Burns R, Nichols L O, Graney M J, Applegate W B
Memphis Veterans Affairs Medical Center, TN.
Am J Public Health. 1993 Jul;83(7):966-71. doi: 10.2105/ajph.83.7.966.
The objectives of this study were to determine (1) if there were significant differences between patients who died at a public hospital and those who died at a university hospital that functions as a private, community hospital, and (2) if those differences were associated with an increased risk of death.
Chart review collected variables used by the Health Care Financing Administration in mortality analyses to examine how severity of illness data contribute to accurate predictions of death in a public hospital compared with a university hospital.
Compared with patients who died at the university hospital, public hospital patients who died had more comorbid disease, were more severely ill, more likely to be emergently admitted, and more likely to be admitted from an extended-care facility. Inclusion of severity of illness with variables previously used to predict mortality significantly improved the accuracy of mortality prediction models for the public hospital but not for the university hospital.
The results suggest that urban public hospitals provide care to more severely ill patients. Administrative data sets may not be adequate to identify these differences between patient populations.
本研究的目的是确定：（1）在公立医院死亡的患者与在作为私立社区医院运营的大学医院死亡的患者之间是否存在显著差异；（2）这些差异是否与死亡风险增加相关。
病历审查收集了医疗保健财务管理局在死亡率分析中使用的变量，以研究与大学医院相比，疾病严重程度数据如何有助于准确预测公立医院的死亡情况。
与在大学医院死亡的患者相比，在公立医院死亡的患者合并症更多、病情更严重、更有可能急诊入院，并且更有可能从长期护理机构入院。将疾病严重程度与先前用于预测死亡率的变量相结合，显著提高了公立医院死亡率预测模型的准确性，但对大学医院则不然。
结果表明，城市公立医院为病情更严重的患者提供护理。行政数据集可能不足以识别患者群体之间的这些差异。
