Landon B, Iezzoni L I, Ash A S, Shwartz M, Daley J, Hughes J S, Mackiernan Y D
Department of Medicine, Beth Israel Hospital, Boston, MA 02215, USA.
Inquiry. 1996 Summer;33(2):155-66.
In many health care marketplaces, outcomes assessment is central to monitoring quality while controlling costs. Comparing outcomes across providers generally requires adjustment for patient severity. For mortality rates and other adverse outcomes comparisons, severity adjustment ideally aims to control for patient characteristics prior to the health care intervention. A variety of severity methodologies, specifically for hospitalized patients, are commercially available. Some have been adopted by state or regional initiatives for publicly comparing hospital outcomes. We applied 14 common severity measures to the same data set to determine whether judgments about risk-adjusted hospital death rates are sensitive to the specific severity method. We examined 7,765 patients undergoing coronary artery bypass graft (CABG) surgery at 38 hospitals. Unadjusted death rates ranged from 0% to 11.2% across hospitals. Comparisons of relative hospital performance were relatively insensitive to the severity adjustment method.
在许多医疗保健市场中，结果评估对于在控制成本的同时监测质量至关重要。比较不同医疗机构的结果通常需要对患者的严重程度进行调整。对于死亡率和其他不良结果的比较，理想情况下，严重程度调整旨在在医疗干预之前控制患者特征。有多种针对住院患者的严重程度评估方法可供商业使用。一些已被州或地区倡议采用，用于公开比较医院的结果。我们将14种常见的严重程度测量方法应用于同一数据集，以确定关于风险调整后的医院死亡率的判断是否对特定的严重程度方法敏感。我们研究了38家医院中7765例接受冠状动脉旁路移植术（CABG）的患者。各医院未经调整的死亡率在0%至11.2%之间。相对医院绩效的比较对严重程度调整方法相对不敏感。
