Thomas J W, Holloway J J, Guire K E
Department of Health Services Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109-2029.
Inquiry. 1993 Spring;30(1):6-22.
Risk-adjusted mortality is perhaps the most commonly referenced outcome indicator for assessments of hospital quality. While mortality rate possesses considerable intuitive appeal as a quality indicator, scientific evidence concerning its appropriateness for this purpose is mixed. In this paper, we use a computerized discharge database to model mortality risks for patients hospitalized for three different conditions: cardiac disease (ischemic heart disease, coronary artery disease, angina, and left ventricular aneurysm), acute myocardial infarction, and septicemia. We then use a database of peer review quality findings to determine whether the ratio of observed to expected deaths in each of these conditions relates validly to quality. The results of our analyses provide strong support for the validity of one of our mortality indicators, weak support for another, and no support for the third. We conclude that before inferences about hospital quality are made using any risk-adjusted mortality indicator, the validity of the quality/outcome relationship must be established explicitly for that measure.
风险调整后的死亡率可能是评估医院质量时最常被引用的结果指标。虽然死亡率作为质量指标具有相当大的直观吸引力，但关于其适用于此目的的科学证据却参差不齐。在本文中，我们使用一个计算机化的出院数据库来为因三种不同病症住院的患者建立死亡风险模型：心脏病（缺血性心脏病、冠状动脉疾病、心绞痛和左心室动脉瘤）、急性心肌梗死和败血症。然后，我们使用同行评审质量调查结果数据库来确定这些病症中每种病症的观察死亡数与预期死亡数之比是否与质量有效相关。我们的分析结果为我们的一个死亡率指标的有效性提供了有力支持，为另一个指标提供了微弱支持，而对第三个指标则没有支持。我们得出结论，在使用任何风险调整后的死亡率指标进行关于医院质量的推断之前，必须明确确定该指标的质量/结果关系的有效性。
