Iezzoni L I, Daley J, Heeren T, Foley S M, Hughes J S, Fisher E S, Duncan C C, Coffman G A
Department of Medicine, Harvard Medical School, Boston, MA.
Inquiry. 1994 Spring;31(1):40-55.
Medicare's Peer Review Organizations (PROs) now are required to work with hospitals to improve patient outcomes. Which hospitals should be targeted? We used 1988 California discharge data to identify hospitals with higher-than-expected rates of complications in six adult, medical-surgical patient populations. Relative hospital complication rates generally were correlated across clinical areas, although correlations were lower between medical and surgical case types. Higher relative rates of complications were associated with larger size, major teaching facilities, and provision of open heart surgery, as well as with coding more diagnoses per case. Complication rates generally were not related significantly to hospital mortality rates as calculated by the Health Care Financing Administration. Different hospitals may be chosen for quality review depending on the method used to identify poor outcomes.
医疗保险的同行评审组织（PROs）现在必须与医院合作以改善患者治疗效果。应该针对哪些医院呢？我们利用1988年加利福尼亚州的出院数据，在六个成人内科-外科患者群体中识别并发症发生率高于预期的医院。尽管内科和外科病例类型之间的相关性较低，但各临床领域的相对医院并发症发生率通常具有相关性。较高的相对并发症发生率与医院规模较大、主要教学机构、开展心脏直视手术以及每个病例编码更多诊断相关。并发症发生率通常与医疗保健财务管理局计算的医院死亡率没有显著关系。根据用于识别不良治疗效果的方法不同，可能会选择不同的医院进行质量评审。
