Dubois R W, Brook R H, Rogers W H
Am J Public Health. 1987 Sep;77(9):1162-6. doi: 10.2105/ajph.77.9.1162.
Increased economic pressure on hospitals has accelerated the need to develop a screening tool for identifying hospitals that potentially provide poor quality care. Based upon data from 93 hospitals and 205,000 admissions, we used a multiple regression model to adjust the hospitals crude death rate. The adjustment process used age, origin of patient from the emergency department or nursing home, and a hospital case mix index based on DRGs (diagnostic related groups). Before adjustment, hospital death rates ranged from 0.3 to 5.8 per 100 admissions. After adjustment, hospital death ratios ranged from 0.36 to 1.36 per 100 (actual death rate divided by predicted death rate). Eleven hospitals (12 per cent) were identified where the actual death rate exceeded the predicted death rate by more than two standard deviations. In nine hospitals (10 per cent), the predicted death rate exceeded the actual death rate by a similar statistical margin. The 11 hospitals with higher than predicted death rates may provide inadequate quality of care or have uniquely ill patient populations. The adjusted death rate model needs to be validated and generalized before it can be used routinely to screen hospitals. However, the remaining large differences in observed versus predicted death rates lead us to believe that important differences in hospital performance may exist.
医院面临的经济压力不断增加，这加速了开发一种筛查工具的需求，以识别那些可能提供劣质医疗服务的医院。基于93家医院和20.5万例住院病例的数据，我们使用多元回归模型来调整医院的粗死亡率。调整过程使用了年龄、患者来自急诊科或养老院的来源，以及基于诊断相关组（DRGs）的医院病例组合指数。调整前，医院死亡率为每100例住院病例0.3至5.8例。调整后，医院死亡比为每100例0.36至1.36例（实际死亡率除以预测死亡率）。确定了11家医院（12%），其实际死亡率超过预测死亡率超过两个标准差。在9家医院（10%）中，预测死亡率超过实际死亡率的幅度类似。这11家死亡率高于预测值的医院可能提供的医疗服务质量不足，或者拥有独特的重症患者群体。在调整后的死亡率模型能够常规用于筛查医院之前，需要对其进行验证和推广。然而，观察到的死亡率与预测死亡率之间仍然存在较大差异，这使我们相信医院绩效可能存在重要差异。
