分析医院死亡率. 患者组合多样性的后果
J Green1, L J Passman, N Wintfeld
1Department of Health Policy Research, University Medical Center, New York, NY 10016.
JAMA
|April 10, 1991
概括
由于患者组合,医院死亡率可能会不准确地标记质量. 调整患者的特征,如年龄和健康状况,对于准确的医疗保健提供者评估至关重要.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 评估护理质量的评估.
- 医疗保健分析 医疗保健分析
背景情况:
- 对医疗保健提供者绩效数据的需求不断增长.
- 关于高死亡率是否反映护理质量或患者人数的辩论.
- 目前使用风险调整后的医院死亡率.
研究的目的:
- 调查医院死亡率异常值是否反映了护理质量或患者人口统计.
- 将"高死亡率异常点"医院的患者特征与其他医院进行比较.
- 为讨论解释医院死亡率数据的辩论提供信息.
主要方法:
- 对医疗保险患者数据的比较分析.
- 医疗保健融资管理局 (HCFA) 标记为"高死亡率异常值"的医院的识别.
- 根据患者年龄,诊断和护理需求等因素进行统计调整.
主要成果:
- 由于高比例的老年患者,复杂的诊断或需要护理的患者,医院被标记为异常值.
- 在调整了患者组合后,近一半的标记医院不再被认为是异常值.
- 患者群体的多样性显著影响了医院死亡率异常值的状态.
结论:
- 医院死亡率统计需要修改,以考虑到患者人群的多样性.
- 仅仅依靠未经调整的死亡率可能会误导医疗保健提供者的质量.
- 准确的医疗保健质量评估需要考虑到患者病例组合的复杂性.
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