Comparing hospital mortality in adult patients with pneumonia: a case study of statistical methods in a managed care program

Article Abstract:

Evaluating the quality of hospital care by analyzing outcome data may result in erroneous findings depending on the statistical method used. One managed care program commissioned a report on quality of care in 22 hospitals, based partly on in-hospital mortality data. Researchers reassessed the findings pertaining to one diagnostic group: pneumonia in adult patients. Different statistical methods were employed to analyze the data and interpret the results. The managed care program report indicated that one hospital had a significantly higher death rate than the others. The re-analysis resulted in a different ranking among the hospitals, and showed that the hospital ranked worst in the report did not have a significantly different mortality rate. The re-analysis included computer simulations to detect the probability of error and comparison of the initial data with more recent data as an additional check.

Patient outcomes, Mortality, Pneumonia

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A report card for report cards

Article Abstract:

Systems that evaluate the performance of hospitals and other health care providers may also need evaluation. Research indicates that four systems currently in use to evaluate patient survival may give different predictions. Managed care providers, however, rely on information generated by these systems when making cost decisions about treatment or whether to include specific health providers in their plans. There may be flaws in the statistics used to generate these evaluations. However, these systems may help to make reporting of patient data more consistent. Members of the medical community need to educate themselves on the usefulness of these evaluations in order to better communicate its relevant information to patients. Current research should include periodic assessments of these evaluation tools and the results should appear in the current medical literature.

Medical care, Quality management, Medical care quality, Managed care plans (Medical care)

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The measure and mismeasure of hospital quality: appropriate risk-adjustment methods in comparing hospitals

Article Abstract:

Comparing hospitals by quality of care is a growing enterprise, but guidelines may be needed to ensure accurate reports. Mortality rates are often used in assessing hospital quality, but data must be adjusted to include variations in patient characteristics and the element of chance. One comparison of several hospitals for a managed care program was re-analyzed and shown to be flawed. The re-analysis suggested that the original comparison did not include the aspects of patient age or random variation, nor did it accurately assess the statistical significance of deviations from the average death rate. Since health-care consumers and employers are likely to be highly influenced by hospital comparisons, standard methodologies for assessing and reporting quality of care should be developed.

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