Measuring Hospital Performance Using Mortality Rates: An Alternative to the RAMR

Measuring Hospital Performance Using Mortality Rates: An Alternative to the RAMR

Background The risk-adjusted mortality rate (RAMR) is used widely by healthcare agencies to evaluate hospital performance. The RAMR is insensitive to case volume and requires a confidence interval for proper interpretation, which results in a hypothesis testing framework. Unfamiliarity with hypothe...

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Bibliographic Details
Main Authors: Christine Pitocco, Thomas R. Sexton
Format: Article
Language:English
Published: Kerman University of Medical Sciences 2018-04-01
Series:International Journal of Health Policy and Management
Subjects:
which results in a hypothesis testing framework. Unfamiliarity with hypothesis testing can lead to erroneous interpretations by the public and other stakeholders. We argue that screening
rather than hypothesis testing
is more defensible. We propose an alternative to the RAMR that is based on sound statistical methodology
easier to understand and can be used in large-scale screening with no additional data requirements. Methods We use an upper-tail probability to screen for hospitals performing poorly and a lower-tail probability to screen for hospitals performing well. Confidence intervals and hypothesis tests are not needed to compute or interpret our measures. Moreover
unlike the RAMR
our measures are sensitive to the number of cases treated. Results To demonstrate our proposed methodology
we obtained data from the New York State Department of Health for 10 Inpatient Quality Indicators (IQIs) for the years 2009-2013. We find strong agreement between the upper tail probability (UTP) and the RAMR
supporting our contention that the UTP is a viable alternative to the RAMR. Conclusion We show that our method is simpler to implement than the RAMR and
with no need for a confidence interval
it is easier to interpret. Moreover
it will be available for all hospitals and all diseases/conditions regardless of patient volume
Hospital Performance Measures
Mortality Rate
Risk Adjustment
Online Access:http://www.ijhpm.com/article_3401_53b0850b799b264f8edd25af68d31dc7.pdf

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http://www.ijhpm.com/article_3401_53b0850b799b264f8edd25af68d31dc7.pdf

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