Shahian David M, Iezzoni Lisa I, Meyer Gregg S, Kirle Leslie, Normand Sharon-Lise T
Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Am J Med Qual. 2012 Mar-Apr;27(2):112-23. doi: 10.1177/1062860611412358. Epub 2011 Sep 14.
Hospital-wide mortality rates are used as a measure of overall hospital quality. However, their parsimony and apparent simplicity belie significant conceptual and methodological concerns. For many diagnoses included in hospital-wide mortality, the association between short-term mortality and quality of care is not well established. Furthermore, compared with condition-specific or procedure-specific mortality, hospital-wide mortality rates pose greater methodological challenges (ie, eligibility and exclusion criteria, risk adjustment, statistical techniques for aggregating across diagnoses, usability). Many of these result from substantial interprovider heterogeneity in diagnosis frequency, sample sizes, and patient severity. Hospital-wide mortality is problematic as a quality metric for public reporting, although hospitals may elect to use such measures for other purposes. Potential alternative approaches include multidimensional composite metrics or mortality measurement limited to selected conditions and procedures for which the link between hospital mortality and quality is clear, legitimate exclusions are uncommon, and sample sizes, end points, and risk adjustment are adequate.
全院死亡率被用作衡量医院整体质量的指标。然而，它们的简约性和表面上的简单性掩盖了重大的概念和方法问题。对于全院死亡率所涵盖的许多诊断而言，短期死亡率与医疗质量之间的关联尚未明确确立。此外，与特定疾病或特定手术的死亡率相比，全院死亡率带来了更大的方法学挑战（即资格和排除标准、风险调整、跨诊断汇总的统计技术、可用性）。其中许多问题源于提供者之间在诊断频率、样本量和患者严重程度方面存在显著的异质性。全院死亡率作为公共报告的质量指标存在问题，尽管医院可能选择将此类指标用于其他目的。潜在的替代方法包括多维综合指标，或仅限于某些特定疾病和手术的死亡率测量，对于这些疾病和手术，医院死亡率与质量之间的联系明确，合理排除情况不常见，且样本量、终点和风险调整都足够。
