Orchard C
National Casemix Office, Information Management Group of the NHS Executive, Winchester, Hampshire.
BMJ. 1994 Jun 4;308(6942):1493-6. doi: 10.1136/bmj.308.6942.1493.
Governments are increasingly concerned to compare the quality and effectiveness of healthcare interventions but find this a complex matter. Crude hospital statistics can be dangerously misleading and need adjusting for case mix, but identifying and weighting the patient characteristics which affect prognosis are problematical for conceptual, methodological, and practical reasons. These include the inherently uncertain nature of prognosis itself and the practical difficulties of collecting and quantifying data on the outcomes of interest for specific healthcare interventions and known risk factors such as severity.
各国政府越来越关注比较医疗干预措施的质量和效果，但发现这是一个复杂的问题。粗略的医院统计数据可能会产生严重的误导，需要根据病例组合进行调整，但出于概念、方法和实际原因，确定影响预后的患者特征并对其进行加权是有问题的。这些问题包括预后本身固有的不确定性，以及收集和量化特定医疗干预措施的相关结果以及诸如病情严重程度等已知风险因素的数据时所面临的实际困难。
