University of Michigan, 2800 Plymouth Road Building 520 Office 3144, Ann Arbor, MI 48109, USA.
Health Serv Res. 2012 Oct;47(5):1861-79. doi: 10.1111/j.1475-6773.2012.01407.x. Epub 2012 Mar 30.
To assess the value of a novel composite measure for identifying the best hospitals for major procedures.
We used national Medicare data for patients undergoing five high-risk surgical procedures between 2005 and 2008.
For each procedure, we used empirical Bayes techniques to create a composite measure combining hospital volume, risk-adjusted mortality with the procedure of interest, risk-adjusted mortality with other related procedures, and other variables. Hospitals were ranked based on 2005-2006 data and placed in one of three groups: 1-star (bottom 20 percent), 2-star (middle 60 percent), and 3-star (top 20 percent). We assessed how well these ratings forecasted risk-adjusted mortality rates in the next 2 years (2007-2008), compared to other measures.
For all five procedures, the composite measures based on 2005-2006 data performed well in predicting future hospital performance. Compared to 1-star hospitals, risk-adjusted mortality was much lower at 3-star hospitals for esophagectomy (6.7 versus 14.4 percent), pancreatectomy (4.7 versus 9.2 percent), coronary artery bypass surgery (2.6 versus 5.0 percent), aortic valve replacement (4.5 versus 8.5 percent), and percutaneous coronary interventions (2.4 versus 4.1 percent). Compared to individual surgical quality measures, the composite measures were better at forecasting future risk-adjusted mortality. These measures also outperformed the Center for Medicare and Medicaid Services (CMS) Hospital Compare ratings.
Composite measures of surgical quality are very effective at predicting hospital mortality rates with major procedures. Such measures would be more informative than existing quality indicators in helping patients and payers identify high-quality hospitals with specific procedures.
评估一种新的综合指标在识别主要手术最佳医院方面的价值。
我们使用了 2005 年至 2008 年期间接受五种高风险手术的全国医疗保险数据。
对于每一种手术，我们使用经验贝叶斯技术创建了一种综合指标，该指标结合了医院的手术量、与感兴趣手术相关的风险调整死亡率、与其他相关手术相关的风险调整死亡率以及其他变量。医院根据 2005-2006 年的数据进行排名，并分为三组：1 星级（底部 20%）、2 星级（中间 60%）和 3 星级（顶部 20%）。我们评估了这些评级与其他指标相比，如何更好地预测未来两年（2007-2008 年）的风险调整死亡率。
对于所有五种手术，基于 2005-2006 年数据的综合指标在预测未来医院绩效方面表现良好。与 1 星级医院相比，食管癌切除术（6.7%对 14.4%）、胰腺切除术（4.7%对 9.2%）、冠状动脉旁路手术（2.6%对 5.0%）、主动脉瓣置换术（4.5%对 8.5%）和经皮冠状动脉介入治疗（2.4%对 4.1%），3 星级医院的风险调整死亡率要低得多。与单个手术质量指标相比，综合指标更能预测未来的风险调整死亡率。这些指标也优于医疗保险和医疗补助服务中心（CMS）医院比较评级。
手术质量的综合指标在预测主要手术的医院死亡率方面非常有效。与现有的质量指标相比，这些指标在帮助患者和支付方识别具有特定手术的高质量医院方面将更加有用。
