To assess whether crude league tables of mortality and league tables of risk adjusted mortality accurately reflect the performance of hospitals.
Longitudinal study of mortality occurring in hospital.
9 neonatal intensive care units in the United Kingdom.
2671 very low birth weight or preterm infants admitted to neonatal intensive care units between 1988 and 1994.
Crude hospital mortality and hospital mortality adjusted using the clinical risk index for babies (CRIB) score.
Hospitals had wide and overlapping confidence intervals when ranked by mortality in annual league tables ; this made it impossible to discriminate between hospitals reliably.
In most years there was no significant difference between hospitals, only random variation.
The apparent performance of individual hospitals fluctuated substantially from year to year.
Annual league tables are not reliable indicators of performance or best practice ; they do not reflect consistent differences between hospitals.
Any action prompted by the annual league tables would have been equally likely to have been beneficial, detrimental, or irrelevant Mortality should be compared between groups of hospitals using specific criteria-such as differences in the volume of patients, staffing policy, training of staff, or aspects of clinical practice-after adjusting for risk. (...)
Mots-clés Pascal : Unité soin intensif, Néonatologie, Evaluation performance, Mortalité, Etude longitudinale, Facteur risque, Royaume Uni, Europe, Marqueur épidémiologique, Epidémiologie, Méthodologie, Etude comparative, Nouveau né, Homme, Nourrisson, Service hospitalier
Mots-clés Pascal anglais : Intensive care unit, Neonatology, Performance evaluation, Mortality, Follow up study, Risk factor, United Kingdom, Europe, Epidemiological marker, Epidemiology, Methodology, Comparative study, Newborn, Human, Infant, Hospital ward
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0322470
Code Inist : 002B30A01A1. Création : 27/11/1998.