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【社会人文】美国普通医院的医疗死亡率偏高
Average or Poor Hospitals Linked to Excess Medicare Mortality
By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
October 16, 2006
GOLDEN, Colo., Oct. 16 -- More than 300,000 Medicare patients died from 2003 to 2005 because they were hospitalized in institutions that were average or poor on report cards issued today by HealthGrades, a for-profit health care quality rating service here. Action Points
Explain to interested patients that the HealthGrades report is based on a retrospective analysis of Medicare records.
Point out that individual hospital quality results are available at www.healthgrades.com. Some of the information is available free and extensive specific hospital reports are available for a fee.
Encourage patients who are interested in purchasing HealthGrades to discuss hospital rating reports with a physician.
HealthGrades, which evaluated Medicare records from 40.6 million hospitalizations during those years, estimated that last year a patient treated at a hospital that received five stars, the stellar rating, had a 69% lower chance of dying than a similar patient treated at a hospital rated one-star, the poorest, and a 49% lower chance of death than if treated at an average hospital (three stars).
The rating service evaluated 5,000 hospitals. A HealthGrades spokesperson said that "roughly 15%" of the hospitals received five-stars in the 28 diagnoses and procedure categories included in the report.
According to the report, if all hospitals that treat Medicare patients performed as well as HealthGrades' five-star rated best hospitals, "302,403 Medicare lives could have potentially been saved from 2003 to 2005."
Half of the excess Medicare deaths occurred in patients diagnosed with heart failure, community acquired pneumonia, sepsis, and respiratory failure treated in hospitals that received a poor rating for treating those conditions, according to HealthGrades.
Additional findings:
Fewer Medicare patients died in hospitals in 2005 than in 2003, but the degree of improvement in mortality rate varied greatly by diagnosis.
Compared with hospitals rated average (three-star), the risk-adjusted mortality rates at five-star hospitals improved 19% across all three years (2003 to 2005).
A typical Medicare patient had about a 49% lower risk of dying in a top rate hospital last year than in hospital that was rated average by HealthGrades.
HealthGrades awards five stars for hospitals that performed significantly better than predicted, three for those that performed as predicted (average), and one star for those that performed significantly worse than predicted.
The ratings are issued on the basis of risk-adjusted mortality rates and complication rates. There are 18 mortality-rating categories: were abdominal aortic aneurysm repair, acute myocardial infarction, atrial fibrillation, bowel obstruction, chronic obstructive pulmonary disease, community acquired pneumonia, coronary bypass surgery, coronary interventional procedures, diabetic acidosis and coma, GI bleed, GI surgery and procedures, heart failure, pancreatitis, pulmonary embolism, respiratory failure, sepsis, stroke and valve replacement surgery.
There are categories for complication rates: back and neck surgery (except spinal fusion), carotid endarterectomy, cholecystectomy, gastrointestinal procedures and surgeries, hip fracture repair, partial hip replacement, peripheral vascular bypass, prostatectomy, total hip replacement, and total knee replacement.
For 26 of the 28 categories, HealthGrades used a multivariate logistic regression-based rating model that included predicted mortality, compared the predicted mortality to actual mortality, and tested to determine whether the difference between predicted and actual mortality was significant. Hospitals with fewer than 30 cases in a specific diagnostic category over the three-year period were removed from the analysis.
Two categories -- respiratory failure and gastrointestinal procedures and surgeries -- were rated using software developed by the 3M Corporation called APR-DRGs that were designed to factor in severity of illness and mortality risk across these two specific diagnosis groups.
HealthGrades, which rates nursing homes and physicians as well as hospitals, sells its quality rating information to employers, health plans, hospitals, and consumers. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 美国普通医院的医疗死亡率偏高
Peggy Peck编辑今天报道
宾夕凡尼亚州医学院名誉退休的教授Zalman S. Agus攥稿
2006年10月16日
金报10月16日报道：2003年至2005年，30多万医疗保险病人死亡，因为他们住在条件一般或较差的医院。这些医院在卫生评分组的报告卡上，卫生评分组是为提高卫生保健利益而设的等级评定工作。
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作者:admin@医学,生命科学 2011-06-28 05:45
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