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dc.contributor.authorIezzoni, Lisa I.
dc.contributor.authorAsh, Arlene S.
dc.contributor.authorShwartz, Michael
dc.contributor.authorDaley, Jennifer
dc.contributor.authorHughes, John S.
dc.contributor.authorMackiernan, Yevgenia D.
dc.date2022-08-11T08:10:41.000
dc.date.accessioned2022-08-23T17:16:59Z
dc.date.available2022-08-23T17:16:59Z
dc.date.issued1996-10-01
dc.date.submitted2010-07-01
dc.identifier.citationAm J Public Health. 1996 Oct;86(10):1379-87. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380647/pdf/amjph00521-0037.pdf">Link to article on publisher's site</a>
dc.identifier.issn0090-0036 (Linking)
dc.identifier.pmid8876505
dc.identifier.urihttp://hdl.handle.net/20.500.14038/47524
dc.description.abstractOBJECTIVES: This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method. METHODS: Data came from 100 acute care hospitals nationwide and 11880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in-hospital death. Observed-to-expected death rates and z scores were calculated with each severity measure for each hospital. RESULTS: Unadjusted mortality rates for the 100 hospitals ranged from 4.8% to 26.4%. For 32 hospitals, observed mortality rates differed significantly from expected rates for 1 or more, but not for all 10, severity measures. Agreement between pairs of severity measures on whether hospitals were flagged as statistical mortality outliers ranged from fair to good. Severity measures based on medical records frequently disagreed with measures based on discharge abstracts. CONCLUSIONS: Although the 10 severity measures agreed about relative hospital performance more often than would be expected by chance, assessments of individual hospital mortality rates varied by different severity-adjustment methods.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=8876505&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380647/pdf/amjph00521-0037.pdf
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAlgorithms
dc.subjectFemale
dc.subject*Hospital Mortality
dc.subjectHumans
dc.subjectInformation Systems
dc.subjectLength of Stay
dc.subjectLogistic Models
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMortality
dc.subjectMyocardial Infarction
dc.subject*Outcome Assessment (Health Care)
dc.subjectPredictive Value of Tests
dc.subjectProbability
dc.subject*Quality of Health Care
dc.subject*Severity of Illness Index
dc.subjectUnited States
dc.subjectBiostatistics
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleJudging hospitals by severity-adjusted mortality rates: the influence of the severity-adjustment method
dc.typeJournal Article
dc.source.journaltitleAmerican journal of public health
dc.source.volume86
dc.source.issue10
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/660
dc.identifier.contextkey1378806
html.description.abstract<p>OBJECTIVES: This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method.</p> <p>METHODS: Data came from 100 acute care hospitals nationwide and 11880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in-hospital death. Observed-to-expected death rates and z scores were calculated with each severity measure for each hospital.</p> <p>RESULTS: Unadjusted mortality rates for the 100 hospitals ranged from 4.8% to 26.4%. For 32 hospitals, observed mortality rates differed significantly from expected rates for 1 or more, but not for all 10, severity measures. Agreement between pairs of severity measures on whether hospitals were flagged as statistical mortality outliers ranged from fair to good. Severity measures based on medical records frequently disagreed with measures based on discharge abstracts.</p> <p>CONCLUSIONS: Although the 10 severity measures agreed about relative hospital performance more often than would be expected by chance, assessments of individual hospital mortality rates varied by different severity-adjustment methods.</p>
dc.identifier.submissionpathqhs_pp/660
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages1379-87


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