title: Variations in the Quality of Care at Large Public Hospitals in Beijing, China: A Condition-Based Outcome Approach.
abstract: BACKGROUND
  Public hospitals deliver over ninety percent of all outpatient and inpatient services in China. Their quality is graded into three levels (A, B, and C) largely based on structural resources, but empirical evidence on the quality of process and outcome of care is extremely scarce. As expectations for quality care rise with higher living standards and cost of care, such evidence is urgently needed and vital to improve care and to inform future health reforms.
  
  
  METHODS
  We compiled and analyzed a multicenter database of over 4 million inpatient discharge summary records to provide a comprehensive assessment of the level and variations in clinical outcomes of hospitalization at 39 tertiary hospitals in Beijing. We assessed six outcome measures of clinical quality: in-hospital mortality rates (RSMR) for AMI, stroke, pneumonia and CABG, post-procedural complication rate (RS-CR), and failure-to-rescue rate (RS-FTR). The measures were adjusted for pre-admission patient case-mix using indirect standardization method with hierarchical linear mixed models.
  
  
  RESULTS
  We found good overall quality with large variations by hospital and condition (mean/range, in %): RSMR-AMI: 6.23 (2.37-14.48), RSMR-stroke: 4.18 (3.58-4.44), RSMR-pneumonia: 7.78 (7.20-8.59), RSMR-CABG: 1.93 (1.55-2.23), RS-CR: 11.38 (9.9-12.88), and RS-FTR: 6.41 (5.17-7.58). Hospital grade was not significantly associated with any risk-adjusted outcome measures.
  
  
  CONCLUSIONS
  Going to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources. A hospital report card with some outcome measures of quality would provide valuable information to patients in choosing providers, and for regulators to identify gaps in health care quality. Reducing the variations in clinical practice and patient outcome should be a focus for policy makers in the next round of health sector reforms in China.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Ye
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Yuanli
authors.initials: Y
authors.lastname: Liu
authors.affiliation: National Institute for Hospital Administration, National Health and Family Planning Commission, Beijing, The People's Republic of China.
authors.forename: Ting
authors.initials: T
authors.lastname: Shu
authors.affiliation: National Institute for Hospital Administration, National Health and Family Planning Commission, Beijing, The People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: National Institute for Hospital Administration, National Health and Family Planning Commission, Beijing, The People's Republic of China.
authors.forename: Minghui
authors.initials: M
authors.lastname: Liang
mesh_terms: D002681:China; D006779:Hospitals, Public / Q000592:standards*; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies