A Report Card for Report Cards
Authors: A. Russell Localio
Journal: Annals of Internal Medicine (1995)

Editorials15 November 1995A Report Card for Report CardsA. Russell Localio, JD, MPH, MS and Bruce H. Hamory, MDA. Russell Localio, JD, MPH, MSPennsylvania State University College of Medicine Hershey, PA 17033Search for more papers by this author and Bruce H. Hamory, MDPennsylvania State University College of Medicine Hershey, PA 17033Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-10-199511150-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Almost daily, we hear about the effects—present and predicted—of managed care on health in the United States. The ability of those who purchase or “manage” care to compare the performances of individual physicians and hospitals is dependent on systems that can effectively compare outcomes for different types of patients across physicians and hospitals. In this issue, Iezzoni and colleagues [1] show that four of the computer-based systems marketed to meet this need give different answers about severity of illness for the same patients.The problems highlighted by Iezzoni and colleagues might well be worse than the study indicates. First, these ...References1. Iezzoni LI, Ash AS, Shwartz M, Daley J, Hughes JS, Mackiernan YD. Predicting who dies depends on how severity is measured. Ann Intern Med. 1995; 123:763-70. Google Scholar2. Ross NP, Black CD, Roos LL, Tate RB, Carriere KC. A populationbased approach to monitoring adverse outcomes of medical care. Med Care. 1995; 33:127-38. Google Scholar3. Miller MG, Miller LS, Fireman B, Black SB. Variation in practice for discretionary admissions. Impact on estimates of quality of hospital care. JAMA. 1994; 271:1493-8. Google Scholar4. Rubin HR, Wu AW. The risk of adjustment [Editorial]. Med Care. 1992; 30:973-5. Google Scholar5. McNeil BJ, Pedersen SH, Gatsonis C. Current issues in profiling quality of care. Inquiry. 1992; 29:298-307. Google Scholar6. Altman DG, Goodman SN. Transfer of technology from statistical journals to the biomedical literature. JAMA. 1994; 272:129-32. Google Scholar7. Kolata G. New frontier in research: mining patient records. The New York Times. 1994 Aug 9; 143:A21(col 6). Google Scholar8. Gibson RF, Haug PJ. An automated Computerized Severity Index. In: Ozbolt JG, ed. Proceedings—the Annual Symposium on Computer Applications in Medical Care. 1994:332-6. Google Scholar9. Moses LE. The evaluation of hospital death rates [Editorial]. JAMA. 1986; 255:2801. Google Scholar10. Kassirer JP. The use and abuse of practice profiles [Editorial]. N Engl J Med. 1994; 330:634-6. Google Scholar11. Wu AW. The measure and mismeasure of hospital quality: appropriate risk-adjustment methods in comparing hospitals [Editorial]. Ann Intern Med. 1995; 122:149-50. Google Scholar12. American College of Physicians. The oversight of medical care: a proposal for reform. Ann Intern Med. 1994; 120:423-31. Google Scholar13. Selker HP. Systems for comparing actual and predicted mortality rates: characteristics to promote cooperation in improving hospital care. Ann Intern Med. 1993; 118:820-2. Google Scholar14. Feinstein AR. Para-analysis, faute de mieux, and the perils of riding on a data barge. J Clin Epidemiol. 1989; 42:929-35. Google Scholar15. Leap of faith over the data tap [Editorial]. Lancet. 1995; 345:1449-51. Google Scholar16. Hamilton RA. FDA examining computer diagnosis. FDA Consumer Magazine [serial online: http://www.fda.gov/fdac/features/795_compdiag. html]; 1995 Sept:29. Google Scholar17. Gostin LO, Widiss AI. What's wrong with the ERISA vacuum? Employers' freedom to limit health care coverage provided by risk retention plans. JAMA. 1993; 269:2527-32. Google Scholar18. O'Neil P. Protecting ERISA health care claimants: Practical assessment of a neglected issue in health care reform. Ohio State Law Journal. 1994; 55:723-80. Google Scholar Author, Article, and Disclosure InformationAffiliations: Pennsylvania State University College of Medicine Hershey, PA 17033Corresponding Author: A. Russell Localio, JD, MPH, MS, Center for Biostatistics and Epidemiology, Pennsylvania State University College of Medicine, P.O. Box 850, Hershey, PA 17033-0850.Current Author Addresses: Dr. Localio: Center for Biostatistics and Epidemiology, Pennsylvania State University College of Medicine, P.O. Box 850, Hershey, PA 17033-0850. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPredicting Who Dies Depends on How Severity Is Measured: Implications for Evaluating Patient Outcomes Lisa I. Iezzoni , Arlene S. Ash , Michael Shwartz , Jennifer Daley , John S. Hughes , and Yevgenia D. Mackiernan Metrics Cited byHow you look determines what you find: severity of illness and variation in blood transfusion for hip fractureEvaluation of Acute Physiology and Chronic Health Evaluation III predictions of hospital mortality in an independent databaseCaveat Doctor: How to Analyze Claims-Based Report CardsReaction and response 15 November 1995Volume 123, Issue 10Page: 802-803KeywordsAlgorithmsHealth careHospitalizationsInformation technologyMortalityMotivationPatientsSoftware toolsStatistical methodsSurgery Issue Published: 15 November 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...