Adequacy of national mortality data for internal hospital use: a case study.
OBJECTIVE
The study investigated the value of using national or regional data bases to examine care in a specific hospital.


METHODS
The following data sources were included: (1) the results of the 1992 HCFA analysis of the index hospital for patients hospitalized in fiscal year 1990; (2) the 1989 Medicare Provider Analysis and Review (MEDPAR) file; and (3) clinical information from bypass surgery patients in Wisconsin and from the index hospital.


RESULTS
The assessment of the mortality rates in the index hospital for all conditions combined and for CABG patients differed depending on what data base was used and how the data were analysed. The national data were most useful in establishing that the coding practices for all patients and the mortality rate for intra-aortic balloon patients differed between the index hospital and other hospitals. The regional clinical data base for bypass surgery patients was used to establish that the high mortality rates for intra-aortic balloon patients were due to patient selection.


CONCLUSIONS
National claims data must be analysed carefully before applying results to an individual hospital. Even a careful analysis is more for raising questions about care at a specific hospital rather than for reaching definitive conclusions.
Hartz
A J
AJ
Division of Family & Community Medicine, Medical College of Wisconsin, Milwaukee 53266, USA.
Kuhn
E M
EM
Yuan
Z
Z
Bailey
R C
RC
Rimm
A A
AA
D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S.; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality; D016208:Databases, Factual; D004282:Documentation / Q000379:methods; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005544:Forecasting; D017052:Hospital Mortality; D006801:Humans; D007345:Insurance Claim Review; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States; D014922:Wisconsin / Q000453:epidemiology