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  1. The risks of risk adjustment.

    Article - En anglais

    Context. - Risk adjustment is essential before comparing patient outcomes across hospitals.

    Hospital report cards around the country use different risk adjustment methods.

    Objectives

    - To examine the history and current practices of risk adjusting hospital death rates and consider the implications for using risk-adjusted mortality comparisons to assess quality.

    Data Sources and Study Selection

    - This article examines severity measures used in states and regions to produce comparisons of risk-adjusted hospital death rates.

    Detailed results are presented from a study comparing current commercial severity measures using a single database.

    It included adults admitted for acute myocardial infarction (n=11 880), coronary artery bypass graft surgery (n=7765), pneumonia (n=18016), and stroke (n=9407).

    Logistic regressions within each condition predicted in-hospital death using severity scores.

    Odds ratios for in-hospital death were compared across pairs of severity measures.

    For each hospital, z scores compared actual and expected death rates.

    Results

    - The severity measure called Disease Staging had the highest c statistic (which measures how well a severity measure discriminates between patients who lived and those who died) for acute myocardial infarction, 0.86 ; the measure called All Patient Refined Diagnosis Related Groups had the highest for coronary artery bypass graft surgery, 0.83 ; and the measure, MedisGroups, had the highest for pneumonia, 0.85 and stroke. (...)

    Mots-clés Pascal : Risque, Ajustement, Mortalité, Hôpital, Evaluation, Qualité service, Homme

    Mots-clés Pascal anglais : Risk, Fitting, Mortality, Hospital, Evaluation, Service quality, Human

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0032601

    Code Inist : 002B30A05. Création : 17/04/1998.