Keeler E B, Kahn K L, Draper D, Sherwood M J, Rubenstein L V, Reinisch E J, Kosecoff J, Brook R H
Health Program, RAND Corp., Santa Monica, Calif. 90406-2138.
JAMA. 1990 Oct 17;264(15):1962-8.
We developed disease-specific measures of sickness at admission based on medical record data to study mortality of Medicare patients with one of five conditions (congestive heart failure, acute myocardial infarction, cerebrovascular accident, pneumonia, and hip fracture). We collected an average of 73 sickness variables per disease, but our final sickness-at-admission scales use, on average, 19 variables. These scales are publicly available, and explain 25% of the variance in 30-day postadmission mortality for patients with acute myocardial infarction, pneumonia, or cerebrovascular accident. Sickness at admission increased following the introduction of the prospective payment system (PPS). For our five diseases combined, the 30-day mortality to be expected because of sickness at admission was 1.0% higher in the 1985-1986 period than in the 1981-1982 period (16.4% vs 15.4%), and the expected 180-day mortality was 1.6% higher (30.1% vs 28.5%). Studies of the effects of PPS on mortality must take this increase in sickness at admission into account.
我们基于病历数据制定了入院时特定疾病的患病指标，以研究患有五种疾病之一（充血性心力衰竭、急性心肌梗死、脑血管意外、肺炎和髋部骨折）的医疗保险患者的死亡率。我们每种疾病平均收集了73个患病变量，但最终的入院时患病量表平均使用19个变量。这些量表是公开可用的，并且可以解释急性心肌梗死、肺炎或脑血管意外患者入院后30天死亡率中25%的方差。引入前瞻性支付系统（PPS）后，入院时的患病情况有所增加。对于我们合并的五种疾病，由于入院时患病，预计1985 - 1986年期间的30天死亡率比1981 - 1982年期间高1.0%（分别为16.4%和15.4%），预计180天死亡率高1.6%（分别为30.1%和28.5%）。关于PPS对死亡率影响的研究必须考虑到入院时患病情况的这种增加。
