Author:
Pitches David W,Mohammed Mohammed A,Lilford Richard J
Abstract
Abstract
Background
Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care.
Methods
We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria.
Results
From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51%) but the remainder showed no correlation (16/51 31%) or a paradoxical correlation (9/51 18%).
Conclusion
The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.
Publisher
Springer Science and Business Media LLC
Reference74 articles.
1. Jacobson B, Mindell J, McKee M: Hospital mortality league tables : Question what they tell you – and how useful they are. British Medical Journal. 326 (7393): 777-778. 10.1136/bmj.326.7393.777. 2003 April 12
2. Barts and the London NHS Trust. Trust "has second lowest mortality rate in the NHS", 28 February 2006. (accessed 5 June 2006), [http://www.bartsandthelondon.org.uk/news/story.asp?id=1141§ion_id=9]
3. The Leapfrog Group. (accessed 5 February 2006), [http://www.leapfroggroup.org/home]
4. US News and World Report – Best Hospitals 2006. (accessed 5 February 2006), [http://www.usnews.com/usnews/health/best-hospitals/tophosp.htm]
5. Dr. Foster Good Hospital Guide. (accessed 5 February 2006), [http://www.drfoster.co.uk/ghg/]
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