The Hospital Compare Mortality Model and the Volume-Outcome Relationship

被引:76
作者
Silber, Jeffrey H. [1 ,2 ,3 ,4 ,5 ]
Rosenbaum, Paul R. [5 ,6 ]
Brachet, Tanguy J. [1 ,2 ,5 ]
Ross, Richard N. [1 ]
Bressler, Laura J. [1 ]
Even-Shoshan, Orit [1 ,5 ]
Lorch, Scott A. [1 ,5 ,7 ]
Volpp, Kevin G. [4 ,5 ,8 ,9 ]
机构
[1] Childrens Hosp Philadelphia, Ctr Outcomes Res, Philadelphia, PA 19104 USA
[2] Univ Penn, Sch Med, Dept Anesthesiol & Crit Care, Philadelphia, PA 19104 USA
[3] Univ Penn, Sch Med, Dept Pediat, Philadelphia, PA 19104 USA
[4] Univ Penn, Wharton Sch, Dept Hlth Care Management, Philadelphia, PA 19104 USA
[5] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA
[6] Univ Penn, Wharton Sch, Dept Stat, Philadelphia, PA 19104 USA
[7] Childrens Hosp Philadelphia, Dept Pediat, Div Neonatol, Philadelphia, PA 19104 USA
[8] Vet Adm Hosp, Ctr Hlth Equ Res & Promot, Philadelphia, PA USA
[9] Univ Penn, Sch Med, Dept Med, Philadelphia, PA 19104 USA
基金
美国国家科学基金会;
关键词
Hospital Compare; mortality; acute myocardial infarction; random effects model; ACUTE MYOCARDIAL-INFARCTION; REPORT CARDS; HEALTH-CARE; QUALITY; SURVIVAL;
D O I
10.1111/j.1475-6773.2010.01130.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective We ask whether Medicare's Hospital Compare random effects model correctly assesses acute myocardial infarction (AMI) hospital mortality rates when there is a volume-outcome relationship. Data Sources/Study Setting Medicare claims on 208,157 AMI patients admitted in 3,629 acute care hospitals throughout the United States. Study Design We compared average-adjusted mortality using logistic regression with average adjusted mortality based on the Hospital Compare random effects model. We then fit random effects models with the same patient variables as in Medicare's Hospital Compare mortality model but also included terms for hospital Medicare AMI volume and another model that additionally included other hospital characteristics. Principal Findings Hospital Compare's average adjusted mortality significantly underestimates average observed death rates in small volume hospitals. Placing hospital volume in the Hospital Compare model significantly improved predictions. Conclusions The Hospital Compare random effects model underestimates the typically poorer performance of low-volume hospitals. Placing hospital volume in the Hospital Compare model, and possibly other important hospital characteristics, appears indicated when using a random effects model to predict outcomes. Care must be taken to insure the proper method of reporting such models, especially if hospital characteristics are included in the random effects model.
引用
收藏
页码:1148 / 1167
页数:20
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