Adjusted hospital death rates: a potential screen for quality of medical care.
Adjusted hospital death rates: a potential screen for quality of medical care.
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调整后的医院死亡率：医疗保健质量的潜在筛查。
DOI：
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发表时间：
1987
影响因子：
12.7
通讯作者：
Barbara Starfield
中科院分区：
文献类型：
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作者：
Robert W. Dubois;Robert H. Brook;William H. Rogers;Kerr L. White;Barbara Starfield
医院面临的经济压力越来越大，因此更需要开发一种筛查工具来识别可能提供低质量护理的医院。基于93家医院和205，000名住院患者的数据，我们使用了多元回归模型来调整医院的粗死亡率。调整过程使用年龄、来自急诊科或疗养院的患者以及基于DRGs（诊断相关组）的医院病例组合指数。调整前，医院死亡率为每100例住院患者0.3至5.8例。调整后，住院死亡率范围为0.36 - 1.36/100（实际死亡率除以预测死亡率）。经查明，有11家医院（12%）的实际死亡率超过预测死亡率两个标准差以上。在9家医院（10%）中，预测死亡率超过实际死亡率的统计幅度相似。死亡率高于预期的11家医院可能提供的护理质量不足，或有独特的病人群体。调整后的死亡率模型需要验证和推广，然后才能常规地用于筛选医院。然而，观察到的死亡率与预测的死亡率之间的巨大差异使我们相信医院绩效可能存在重要差异。
Increased economic pressure on hospitals has accelerated the need to develop a screening tool for identifying hospitals that potentially provide poor quality care. Based upon data from 93 hospitals and 205,000 admissions, we used a multiple regression model to adjust the hospitals crude death rate. The adjustment process used age, origin of patient from the emergency department or nursing home, and a hospital case mix index based on DRGs (diagnostic related groups). Before adjustment, hospital death rates ranged from 0.3 to 5.8 per 100 admissions. After adjustment, hospital death ratios ranged from 0.36 to 1.36 per 100 (actual death rate divided by predicted death rate). Eleven hospitals (12 per cent) were identified where the actual death rate exceeded the predicted death rate by more than two standard deviations. In nine hospitals (10 per cent), the predicted death rate exceeded the actual death rate by a similar statistical margin. The 11 hospitals with higher than predicted death rates may provide inadequate quality of care or have uniquely ill patient populations. The adjusted death rate model needs to be validated and generalized before it can be used routinely to screen hospitals. However, the remaining large differences in observed versus predicted death rates lead us to believe that important differences in hospital performance may exist.