Ranking Hospitals on Surgical Mortality: The Importance of Reliability Adjustment
Ranking Hospitals on Surgical Mortality: The Importance of Reliability Adjustment
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DOI：
10.1111/j.1475-6773.2010.01158.x
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发表时间：
2010-12-01
影响因子：
3.4
通讯作者：
Birkmeyer, John D.
中科院分区：
文献类型：
--
作者：
Dimick, Justin B.;Staiger, Douglas O.;Birkmeyer, John D.
我们研究了可靠性调整对医院手术死亡率的影响。数据来源我们使用了2003-2006年的国家医疗保险数据，用于三种外科手术：冠状动脉旁路移植术（CABG），腹主动脉瘤（AAA）修复术和胰腺切除术。研究设计我们进行了一项观察性研究，以评估可靠性调整对医院死亡率排名的影响。使用分层模型，我们调整医院死亡率的可靠性，使用经验贝叶斯技术。我们评估了这种调整的影响，对医院的明显变化和历史医院死亡率（2003-2004年）的能力，以预测未来的死亡率（2005-2006年）。主要FindingsThe净效应的可靠性调整是大大减少明显的变化，所有三个操作。可靠性调整对于确定未来死亡率最低的医院也特别重要。在没有可靠性调整的情况下，2005-2006年胰腺切除术“最好”的五分之一医院（2003-2004年）的死亡率为7.6%;在可靠性调整的情况下，2005-2006年“最好”的五分之一医院的死亡率为2.7%。对于AAA修复，可靠性调整也提高了识别未来死亡率较低的医院的能力。对于CABG，可靠性调整的好处是有限的最低容量hospital.ConclusionReliability调整结果在更稳定的估计死亡率，更好地预测未来的表现。这种统计技术对于帮助患者选择最好的医院进行特定手术，特别是不常见的手术至关重要，并且应该用于医院死亡率的公开报告。
ObjectiveWe examined the implications of reliability adjustment on hospital mortality with surgery.Data SourceWe used national Medicare data (2003-2006) for three surgical procedures: coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, and pancreatic resection.Study DesignWe conducted an observational study to evaluate the impact of reliability adjustment on hospital mortality rankings. Using hierarchical modeling, we adjusted hospital mortality for reliability using empirical Bayes techniques. We assessed the implication of this adjustment on the apparent variation across hospitals and the ability of historical hospital mortality rates (2003-2004) to forecast future mortality (2005-2006).Principal FindingsThe net effect of reliability adjustment was to greatly diminish apparent variation for all three operations. Reliability adjustment was also particularly important for identifying hospitals with the lowest future mortality. Without reliability adjustment, hospitals in the "best" quintile (2003-2004) with pancreatic resection had a mortality of 7.6 percent in 2005-2006; with reliability adjustment, the "best" hospital quintile had a mortality of 2.7 percent in 2005-2006. For AAA repair, reliability adjustment also improved the ability to identify hospitals with lower future mortality. For CABG, the benefits of reliability adjustment were limited to the lowest volume hospitals.ConclusionReliability adjustment results in more stable estimates of mortality that better forecast future performance. This statistical technique is crucial for helping patients select the best hospitals for specific procedures, particularly uncommon ones, and should be used for public reporting of hospital mortality.