Hartz A J, Krakauer H, Kuhn E M, Young M, Jacobsen S J, Gay G, Muenz L, Katzoff M, Bailey R C, Rimm A A
Division of Biostatistics/Clinical Epidemiology, Medical College of Wisconsin, Milwaukee 53226.
N Engl J Med. 1989 Dec 21;321(25):1720-5. doi: 10.1056/NEJM198912213212506.
The Health Care Financing Administration (HCFA) publishes hospital mortality rates each year. We undertook a study to identify characteristics of hospitals associated with variations in these rates. To do so, we obtained data on 3100 hospitals from the 1986 HCFA mortality study and the American Hospital Association's 1986 annual survey of hospitals. The mortality rates were adjusted for each hospital's case mix and other characteristics of its patients. The mortality rate for all hospitalizations was 116 per 1000 patients. Adjusted mortality rates were significantly higher for for-profit hospitals (121 per 1000) and public hospitals (120 per 1000) than for private not-for-profit hospitals (114 per 1000; P less than 0.0001 for both comparisons). Osteopathic hospitals also had an adjusted mortality rate that was significantly higher than average (129 per 1000; P less than 0.0001). Private teaching hospitals had a significantly lower adjusted mortality rate (108 per 1000) than private nonteaching hospitals (116 per 1000; P less than 0.0001). Adjusted mortality rates were also compared for hospitals in the upper and lower fourths of the sample in terms of certain hospital characteristics. The mortality rates were 112 and 121 per 1000 for the hospitals in the upper and lower fourths, respectively, in terms of the percentage of physicians who were board-certified specialists (P less than 0.0001), 112 and 120 per 1000 for occupancy rate (P less than 0.0001), 113 and 120 per 1000 for payroll expenses per hospital bed (P less than 0.0001), and 113 and 119 per 1000 for the percentage of nurses who were registered (P less than 0.0001).
医疗保健财务管理局（HCFA）每年都会公布医院死亡率。我们开展了一项研究，以确定与这些死亡率差异相关的医院特征。为此，我们从1986年HCFA死亡率研究和美国医院协会1986年医院年度调查中获取了3100家医院的数据。对每家医院的病例组合及其患者的其他特征进行了死亡率调整。所有住院患者的死亡率为每1000例患者中有116例。营利性医院（每1000例中有121例）和公立医院（每1000例中有120例）的调整后死亡率显著高于私立非营利性医院（每1000例中有114例；两项比较的P值均小于0.0001）。整骨医院的调整后死亡率也显著高于平均水平（每1000例中有129例；P值小于0.0001）。私立教学医院的调整后死亡率（每1000例中有108例）显著低于私立非教学医院（每1000例中有116例；P值小于0.0001）。还根据某些医院特征对样本中处于上四分位和下四分位的医院的调整后死亡率进行了比较。就获得委员会认证的专科医生比例而言，上四分位和下四分位医院的死亡率分别为每1000例中有112例和121例（P值小于0.0001），就床位占用率而言分别为每1000例中有112例和120例（P值小于0.0001），就每张医院床位的工资支出而言分别为每1000例中有113例和120例（P值小于0.0001），就注册护士比例而言分别为每1000例中有113例和119例（P值小于0.0001）。
