风险调整的风险风险的风险
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
概括
医院风险调整方法各不相同,不同严重程度的措施可能导致对医院绩效的相互矛盾的结论. 仅仅根据严重程度调整后的死亡率可能无法准确地反映真正的质量差异.
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
- 提高质量 提高质量
背景情况:
- 风险调整对于在不同医院比较患者结果至关重要.
- 目前的医院报告卡使用不同的风险调整方法.
研究的目的:
- 审查医院死亡率风险调整的历史发展和当前做法.
- 分析使用风险调整的死亡率比较来评估医疗保健质量的影响.
主要方法:
- 检查了用于风险调整全国医院死亡率的严重程度指标.
- 使用一个数据库对比商业严重程度的措施47,000+成年人入院四个条件:AMI,CABG,肺炎和中风.
- 采用后勤回归来预测住院死亡率,并计算z-score来比较每家医院的观察到与预期死亡率.
主要成果:
- 疾病分期,APR-DRGs和MedisGroups在预测疾病中的死亡率方面表现不同.
- 不同的严重程度指标产生了对死亡概率的不同预测,并且在医院绩效排名上存在分歧 (低/高z-score).
- 关于确定高或低死亡率医院的协议在未调整率和严重程度调整率之间往往比在不同严重程度指标之间更好.
结论:
- 患者的严重程度并不能完全解释观察到的医院死亡率的差异.
- 选择严重程度的措施显著影响了对医院相对表现的看法.
- 仅仅依靠严重程度调整后的死亡率是不足以准确识别医院质量的变化.
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