Mortality trends during a program that publicly reported hospital performance
Mortality trends during a program that publicly reported hospital performance
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DOI：
10.1097/00005650-200210000-00006
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发表时间：
2002-10-01
期刊：
影响因子：
3
通讯作者：
Cebul, RD
中科院分区：
文献类型：
--
作者：
Baker, DW;Einstadter, D;Cebul, RD
背景。目前尚不清楚公开报告医院的风险调整死亡率是否会改善结果。 目标。研究克利夫兰健康质量选择计划运行期间（1991-1997 年）的死亡率趋势。研究设计。时间序列。主题。因急性心肌梗塞 (AMI；n = 10,439)、充血性心力衰竭 (CHF；n = 23,505)、胃肠道出血 (GIH；n = 11,088)、慢性阻塞性肺疾病 (COPD；n = 8495)、肺炎 (n = 23,719) 或中风 (n = 14,293) 住院的医疗保险患者。风险调整后的院内死亡率、出院后早期死亡率（出院后至入院后 30 天）和 30 天死亡率。 结果。除中风和胃肠道出血外，所有疾病的风险调整院内死亡率均显着下降，绝对下降范围为慢性阻塞性肺病的 -2.1% 至肺炎的 -4.8%。然而，除 COPD 外，出院后早期的死亡率均显着上升，增幅范围从 GIH 的 1.4% 到中风的 3.8%。因此，仅 CHF（绝对下降 1.4%，95% CI，-2.5 至 -0.1%）和 COPD（绝对下降 1.6%，95% CI，-2.8-0.0%）的 30 天死亡率显着下降。对于中风，风险调整后的 30 天死亡率实际上增加了 4.3%（95% Cl，1.8-7.1%）。结论。在克利夫兰对医院报告卡进行的实验中，死亡人数从住院期间转移到出院后立即死亡期间，大多数情况下 30 天死亡率几乎没有或没有净减少。医院概况分析仍然是一种未经证实的改善医疗状况护理结果的策略。使用院内死亡率来监测住院患者的结局趋势可能会导致虚假结论。
BACKGROUND. It is unclear whether publicly reporting hospitals' risk-adjusted mortality leads to improvements in outcomes.OBJECTIVES. To examine mortality trends during a period (1991-1997) when the Cleveland Health Quality Choice program was operational.RESEARCH DESIGN. Time series.SUBJECTS. Medicare patients hospitalized with acute myocardial infarction (AMI; n = 10,439), congestive heart failure (CHF; n = 23,505), gastrointestinal hemorrhage (GIH; n = 11,088), chronic obstructive pulmonary disease (COPD; n 8495), pneumonia (n = 23,719), or stroke (n 14,293).MEASURES. Risk-adjusted in-hospital mortality, early postdischarge mortality (between discharge and 30 days after admission), and 30-day mortality.RESULTS. Risk-adjusted in-hospital mortality declined significantly for all conditions except stroke and GIH, with absolute declines ranging from -2.1% for COPD to -4.8% for pneumonia. However, the mortality rate in the early postdischarge period rose significantly for all conditions except COPD, with increases ranging from 1.4% for GIH to 3.8% for stroke. As a consequence, the 30-day mortality declined significantly only for CHF (absolute decline 1.4%, 95% CI, -2.5 to -0.1%) and COPD (absolute decline 1.6%, 95% Cl, -2.8-0.0%). For stroke, risk-adjusted 30-day mortality actually increased by 4.3% (95% Cl, 1.8-7.1%).CONCLUSION. During Cleveland's experiment with hospital report cards, deaths shifted from in hospital to the period immediately after discharge with little or no net reduction in 30-day mortality for most conditions. Hospital profiling remains an unproven strategy for improving outcomes of care for medical conditions. Using in-hospital mortality rates to monitor trends in outcomes for hospitalized patients may lead to spurious conclusions.