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The relationship between adjusted hospital mortality and the results of peer review
A J Hartz1, M S Gottlieb, E M Kuhn
1Division of Biostatistics/Clinical Epidemiology, Medical College of Wisconsin, Milwaukee 53226.
Abstract:
This study assessed the relationship between the Health Care Financing Administration adjusted mortality rate for a hospital and the errors in care found by the peer review process. The three data sets used were: (1) the 1987-1988 completed reviews from 38 peer review organizations (PROs) of 4,132 hospitals and 2,035,128 patients; (2) all 1987 hospital mortality rates for Medicare patients as adjusted by HCFA for patient mix; and (3) the 1986 American Hospital Association Survey. The PRO data were used to compute the percentage of cases reviewed from each hospital confirmed by a reviewing physician to have a quality problem. The average percentage of confirmed problems was 3.73 percent with state rates ranging from 0.03 percent to 38.5 percent. The average within-state correlation between the problem rate and the adjusted mortality rate for all PROs was .19 (p < .0001), but the correlations were much higher for relatively homogeneous groups of hospitals, .42 for public hospitals and .36 for hospitals in large metropolitan statistical areas (MSAs). These results suggest that the HCFA adjusted hospital mortality rate and the PRO-confirmed problem rate are related methods to compare hospitals on the basis of quality of care. Both methods may compare quality better if used within a group of homogenous hospitals.
Insights
The Health Care Financing Administration (HCFA) adjusted mortality rate and peer review organization (PRO) problem rates are related measures of hospital quality. Comparing similar hospitals may yield more accurate quality assessments.
Area of Science:
- Health Services Research
- Quality Improvement
- Medical Care Evaluation
Background:
- Assessing hospital quality is crucial for healthcare improvement.
- The Health Care Financing Administration (HCFA) developed an adjusted mortality rate to account for patient mix.
- Peer Review Organizations (PROs) identify errors in care through physician reviews.
Purpose of the Study:
- To examine the relationship between HCFA-adjusted hospital mortality rates and PRO-identified errors in care.
- To determine if these measures correlate and can be used to compare hospital quality.
Main Methods:
- Utilized data from 38 PROs (1987-1988) covering 4,132 hospitals and over 2 million patients.
- Incorporated 1987 HCFA-adjusted mortality rates for Medicare patients and the 1986 American Hospital Association Survey.
- Calculated the percentage of PRO-reviewed cases with confirmed quality problems per hospital.
Main Results:
- The average confirmed problem rate across hospitals was 3.73%.
- A statistically significant positive correlation (r=0.19, p<0.0001) was found between HCFA-adjusted mortality and PRO problem rates.
- Higher correlations were observed within homogeneous hospital groups: public hospitals (r=0.42) and large metropolitan statistical area (MSA) hospitals (r=0.36).
Conclusions:
- The HCFA-adjusted mortality rate and PRO-confirmed problem rate are related indicators of hospital quality.
- Both metrics may provide more accurate hospital comparisons when applied to homogeneous groups of facilities.
- Further research could explore the combined utility of these quality assessment tools.