A proposed hospital quality index: hospital death rates adjusted for case severity.

It is proposed that an appropriate measure of the quality of hospital care might be a measure of its outcome—the death rate, corrected to take into account the fact that certain types of hospitals have a larger proportion of seriously ill patients than others. Various indicators of case severity are assessed, under the constraints of simplicity and practicality of data collection and of calculation; and it is shown that the easily determined factor of length of hospital stay, especially when corrected so as to exclude external factors not related to the patient's condition, offers a valuable approach to such an adjustment of the crude death rate. An equation is proposed by which the crude death rate in general hospitals may be adjusted for case severity by the length of stay, corrected in turn by the occupancy rate, to give a more objective measure of hospital performance than the currently used measures based chiefly on evaluation of the hospital's staffing, equipment, and services.