Assessing hospital-associated deaths from discharge data. The role of length of stay and comorbidities.
Assessing hospital-associated deaths from discharge data. The role of length of stay and comorbidities.
复制标题
根据出院数据评估与医院相关的死亡。
DOI：
10.1001/jama.1988.03410150088036
复制
发表时间：
1988
期刊：
影响因子：
--
通讯作者：
T. Kay
中科院分区：
文献类型：
--
作者：
S. Jencks;Deborah K. Williams;T. Kay
为了评估医院相关死亡率的意义，我们研究了入院后30天内的死亡率（30天死亡率）是否比住院死亡率更能提供信息，以及对额外出院诊断的详细评估是否有助于理解死亡率。我们研究了住院的老年医疗保险患者的主要诊断中风，细菌性肺炎，心肌梗死，充血性心力衰竭，这些条件占30.8%的医疗保险30天死亡率。这些疾病的平均住院时间比纽约长99.0%，住院死亡率比加州高25.0%，但加州的30天死亡率高1.6%。我们的结论是，住院死亡率取决于住院时间的模式，并给出了一个有偏见的死亡率。休克和肺炎等其他诊断与死亡率增加密切相关，但医疗保险数据并未显示哪些患者在入院时患有这些疾病。记录的慢性疾病诊断，如高血压、糖尿病、肥胖、良性前列腺肥大和骨关节炎通常与死亡风险降低相关;这种风险降低在临床上不合理。多项证据表明，慢性疾病在危及生命的疾病患者中报告不足。我们建议在使用合并症的出院诊断来根据患者人群的临床差异调整医院死亡率时要非常谨慎。
To assess the meaning of hospital-associated death rates, we studied whether mortality within 30 days of hospital admission (30-day mortality) is more informative than inpatient mortality and whether detailed assessment of additional discharge diagnoses helps in understanding death rates. We examined hospitalizations for elderly Medicare patients with principal diagnoses of stroke, bacterial pneumonia, myocardial infarction, and congestive heart failure; these conditions account for 30.8% of Medicare 30-day mortality. Average hospital stays for these conditions were 99.0% longer, and inpatient mortality was 25.0% higher in New York than in California, but 30-day mortality was 1.6% higher in California. We conclude that inpatient death rates depend on length-of-stay patterns and give a biased picture of mortality. Additional diagnoses such as shock and pneumonia were strongly associated with increased mortality, but Medicare data do not reveal which patients had these conditions at the time of admission. Recorded diagnoses of chronic diseases such as hypertension, diabetes mellitus, obesity, benign prostatic hypertrophy, and osteoarthritis were commonly associated with reduced risk of death; such reduced risk is not clinically plausible. Several lines of evidence suggest that chronic disorders are underreported for patients with life-threatening disorders. We recommend great caution in using discharge diagnoses of comorbid conditions to adjust hospital death rates for clinical differences in the patient populations.