Articles: outcome-assessment-health-care.
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Health services research · Oct 1991
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. After these measures were developed, we tested the relationships among the three indexes using a sample of 300 hospitals. ⋯ 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.
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As part of routine Quality Assurance (QA) activity in our Department, a quarterly audit of patient outcome after obstetric anaesthetic care is completed. Previously this consisted of a technical (criteria-based) audit and some assessment of patient satisfaction. The most recent audit was carried out by a volunteer providing a cost-effective and flexible means of data collection. ⋯ Technical details allow comparison to internal and published standards. PDO data provide a complementary means of assessing Structure, Process and Outcome. Thus, the audit permits internal and external evaluation of departmental activities and feedback of QA information necessary to a comprehensive QA program.
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This paper reports on the development and application of multiple risk-adjusted measures of hospital performance (mortality, readmission, complications). The indices are based on patient-level data so they can be aggregated at any level (hospital, specialty, physician), are easy to use and interpret by hospitals, and provide an inexpensive method for evaluating hospital performance using existing databases. This paper focuses on the development of practical applications of these measures in the quality improvement process.