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. 2018 Apr 1;7(4):308-316.
doi: 10.15171/ijhpm.2017.94.

Measuring Hospital Performance Using Mortality Rates: An Alternative to the RAMR

Christine Pitocco  1 , Thomas R Sexton  1
Affiliations

Measuring Hospital Performance Using Mortality Rates: An Alternative to the RAMR

Christine Pitocco et al. Int J Health Policy Manag. .

Abstract

Background: The risk-adjusted mortality rate (RAMR) is used widely by healthcare agencies to evaluate hospital performance. The RAMR is insensitive to case volume and requires a confidence interval for proper interpretation, which results in a hypothesis testing framework. Unfamiliarity with hypothesis testing can lead to erroneous interpretations by the public and other stakeholders. We argue that screening, rather than hypothesis testing, is more defensible. We propose an alternative to the RAMR that is based on sound statistical methodology, easier to understand and can be used in large-scale screening with no additional data requirements.

Methods: We use an upper-tail probability to screen for hospitals performing poorly and a lower-tail probability to screen for hospitals performing well. Confidence intervals and hypothesis tests are not needed to compute or interpret our measures. Moreover, unlike the RAMR, our measures are sensitive to the number of cases treated.

Results: To demonstrate our proposed methodology, we obtained data from the New York State Department of Health for 10 Inpatient Quality Indicators (IQIs) for the years 2009-2013. We find strong agreement between the upper tail probability (UTP) and the RAMR, supporting our contention that the UTP is a viable alternative to the RAMR.

Conclusion: We show that our method is simpler to implement than the RAMR and, with no need for a confidence interval, it is easier to interpret. Moreover, it will be available for all hospitals and all diseases/conditions regardless of patient volume.

Keywords: Hospital Performance Measures; Mortality Rate; Risk Adjustment.

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References

    1. Centers for Medicare & Medicaid Services. Research, Statistics, Data & Systems. Historical. http://www.cms.gov. Accessed March 22, 2016. Published December 3, 2015.
    1. Center for Medicare and Medicaid Services. https://data.medicare.gov/. Accessed March 25, 2016.
    1. Your Hospital’s Safety Grade. Leapfrog Hospital Safety Grade website. http://www.hospitalsafetyscore.org/your-hospitals-safety-score/. Published October 2015.
    1. Bardach N, Hibbard JH, Dudley RA. Users of public reports of hospital quality: who, what, why and how? Agency for Healthcare Research and Quality; 2011.
    1. Hibbard JH, Stockard J, Tusler M. Does publicizing hospital performance stimulate quality improvement efforts? Health Aff (Millwood) 2003;22(2):84–94. - PubMed