リスク調整のリスク
1Department of Medicine, the Charles A. Dana Research Institute, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
JAMA
|November 25, 1997
まとめ
病院のリスク調整の方法は様々であり,異なる重度の測定は,病院のパフォーマンスに関する矛盾した結論につながる可能性があります. 重症度調整による死亡率だけでは,真の質の違いを正確に反映していない可能性があります.
科学分野:
- 医療サービス 研究 医療サービス
- 医療情報工学 医療情報工学
- 品質の向上 品質の向上
背景:
- リスク調整は,病院間の患者のアウトカムを比較するために不可欠です.
- 現在の病院の報告書カードは,さまざまなリスク調整方法論を使用しています.
研究 の 目的:
- 病院死亡率に対するリスク調整の歴史的発展と現在の実践をレビューする.
- 医療の質を評価するためにリスク調整された死亡率比較を使用することの影響を分析する.
主な方法:
- 病院での死亡率を全国的にリスク調整するために使用された重症度測定法を調べた.
- AMI,CABG,肺炎,脳卒中など4つの疾患で,成人患者4万7000人以上を対象としたデータベースを使って,商業的な重症度合いを比較した.
- 病院内死亡率を予測するためにロジスティック回帰を用い,病院ごとに観察された死亡率と予想された死亡率を比較するためにzスコアを計算した.
主要な成果:
- 病気のステージング,APR-DRG,およびMedisGroupsは,疾患の間で死亡率を予測する際の性能が異なることを示しました.
- 異なる重症度測定は,死亡確率の異なる予測を生み出し,病院のパフォーマンスランキング (低い/高いz-スコア) に異論がありました.
- 高死亡率または低死亡率の病院を特定するための合意は,異なる重症度測定値よりも,調整されていない率と重症度調整された率の間でしばしば優れていた.
結論:
- 患者の重症度は,病院での死亡率の観察された違いを完全に説明しません.
- 重症度測定法の選択は,病院の相対的なパフォーマンスの認識に大きな影響を与えます.
- 重症度調整による死亡率のみに頼るだけでは,病院の質の変動を正確に特定するには不十分です.
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