Ranstam J, Wagner P, Robertsson O, Lidgren L
Swedish National, Musculoskeletal Competence Centre (NKO), LundUniversity Hospital,Lund, Sweden.
J Bone Joint Surg Br. 2008 Dec;90(12):1558-61. doi: 10.1302/0301-620X.90B12.21172.
Public disclosure of outcome-orientated ranking of hospitals is becoming increasingly popular and is routinely used by Swedish health-care authorities. Whereas uncertainty about an outcome is usually presented with 95% confidence intervals, ranking's based on the same outcome are typically presented without any concern for bias or statistical precision. In order to study the effect of incomplete registration of re-operation on hospital ranking we performed a simulation study using published data on the two-year risk of re-operation after total hip replacement. This showed that whereas minor registration incompleteness has little effect on the observed risk of revision, it can lead to major errors in the ranking of hospitals. We doubt whether a level of data entry sufficient to generate a correct ranking can be achieved, and recommend that when ranking hospitals, the uncertainties about data quality and random events should be clearly described as an integral part of the results.
公开以结果为导向的医院排名越来越普遍，瑞典医疗保健当局经常使用这种排名。虽然结果的不确定性通常用95%的置信区间来表示，但基于相同结果的排名通常在呈现时不考虑偏差或统计精度。为了研究再次手术登记不完整对医院排名的影响，我们利用已发表的全髋关节置换术后两年再次手术风险的数据进行了一项模拟研究。结果表明，虽然轻微的登记不完整对观察到的翻修风险影响不大，但可能导致医院排名出现重大错误。我们怀疑是否能够实现足以产生正确排名的数据录入水平，并建议在对医院进行排名时，应将数据质量和随机事件的不确定性作为结果的一个组成部分清晰地描述出来。
