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面向消费者的互联网医疗报告卡的评估:基于死亡率数据的质量评级的风险

Harlan M Krumholz¹, Saif S Rathore, Jersey Chen

¹Yale University School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520-8025, USA.

|March 12, 2002

概括

此摘要是机器生成的。

互联网医院评级显示护理质量的总体差异,但差异很小,无法区分个体医院的表现. 这些评级可能会误导患者和支付人,关于急性心肌梗塞 (AMI) 的特定医院结果.

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科学领域:

医疗保健服务研究医疗服务研究
心脏病学心脏病学
医疗信息学医疗信息学

背景情况:

公共可用的互联网医疗保健质量评级系统正在引起消费者的兴趣.
这些评级对医院绩效的区分能力在很大程度上是未知的.

研究的目的:

评估急性心肌梗塞 (AMI) 死亡率的著名互联网医院评级是否准确地反映了医院的表现.
该研究评估了评级与护理过程和患者结果的对比.

主要方法:

对141,914名65岁以上的医疗保险受益者进行了回顾性分析,这些受益者因AMI住院治疗.
来自美国3363家急症医院 (1994-1996年) 的数据与HealthGrades.com评级 (1-5星) 进行了比较.
关键质量指标包括再注射疗法,阿司匹林,β抑制剂,ACE抑制剂和30天死亡率.

主要成果:

高等级医院显示阿司匹林和β-阻断剂使用量增加.
风险标准化的30天死亡率在评级较高的医院较低.
评级组内存在显著的重叠和异质性;只有3.1%的1星与5星比较显示5星医院的死亡率在统计上较低.

结论:

互联网评级确定了AMI护理医院质量的总体差异.
然而,评级显示,医院个体的护理流程和死亡率之间差别很差.
歧视权的限制可能导致对医院绩效的误解,并影响患者/付款人的决策.