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To evaluate historical and current risk adjustment practices for hospital death rates and their implications for quality assessment.

November 19, 1997JAMA

The risks of risk adjustment

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To evaluate historical and current risk adjustment practices for hospital death rates and their implications for quality assessment.
Analyzed severity measures used for comparing risk-adjusted hospital death rates in various regions.
Included data from 10,000+ patients admitted for conditions like myocardial infarction and stroke.
Employed logistic regression to predict in-hospital death and compared odds ratios across severity measures.
Disease Staging had the highest c statistic of 0.86 for predicting death in acute myocardial infarction patients.
Different severity measures showed inconsistent predictions about hospital performance, affecting the identification of high- and low-mortality hospitals.
Agreement between severity-adjusted and unadjusted death rates was often better than between severity measures.

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Article reviews various risk adjustment methods for assessing mortality rates in hospitals, highlighting variability in quality measures.

Lisa I. Iezzoni (1997) studied this question.

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