The objective of this study was to assess the merit of multi-outcome measurements on the evaluation of quality of care, comparing different health care providers. We performed a cross-sectional study in 3 medical centers. Three hundred three patients undergoing surgical repair of traumatic femoral neck fracture were included. Trained nurses gathered data by patient and proxy interview and by chart abstraction. Multivariate analysis was performed to obtain an explanatory model for each outcome. Then, the additional contribution of each of the centers to the explanatory power of the model was examined. The outcomes were mortality, functional capacity, post-operative complications, and length of stay. Explanatory variables included were sociodemographic details, comorbidity indices, preoperative functional capacity, depression, and cognition. The results demonstrated that center A was a "good" outlier for mortality rate but, in contrast, was a "bad" outlier for complication rate and length of stay. Center B was a "bad" outlier for functional capacity but a "good" outlier for length of stay. We conclude that outcome studies for quality assurance programs should include all relevant outcomes, as the assumption that one major outcome may be representative for quality of care assessment may be misleading.
Get full access to this article
View all access options for this article.
References
1.
Hannan EL, Kilburn H Jr, O'Donnell JF, et al.Adult open heart surgery in New York State: an analysis of risk factors and hospital mortality rates. J Am Med Assoc1990;264:2768-2774.
2.
Hannan EL, Kilburn H, Racz M, et al.Improving the outcomes of coronary artery bypass surgery in New York State. J Am Med Assoc1994;271:761-766.
3.
Williams SV, Nash DB, Goldfarb N. Differences in mortality from coronary artery bypass surgery at five teaching hospitals. J Am Med Assoc1991;266:810-815.
4.
O'Connnor GT, Plume SK, Olmstead EM, et al.A regional prospective study of in hospital mortality associated with coronary artery bypass grafting. J Am Med Assoc1991;266:803-809.
5.
Localio AR, Hamory BH, Sharp TJ, et al.Comparing hospital mortality in adult patients with pneumonia. Ann Intern Med1995;122:125-132.
6.
Rosen AK, Geraci JM, Ash AS, et al.Postoperative adverse events of common surgical procedure in the medicare population. Med Care1992;30:753-765.
7.
Spector WD, Katz S, Murphy JB, et al.The hierarchial relationship between activities of daily living and instrumental activities of daily living. J Chron Dis1987;40:481-489.
8.
Guttman LA. A basis for scaling qualitative data. Am Sociol Rev1944;91:139-150.
9.
Charlson ME, Pompei P, Ales KL, et al.A new method of classifying prognostic comorbidity in longitudinal studies, development and validation. J Chron Dis1987;40:373-383.
10.
Health Care Financing Administration, Office of Medical Review, Health Standards and Quality Bureau. Medicare Hospital Mortality Information Technical Appendix. Baltimore, MD: Health Care Financing Administration, 1989.
11.
Radloff LS. The CES-Dscale: a self-report depression scale for research in the general population. Appl Psychol Meas1977;3: 385-401.
12.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res1975;12:189-198.
13.
Green J, Passman LJ, Wintfeld N. Analyzing hospital mortality. The consequences of diversity in patient mix. J Am Med Assoc1991;265:1849-1853.
14.
Wu AW. The measure and mismeasure of hospital quality: appropriate risk adjustment methods in comparing hospitals. Ann Intern Med1995;122:149-150.
15.
McAleese P, Odling-Smee W. The effect of complications on length of stay. Ann Surg1994;6:740-744.
16.
O'Connor GT, Plume SK, Olmstead EM. A regional prospective study of in-hospital mortality associated with coronary artery bypass graft. J Am Med Assoc1991;266:803-809.
