Fleming S T, McMahon L F, Desharnais S I, Chesney J D, Wroblewski R T
Department of Health Services Management, University of Missouri-Columbia 65211.
Med Care. 1991 Sep;29(9):815-28. doi: 10.1097/00005650-199109000-00003.
This paper describes the development of risk-adjusted mortality indices (RAMI) using 1985 MEDPAR data from 657 hospitals. The RAMI methodology is adopted from the Commission on Professional and Hospital Activities, however, both inhospital and post-discharge deaths are counted within time windows that vary by clinical condition. Five different RAMI measures (expected deaths/observed deaths) are developed, compared, and aggregated into various hospital characteristic strata. These measures vary by which discharge is held responsible for deaths within a time window, and whether or not inhospital deaths that occur beyond the time window are included. The RAMIs using varying time windows are compared with the RAMIs based upon inhospital deaths only. The inhospital RAMI was higher for the nonteaching hospitals (.95) as compared with the major and minor teaching institutions (.91 and .89). The RAMIs using the varying time windows, on the other hand, tend to be higher for the teaching institutions (e.g., 1.07 for major teaching hospitals; 0.99 for nonteaching hospitals).
本文描述了利用657家医院1985年的医疗费用和住院病历数据库（MEDPAR）数据开发风险调整死亡率指数（RAMI）的过程。RAMI方法采用了专业与医院活动委员会的方法，不过，住院死亡和出院后死亡都在根据临床情况而有所不同的时间范围内进行统计。开发、比较了五种不同的RAMI指标（预期死亡数/观察到的死亡数），并将其汇总到不同的医院特征分层中。这些指标因在一个时间范围内对死亡负责的出院情况不同，以及是否包括超出时间范围发生的住院死亡而有所差异。将使用不同时间范围的RAMI与仅基于住院死亡的RAMI进行了比较。非教学医院的住院RAMI（0.95）高于主要和次要教学机构（分别为0.91和0.89）。另一方面，使用不同时间范围的RAMI在教学机构中往往更高（例如，主要教学医院为1.07；非教学医院为0.99）。
