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Adjusted hospital death rates: A potential screen for quality of medical care

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  • Dubois, R.W.
  • Brook, R.H.
  • Rogers, W.H.

Abstract

Increased economic pressure on hospitals has accelerated the need to develop a screening tool for identifying hospitals that potentially provide poor quality care. Based upon data from 93 hospitals and 205,000 admissions, we used a multiple regression model to adjust the hospitals crude death rate. The adjustment process used age, origin of patient from the emergency department or nursing home, and a hospital case mix index based on DRGs (diagnostic related groups). Before adjustment, hospital death rates ranged from 0.3 to 5.8 per 100 admissions. After adjustment, hospital death ratios ranged from 0.36 to 1.36 per 100 (actual death rate divided by predicted death rate). Eleven hospitals (12 per cent) were identified where the actual death rate exceeded the predicted death rate by more than two standard deviations. In nine hospitals (10 per cent), the predicted death rate exceeded the actual death rate by a similar statistical margin. The 11 hospitals with higher than predicted death rates may provide inadequate quality of care or have uniquely ill patient populations. The adjusted death rate model needs to be validated and generalized before it can be used routinely to screen hospitals. However, the remaining large differences in observed versus predicted death rates lead us to believe that important differences in hospital performance may exist.

Suggested Citation

  • Dubois, R.W. & Brook, R.H. & Rogers, W.H., 1987. "Adjusted hospital death rates: A potential screen for quality of medical care," American Journal of Public Health, American Public Health Association, vol. 77(9), pages 1162-1167.
  • Handle: RePEc:aph:ajpbhl:1987:77:9:1162-1167_0
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    Cited by:

    1. Pallotti, Francesca & Lomi, Alessandro, 2011. "Network influence and organizational performance: The effects of tie strength and structural equivalence," European Management Journal, Elsevier, vol. 29(5), pages 389-403.
    2. repec:ebl:ecbull:v:9:y:2006:i:4:p:1-13 is not listed on IDEAS
    3. Paolo Berta & Salvatore Ingrassia & Antonio Punzo & Giorgio Vittadini, 2016. "Multilevel cluster-weighted models for the evaluation of hospitals," METRON, Springer;Sapienza Università di Roma, vol. 74(3), pages 275-292, December.
    4. Pietro Giorgio Lovaglio, 2017. "Are quality indicators predictive of compensated injury claims?," Quality & Quantity: International Journal of Methodology, Springer, vol. 51(4), pages 1903-1919, July.
    5. Charles Hegji, 2006. "Correlates of hospital quality: a preliminary study," Economics Bulletin, AccessEcon, vol. 9(4), pages 1-13.
    6. Gowrisankaran, Gautam & Town, Robert J., 1999. "Estimating the quality of care in hospitals using instrumental variables," Journal of Health Economics, Elsevier, vol. 18(6), pages 747-767, December.
    7. Paolo Berta & Chiara Seghieri & Giorgio Vittadini, 2013. "Comparing health outcomes among hospitals: the experience of the Lombardy Region," Health Care Management Science, Springer, vol. 16(3), pages 245-257, September.

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