EVALUATION OF THE COMPLICATION RATE AS A MEASURE OF QUALITY OF CARE IN CORONARY-ARTERY BYPASS GRAFT-SURGERY
EVALUATION OF THE COMPLICATION RATE AS A MEASURE OF QUALITY OF CARE IN CORONARY-ARTERY BYPASS GRAFT-SURGERY
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DOI：
10.1001/jama.274.4.317
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发表时间：
1995-07-26
影响因子：
120.7
通讯作者：
WILLIAMS, SV
中科院分区：
文献类型：
--
作者：
SILBER, JH;ROSENBAUM, PR;WILLIAMS, SV
目的.-确定基于并发症发生率的医院排名是否提供与基于死亡率的医院排名相同的信息。设计.-院内死亡、并发症和并发症后死亡（抢救失败）的回顾性研究。根据观察到的事件数与预期事件数（来自逻辑回归模型）之间的差异，使用残差对医院进行排名；使用 Spearman 等级相关性对排名进行比较。设置。-1991 年和 1992 年 MedisGroups 国家比较数据库中进行冠状动脉搭桥术 (CABG) 手术的医院。患者和数据集，-记录在 57 家医院接受 CABG 手术的 16 673 名患者的抽象数据，与 1991 年美国医院协会年度调查的数据相联系。结果。-对患者进行调整后 入院时病情严重程度，基于死亡或抢救失败的医院排名与基于并发症的医院排名之间相关性较低（死亡与并发症，r=0.07，P=.58；抢救失败与并发症，r=-0.22，P=.11）。此外，许多通常与较高护理质量相关的医院特征与较高的并发症发生率相关，但与预期或低于预期的死亡率相关。结论：基于并发症发生率的医院排名提供的信息与基于死亡率的医院排名不同。在更多地了解这些差异之前，不应使用并发症发生率来判断医院 CABG 手术的护理质量。
Objective.-To determine whether hospital rankings based on complication rates provide the same information as hospital rankings based on mortality rates.Design.-A retrospective study of in-hospital death, complication, and death following complication (failure to rescue). Hospitals were ranked using residuals based on the difference between the observed and the expected number of events (from logistic regression models); rankings were compared using Spearman rank correlations.Setting.-Hospitals performing coronary artery bypass graft (CABG) surgery in the 1991 and 1992 MedisGroups National Comparative Data Bases.Patients and Data Sets,-Record abstraction data for 16 673 patients who underwent CABG procedures at 57 hospitals, linked with data from the 1991 American Hospital Association Annual Survey.Results.-After adjusting for patient admission severity of illness, there were low correlations between hospital rankings based on death or failure to rescue and those rankings based on complication (death vs complication, r=0.07, P=.58; failure to rescue vs complication, r=-0.22, P=.11). In addition, many hospital characteristics that are generally associated with a higher quality of care were associated with higher complication rates but with expected or lower-than-expected mortality rates.Conclusions.-HospitaI rankings based on complication rates provide different information than those based on mortality rates. Until more is known about these differences, complication rates should not be used to judge hospital quality of care in CABG surgery.