Journal of Preventive Medicine and Public Health
- Volume 34 Issue 3
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- Pages.244-252
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- 2001
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- 1975-8375(pISSN)
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- 2233-4521(eISSN)
Severity Measurement Methods and Comparing Hospital Death Rates for Coronary Artery Bypass Graft Surgery
관상동맥우회술의 중증도 측정과 병원 사망률 비교에 관한 연구
- Ahn, Hyung-Sik (Department of Preventive Medicine, College of Medicine, Korea University) ;
- Shin, Young-Soo (Department of Health Policy and Management, Seoul National University College of Medicine) ;
- Kwon, Young-Dae (Department of Health Services Management, Kyunghee University)
- Published : 2001.09.01
Abstract
Objective : Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. Methods : The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHE III and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. Results : The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and
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