The Measure and Mismeasure of Hospital Quality: Appropriate Risk-Adjustment Methods in Comparing Hospitals
Authors: Albert W. Wu
Journal: Annals of Internal Medicine (1995)

Editorials15 January 1995The Measure and Mismeasure of Hospital Quality: Appropriate Risk-Adjustment Methods in Comparing HospitalsAlbert W. Wu, MD, MPHAlbert W. Wu, MD, MPHThe Johns Hopkins University; Baltimore, MD 21205-1901Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-2-199501150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hospital quality assessment is a growth industry. Initial attention has focused on mortality rates as a measure of quality. Since the Medicare mortality rates were first released in 1986 [1], increasingly numerous and various parties have compiled actual and expected hospital mortality rates to motivate improvements in quality and to compare hospitals. The federal government, state governments, peer review organizations, private insurers, and hospital associations have been among those producing such assessments. Lately, large employers have also become interested in assessing hospital quality [2]. Concerned about the value they receive for dollars invested in employee health benefit packages, companies are ...References1. U.S. Health Care Financing Administration. Medicare Hospital Mortality Information. Washington, D.C.: U.S. Department of Health and Human Services, Health Care Financing Administration; 1987. Google Scholar2. Steinwachs DM, Wu AW, Skinner EA. Outcomes management: how will it work? Health Affairs. 1994; 13:153-62. Google Scholar3. Localio AR, Hamory BH, Sharp TJ, Weaver SL, TenHave TR, Landis JR. Comparing hospital mortality in adult patients with pneumonia: a case study of statistical methods in a managed care program. Ann Intern Med. 1994; 122:125-32. Google Scholar4. Berwick DM, Wald DL. Hospital leaders' opinions of the HCFA mortality data. JAMA. 1990; 263:247-9. Google Scholar5. Luft HS, Garnick DW, Mark DH, Peltzman DJ, Phibbs CS, Lichtenberg E, et al. Does quality influence choice of hospital? JAMA. 1990; 263:2899-906. Google Scholar6. Green J, Passman LJ, Wintfeld N. Analyzing hospital mortality. The consequences of diversity in patient mix. JAMA. 1991; 265:1849-53. Google Scholar7. Shapiro MF, Park RE, Keesey J, Brook RH. The effect of alternative case-mix adjustments on mortality differences between municipal and voluntary hospitals in New York City. Health Serv Res. 1994:29:95-112. Google Scholar8. Park RE, Brook RH, Kosecoff J, Keesey J, Rubenstein L, Keeler E, et al. Explaining variations in hospital death rates. Randomness, severity of illness, qualty of care. JAMA. 1990; 264:484-90. Google Scholar9. Brewster AC, Karlin BG, Hyde LA, Jacobs CM, Bradbury RC, Chae YM. MEDISGRPS: a clinically based approach to classifying hospital patients at admission. Inquiry. 1985; 22:377-87. Google Scholar10. Selker HP. Systems for comparing actual and predicted mortality rates: characteristics to promote cooperation in improving hospital care (Editorial). Ann Intern Med. 1993; 118:820-2. Google Scholar11. Blumberg MS. Biased estimates of expected acute myocardial infarction mortality using MedisGroups admission severity groups. JAMA. 1991; 265:2965-70. Google Scholar12. Iezzoni LI, Ash AS, Coffman GA, Moskowitz MA. Admission and mid-stay MedisGroups scores as predictors of death within 30 days of hospital admission. Am J Public Health. 1991; 81:74-8. Google Scholar13. Fine MJ, Singer DE, Hanusa BH, Lave JR, Kapoor WN. Validation of a pneumonia prognostic index using the MedisGroups Comparative Hospital Database. Am J Med. 1993; 94:153-9. Google Scholar14. Rubin HR. For what should hospitals be accountable? Joint Commission Journal on Quality Improvement. 1994; 20:411-8. Google Scholar Author, Article, and Disclosure InformationAuthors: Albert W. Wu, MD, MPHAffiliations: The Johns Hopkins University; Baltimore, MD 21205-1901Corresponding Author: Albert W. Wu, MD, MPH, Health Services Research and Development Center, Department of Health Policy and Management, The Johns Hopkins University, School of Hygiene and Public Health, 624 North Broadway, Baltimore, MD 21205-1901. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparing Hospital Mortality in Adult Patients with Pneumonia: A Case Study of Statistical Methods in a Managed Care Program A. Russell Localio , Bruce H. Hamory , Tonya J. Sharp , Susan L. Weaver , Thomas R. TenHave , and J. 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