Bradbury R C, Stearns F E, Steen P M
Master of Health Administration Program, Clark University, Worcester, MA 01610.
Health Serv Res. 1991 Oct;26(4):407-24.
In this study hospital admissions are categorized into admission severity groups based on key clinical findings. Severity of illness is determined again later in the hospital stay after treatment has been initiated. High severity on this second review is labeled major morbidity or morbidity, depending on the severity level, and these rates serve as a health outcome indicator along with in-hospital mortality. This study's findings show, for ten hospitals randomly selected from MedisGroups users, considerable interhospital variation in standardized mortality and morbidity ratios for ten frequently occurring DRGs on the adult medical service. After adjusting for admission severity and case mix, three of the ten study hospitals have a statistically significant (p less than .01) difference between the hospital's standardized mortality ratio and 1.0. Such a significant difference exists for the standardized major morbidity ratio of four hospitals and for the standardized morbidity ratio of three hospitals. At the DRG-specific level, our results show that 8.9 percent, 4.4 percent, and 15.0 percent of the hospital-specific mortality, major morbidity, and morbidity ratios, respectively, are statistically significant. Most hospital outliers have fewer deaths or morbid cases than expected. We caution that the study hospitals may not be representative of a larger group of U.S. hospitals.
在本研究中，根据关键临床发现将医院入院病例分为不同的入院严重程度组。在开始治疗后的住院期间，再次确定疾病的严重程度。根据严重程度，第二次评估中的高严重程度被标记为主要发病率或发病率，这些比率与住院死亡率一起作为健康结果指标。本研究结果显示，从MedisGroups用户中随机选择的十家医院，成人医疗服务中十种常见诊断相关分组（DRG）的标准化死亡率和发病率在医院间存在相当大的差异。在调整入院严重程度和病例组合后，十家研究医院中有三家医院的标准化死亡率与1.0之间存在统计学显著差异（p小于0.01）。四家医院的标准化主要发病率和三家医院的标准化发病率存在这种显著差异。在特定DRG水平上，我们的结果显示，各医院特定的死亡率、主要发病率和发病率比率分别有8.9%、4.4%和15.0%具有统计学显著性。大多数医院的异常值死亡或发病病例比预期的少。我们提醒，研究中的医院可能不代表美国更大范围的医院群体。
