caa a22 4500 397519192 CHVBK 20180308164628.0 cr unu---uuuuu 161202e199506 xx s 000 0 eng 10.1093/intqhc/7.2.81 doi (NATIONALLICENCE)oxford-10.1093/intqhc/7.2.81 Using Severity-adjusted Stroke Mortality Rates to Judge Hospitals [Elektronische Daten] [LISA I. IEZZONI, MICHAEL SHWARTZ, ARLENE S. ASH, JOHN S. HUGHES, JENNIFER DALEY, YEVGENIA D. MACKIERNAN] Mortality rates are commonly used to judge hospital performance. In comparing death rates across hospitals, it is important to control for differences in patient severity. Various severity tools are now actively marketed in the United States. This study asked whether one would identify different hospitals as having higher- or lower-than-expected death rates using different severity measures. We applied 11 widely-used severity measures to the same database containing 9407 medically-treated stroke patients from 94 hospitals, with 916 (9.7%) in-hospital deaths. Unadjusted hospital mortality rates ranged from 0 to 24.4%. For 27 hospitals, observed mortality rates differed significantly from expected rates when judged by one or more, but not all 11, severity methods. The agreement between pairs of severity methods for identifying the worst 10% or best 50% of hospitals was fair to good. Efforts to evaluate hospital performance based on severity-adjusted, in-hospital death rates for stroke patients are likely to be sensitive to how severity is measured. © 1995 Elsevier Science Ltd Articles nationallicence Mortality rates nationallicence severity nationallicence hospital quality nationallicence IEZZONI LISA I. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, The Charles A. Dana Research Institute, and The Harvard-Thorndike Laboratory Boston, MA, USA aut SHWARTZ MICHAEL Health Care Management Program and Operations Management Department, School of Management, Boston University Boston, MA, USA aut ASH ARLENE S. Health Care Research Unit, Section of General Internal Medicine, Evans Memorial Department of Clinical Research and Medicine, Boston University Medical Center Boston, MA, USA aut HUGHES JOHN S. Department of Medicine, West Haven Veterans Affairs Medical Center West Haven, CT, USA aut DALEY JENNIFER Health Services Research and Development, Department of Medicine, Brockton/West Roxbury Veterans Affairs Medical Center West Roxbury, MA, USA aut MACKIERNAN YEVGENIA D. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, The Charles A. Dana Research Institute, and The Harvard-Thorndike Laboratory Boston, MA, USA aut International Journal for Quality in Health Care Oxford University Press 7/2(1995-06), 81-94 1353-4505 7:2<81 1995 7 intqhc https://doi.org/10.1093/intqhc/7.2.81 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/intqhc/7.2.81 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- IEZZONI LISA I. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, The Charles A. Dana Research Institute, and The Harvard-Thorndike Laboratory Boston, MA, USA aut NATIONALLICENCE 700 1- SHWARTZ MICHAEL Health Care Management Program and Operations Management Department, School of Management, Boston University Boston, MA, USA aut NATIONALLICENCE 700 1- ASH ARLENE S. Health Care Research Unit, Section of General Internal Medicine, Evans Memorial Department of Clinical Research and Medicine, Boston University Medical Center Boston, MA, USA aut NATIONALLICENCE 700 1- HUGHES JOHN S. Department of Medicine, West Haven Veterans Affairs Medical Center West Haven, CT, USA aut NATIONALLICENCE 700 1- DALEY JENNIFER Health Services Research and Development, Department of Medicine, Brockton/West Roxbury Veterans Affairs Medical Center West Roxbury, MA, USA aut NATIONALLICENCE 700 1- MACKIERNAN YEVGENIA D. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, The Charles A. Dana Research Institute, and The Harvard-Thorndike Laboratory Boston, MA, USA aut NATIONALLICENCE 773 0- International Journal for Quality in Health Care Oxford University Press 7/2(1995-06), 81-94 1353-4505 7:2<81 1995 7 intqhc Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford