table based on the results of abdominal aortic aneurysm (AAA) repair. The purpose of our study was to establish the validity of the data used in benchmarking.
Data on elective infra-renal AAA (IRAAA) repair was obtained from three sources. Data used by Dr Foster was based on the hospital PAS system. The databases for both Dr Foster and PAS were analysed and cross-referenced to the vascular unit database maintained by a separately employed audit co-ordinator.
Of 395 total aortic aneurysm repairs, 223 (56%) were identified as elective IRAAA repairs on the unit database. Of these, 125 were identified on the PAS database and 115 on the Dr Foster database. The number of deaths was the same in both the unit and Dr Foster databases (n = 11) but the Dr Foster database included deaths in patients who had undergone juxtarenal (n = 1), Type III TAAA (n = 2) and Type IV TAAA (n = 4) repairs and omitted 7 deaths following IRAAA. The sensitivity and specificity for the PAS dataset was 0.51 and 0.93, respectively. For Dr Foster, the results were worse with a sensitivity and specificity of 0.41 and 0.86, respectively. The accuracy of the data was 0.6 and 0.69 for Dr Foster and PAS, respectively. Standardised mortality ratios (SMRs) were used to rank hospitals. Dr Foster's published SMR for elective AAA repair for our unit was 160. The actual SMR was 67.
Robust and accurate published league tables should be supported and commended but currently available data appear to be misleading and may cause unnecessary concern to patients.
公布医院可解读的绩效数据是一项重要服务。2002年11月，医疗基准评估公司福斯特博士发布了一份基于腹主动脉瘤（AAA）修复结果的排名表。我们研究的目的是确定用于基准评估的数据的有效性。
择期肾下AAA（IRAAA）修复的数据来自三个来源。福斯特博士使用的数据基于医院的患者管理系统（PAS）。对福斯特博士和PAS的数据库进行了分析，并与由单独聘请的审计协调员维护的血管科数据库进行了交叉核对。
在总共395例主动脉瘤修复手术中，223例（56%）在科室数据库中被确定为择期IRAAA修复。其中，125例在PAS数据库中被识别，115例在福斯特博士数据库中被识别。科室数据库和福斯特博士数据库中的死亡人数相同（n = 11），但福斯特博士数据库包括了接受近肾主动脉瘤（n = 1）、III型胸腹主动脉瘤（n = 2）和IV型胸腹主动脉瘤（n = 4）修复患者的死亡情况，并且遗漏了IRAAA修复术后的7例死亡。PAS数据集的敏感性和特异性分别为0.51和0.93。对于福斯特博士的数据，结果更差，敏感性和特异性分别为0.41和0.86。福斯特博士和PAS数据的准确性分别为0.6和0.69。标准化死亡率（SMR）用于对医院进行排名。福斯特博士公布的我们科室择期AAA修复的SMR为160。实际SMR为67。
应支持和赞扬稳健且准确的已发布排名表，但目前可用的数据似乎具有误导性，可能会引起患者不必要的担忧。
