Explaining variations in hospital death rates: randomness, severity of illness, quality of care
Article Abstract:
Previous studies have demonstrated variations in hospital death rates, and since 1986 the Health Care Financing Administration (HCFA) has released an annual report of individual hospital death rates for Medicare patients. Variations in hospital death rate may be due to several factors, including age, sex, race, disease, severity of illness, and quality of care. Congestive heart failure and myocardial infarction patients from four acute-care US hospitals were studied to determine first, if hospitals with high death rates provide lower quality of care or treat more severely ill patients than hospitals with lower death rates; and second, if the probability of death is related to severity of illness and quality of care. Hospitals that had high mortality categorized by age, sex, race, and disease did not provide lower quality of care. More severe illness resulted in an increased probability of death, while better quality of care somewhat reduced the chance of death. HCFA has developed methods to target hospitals that provide lower quality of care; however, further improvements are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
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The appropriateness of use of percutaneous transluminal coronary angioplasty in New York State
Article Abstract:
A significant number of patients may undergo a percutaneous transluminal coronary angioplasty (PTCA) in New York State for uncertain indications (signs) of disease. PTCA is a procedure that uses a balloon catheter to clear blood vessels. It is used to treat patients suffering from different types of coronary artery disease. Among 1,306 patients who underwent a PTCA in New York State in 1990, 40% were suffering from chronic stable angina, 27% were suffering from unstable angina, 24% had suffered a heart attack and 6% had no symptoms at the time. Fifty-eight percent of the procedures were performed for appropriate symptoms and diagnoses (indications), 38% for uncertain indications and only 4% for inappropriate indications. The number of inappropriate procedures and number of uncertain procedures varied among the 15 different hospitals studied. The development of clinical guidelines for the use of PTCA may decrease the noticeably high number of procedures that are performed for uncertain indications.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1993
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