title: Using administrative data to screen hospitals for high complication rates.
abstract: Medicare's Peer Review Organizations (PROs) now are required to work with hospitals to improve patient outcomes. Which hospitals should be targeted? We used 1988 California discharge data to identify hospitals with higher-than-expected rates of complications in six adult, medical-surgical patient populations. Relative hospital complication rates generally were correlated across clinical areas, although correlations were lower between medical and surgical case types. Higher relative rates of complications were associated with larger size, major teaching facilities, and provision of open heart surgery, as well as with coding more diagnoses per case. Complication rates generally were not related significantly to hospital mortality rates as calculated by the Health Care Financing Administration. Different hospitals may be chosen for quality review depending on the method used to identify poor outcomes.
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: L I
authors.initials: LI
authors.lastname: Iezzoni
authors.forename: J
authors.initials: J
authors.lastname: Daley
authors.forename: T
authors.initials: T
authors.lastname: Heeren
authors.forename: S M
authors.initials: SM
authors.lastname: Foley
authors.forename: J S
authors.initials: JS
authors.lastname: Hughes
authors.forename: E S
authors.initials: ES
authors.lastname: Fisher
authors.forename: C C
authors.initials: CC
authors.lastname: Duncan
authors.forename: G A
authors.initials: GA
authors.lastname: Coffman
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D014487:Centers for Medicare and Medicaid Services, U.S.; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D003953:Diagnosis-Related Groups; D005260:Female; D006302:Health Services Research; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010067:Ownership; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011366:Professional Review Organizations; D012307:Risk Factors; D014481:United States