Using administrative data to screen hospitals for high complication rates.

TLDR

Medicare’s Peer Review Organizations are mandated to collaborate with hospitals to improve patient outcomes. The study seeks to determine which hospitals should be targeted for quality improvement. Using 1988 California discharge data, the authors identified hospitals with higher‑than‑expected complication rates across six adult medical‑surgical populations. Complication rates were generally correlated across clinical areas but less so between medical and surgical cases; higher rates were linked to larger, teaching hospitals, open‑heart surgery, and extensive diagnosis coding, yet were not significantly associated with mortality, indicating that hospital selection for review depends on the chosen identification method.

Abstract

Medicare's Peer Review Organizations (PROs) now are required to work with hospitals to improve patient outcomes. Which hospitals should be targeted? We used 1988 California discharge data to identify hospitals with higher-than-expected rates of complications in six adult, medical-surgical patient populations. Relative hospital complication rates generally were correlated across clinical areas, although correlations were lower between medical and surgical case types. Higher relative rates of complications were associated with larger size, major teaching facilities, and provision of open heart surgery, as well as with coding more diagnoses per case. Complication rates generally were not related significantly to hospital mortality rates as calculated by the Health Care Financing Administration. Different hospitals may be chosen for quality review depending on the method used to identify poor outcomes.