Measuring outcomes of hospital care using multiple risk-adjusted indexes

Using existing data sources, we developed three risk-adjusted measures of hospital quality: the risk-adjusted mortality index (RAMI), the risk-adjusted readmissions index (RARI), and the risk-adjusted complication index (RACI). We describe the construction and validation of each of these indexes. Af...

Full description

Saved in:
Bibliographic Details
Published in:Health services research 1991-10, Vol.26 (4), p.425-445
Main Authors: DesHarnais, S, McMahon, Jr, L F, Wroblewski, R
Format: Article
Language:English
Subjects:
Abstracting and Indexing as Topic
Comparative studies
Evaluation
Health care delivery
Health risk assessment
Health Services Research - methods
Hospital care
Hospital Mortality
Hospitalization
Hospitals
Hospitals - standards
Humans
Logistic Models
Medical statistics
Methods
Mortality
Outcome Assessment (Health Care) - methods
Patient Readmission - statistics & numerical data
Postoperative Complications - epidemiology
Quality of service
Ratings & rankings
Regression Analysis
Risk
Risk Factors
Statistical analysis
Statistics
United States - epidemiology
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Using existing data sources, we developed three risk-adjusted measures of hospital quality: the risk-adjusted mortality index (RAMI), the risk-adjusted readmissions index (RARI), and the risk-adjusted complication index (RACI). We describe the construction and validation of each of these indexes. After these measures were developed, we tested the relationships among the three indexes using a sample of 300 hospitals. Actual numbers of adverse events were observed for each hospital and compared to the number predicted by the RAMI, RARI, and RACI models. Then each hospital was ranked on each index. Our results showed that no relationship existed between a hospital's ranking on any one of these indexes and its ranking on the other two indexes. This result provides some evidence that no measure of quality should be used by itself to represent different aspects of the quality of hospital care. Adequate overall measures of hospital quality will need to include multiple measures in order to be credible and to reflect the complexity of hospital care. The findings suggest that consumers, payers, and policymakers cannot simply choose one hospitalwide measure, such as the mortality rate, to validly represent a hospital's performance: those hospitals with high rankings on their mortality rates do not necessarily rank high on their readmission rates or complication rates.
ISSN:0017-9124
1475-6773