An evaluation of generic screens for poor quality of hospital care on a general medicine service.
In this study, 675 general medicine admissions at a university teaching hospital were reviewed to evaluate six potential generic quality screens: 1) in-hospital death; 2) 28-day early readmission; 3) low patient satisfaction; 4) worsening severity of illness (as determined by an increase in Laboratory Acute Physiology and Chronic Health Evaluation APACHE-L); and 5) deviations from expected hospital length of stay; and 6) expected ancillary resource use. The quality of care for a stratified random sample of admissions were evaluated using structured implicit review (inter-rate reliability, Kappa = 0.5). Patients who died in-hospital were substantially more likely than those who were discharged alive to be rated as having had substandard care (30% vs. 10%; P < 0.001). In contrast, cases who had subsequent early readmissions did not have poorer quality ratings. Similarly, lower patient satisfaction was not associated with poorer ratings of technical process of care. Cases with lower-than-expected ancillary resource use (case-mix adjusted for diagnosis-related group) were more likely to be rated as having received substandard care than those with higher-than-expected resource use (16% vs. 6%; P < 0.05), and there was a similar trend for cases with shorter than expected length of stays. Associations between worsening severity of illness, as determined by APACHE-L scores, and quality were confounded because such patients were more likely to have died in-hospital.(ABSTRACT TRUNCATED AT 250 WORDS)
Division of General Medicine, University of Michigan, Ann Arbor.
R A
RA
Hayward
A M
AM
Bernard
J S
JS
Rosevear
J E
JE
Anderson
L F
LF
McMahon
D000293:Adolescent; D000328:Adult; D000368:Aged; D000720:Ancillary Services, Hospital / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D017052:Hospital Mortality; D006785:Hospitals, University / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000145:classification*; D012720:Severity of Illness Index