Ranking Hospitals According to Surgical Mortality: An Analysis of Methodological Issues

• Main Authors: Huan-YuChen, 陳奐妤
• Other Authors: Tsung-Hsueh Lu
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/cdqq5b

碩士 === 國立成功大學 === 公共衛生研究所 === 102 === Background: Ranking hospital quality of care according to surgical mortality had many debates. Silber proposed “failure-to-rescue”, the mortality rate among surgical patients with complications, as an emerging quality indicator. Objectives: The objective of this study was to assess the correlation among hospital quality assessment ranking based on crude/ age-adjusted/ risk-adjusted mortality, complication and failure-to-rescue rate. We then assessed the ranking hospitals by combining three indicators and using aggregated information to provide better benchmark learning. Materials and methods: This study use inpatient claims data set to compare hospital outcome rankings for three different measure of quality of care: hospital death, complication and failure-to-rescue. Results: For 41 hospitals of CABG and 84 hospitals of PTCA, the correlation between hospital rankings based on age-adjusted mortality rate and patient-risk-adjusted mortality rate were high correlations (CABG, r=.99; PTCA, r=.98). A similarly high correlation was present between the patient-risk-adjusted mortality and FTR rate (CABG, r=.80; PTCA, r=.87). There were moderate correlations between patient-risk-adjusted complication and mortality (CABG, r=.62; PTCA, r=.63). Conclusions: The findings of this study indicate that the correlation between failure-to-rescue and patient-risk-adjusted mortality rate was not as high as expected. One of the possible explanations was that many severity of illness information were not available in claims data. Studies using medical record to verify the validity of failure-to-rescue concept are needed. However, the classification of hospitals according to combined information could provide useful information for benchmark learning.