公开报告疾病的死亡率和医院总死亡率。

Mortality for publicly reported conditions and overall hospital mortality rates.

机构信息

Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, USA.

出版信息

JAMA Intern Med. 2013 Jul 22;173(14):1351-7. doi: 10.1001/jamainternmed.2013.7049.

DOI:10.1001/jamainternmed.2013.7049

PMID:23797306

Abstract

IMPORTANCE

Federal efforts about public reporting and quality improvement programs for hospitals have focused primarily on a small number of medical conditions. Whether performance on these conditions accurately predicts the quality of broader hospital care is unknown.

OBJECTIVE

To determine whether mortality rates for publicly reported medical conditions are correlated with hospitals' overall performance.

METHODS

Using national Medicare data, we compared hospital performance at 2322 US acute care hospitals on 30-day risk-adjusted mortality, aggregated across the 3 publicly reported conditions (acute myocardial infarction, congestive heart failure, and pneumonia), with performance on a composite risk-adjusted mortality rate across 9 other common medical conditions, a composite mortality rate across 10 surgical conditions, and both composites combined. We also examined the relationship between alternative surrogates of quality (hospital size and teaching status) and performance on these composite outcomes.

RESULTS

Our sample included 6,670,859 hospitalizations for Medicare fee-for-service beneficiaries from 2008 through 2009. Hospitals in the top quartile of performance on publicly reported conditions had a 3.6% lower absolute risk-adjusted mortality rate on the combined medical-surgical composite than those in the bottom quartile (9.4% vs 13.0%; P < .001). These top performers on publicly reported conditions had 5 times greater odds of being in the top quartile on the overall combined composite risk-adjusted mortality rate (odds ratio [OR], 5.3; 95% CI, 4.3-6.5). Mortality rates for the index condition were predictive of medical (OR, 8.4; 95% CI, 6.8-10.3) and surgical (2.7; 2.2-3.3) performance when these groups were considered separately. In comparison, large size (OR, 1.9; 95% CI, 1.5-2.4) and teaching status (2.4; 1.8-3.2) showed weaker relationships with overall hospital mortality rates.

CONCLUSIONS AND RELEVANCE

Hospital performance on publicly reported conditions can potentially be used as a signal of overall hospital mortality rates.

摘要

重要性

联邦政府在医院公共报告和质量改进计划方面的努力主要集中在少数几种医疗条件上。这些条件的表现是否准确预测更广泛的医院护理质量尚不清楚。

目的

确定公开报告的医疗条件的死亡率是否与医院的整体表现相关。

方法

使用国家医疗保险数据，我们比较了美国 2322 家急性护理医院在 30 天风险调整死亡率方面的表现，这些医院的死亡率是根据 3 种公开报告的疾病（急性心肌梗死、充血性心力衰竭和肺炎）进行汇总的，同时还比较了 9 种其他常见医疗条件的综合风险调整死亡率、10 种手术条件的综合死亡率以及这两种组合的死亡率。我们还研究了替代质量指标（医院规模和教学地位）与这些综合结果之间的关系。

结果

我们的样本包括 2008 年至 2009 年期间医疗保险费用受益人的 6670859 例住院治疗。在公开报告的疾病方面表现最好的四分之一医院在综合医疗手术组合的死亡率比表现最差的四分之一医院低 3.6%（9.4%比 13.0%；P <.001）。在公开报告的疾病方面表现最好的这些医院，其整体综合风险调整死亡率处于最高四分位数的可能性是最高的（优势比[OR]，5.3；95%CI，4.3-6.5）。当单独考虑这些组时，指数疾病的死亡率可预测医疗（OR，8.4；95%CI，6.8-10.3）和手术（2.7；2.2-3.3）的表现。相比之下，医院规模较大（OR，1.9；95%CI，1.5-2.4）和教学地位（2.4；1.8-3.2）与医院整体死亡率的相关性较弱。