疾病严重程度在评估医院死亡率中的重要性
J Green1, N Wintfeld, P Sharkey
1Department of Health Policy Research, New York University Medical Center/New York University School of Medicine 10016.
JAMA
|January 12, 1990
概括
医疗保健融资管理局 (HCFA) 模型对医院死亡率的预测很差. 纳入患者严重程度显著提高了预测准确性,建议对有效的医院质量评估进行必要的修订.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
- 公共卫生政策 公共卫生政策
背景情况:
- 医疗保健融资管理局 (HCFA) 每年都会发布医院死亡率的比较数据.
- 有关HCFA预测模型在考虑患者严重性方面的充分性存在担忧.
- 准确的风险调整对于有效的医院绩效评估至关重要.
研究的目的:
- 评估HCFA医院死亡率模型的预测能力.
- 评估将患者严重程度纳入死亡率预测的影响.
- 确定HCFA模型是否根据严重程度充分区分医院质量.
主要方法:
- 复制了HCFA的死亡率预测模型.
- 开发了第二个模型,其中包含了患者严重程度的测量 (入院时的主要诊断阶段).
- 使用模拟数据比较了两种模型的预测性能 (R平方).
主要成果:
- 原始的HCFA模型显示了非常有限的预测能力 (平均R2为2.5%).
- 在HCFA模型中,无法区分不同患者重症级别和医院的死亡率.
- 将患者的严重程度添加到模型中,预测能力增加了八倍 (R2至21.5%),并使死亡率差异正常化.
结论:
- 目前的HCFA死亡率预测模型对患者入院的严重程度缺乏敏感性.
- 在预测医院死亡率方面,通过包括严重程度措施,可以实现显著的改进.
- 医院死亡率发布的HCFA需要实质性修改,以准确反映医院的质量和有效性.
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