An Evaluation of Generic Screens for Poor Quality of Hospital Care on a General Medicine Service

In this study, 675 general medicine admissions at a university teaching hospital were reviewed to evaluate six potential generic quality screens: 1) in-hospital death; 2) 28-day early readmission; 3) low patient satisfaction; 4) worsening severity of illness (as determined by an increase in Laboratory Acute Physiology and Chronic Health Evaluation APACHE-L); and 5) deviations from expected hospital length of stay; and 6) expected ancillary resource use. The quality of care for a stratified random sample of admissions were evaluated using structured implicit review (inter-rater reliability, Kappa=0.5). Patients who died in-hospital were substantially more likely than those who were discharged alive to be rated as having had substandard care (30% vs. 10%; P<0.001). In contrast, cases who had subsequent early readmissions did not have poorer quality ratings. Similarly, lower patient satisfaction was not associated with poorer ratings of technical process of care. Cases with lower-than-expected ancillary resource use (case-mix adjusted for diagnosis-related group) were more likely to be rated as having received substandard care than those with higher-than-expected resource use (16% vs. 6%; P<0.05), and there was a similar trend for cases with shorter than expected length of stays. Associations between worsening severity of illness, as determined by APACHE-L scores, and quality were confounded because such patients were more likely to have died in-hospital. When deaths were excluded from the analysis, we found no association between increases in APACHE-L scores during the hospital course and quality of care. It was found that in-hospital death and lower-than-expected ancillary resource use were associated with poorer implicit quality ratings, but that early readmission, lower patient satisfaction, and increases in APACHE-L scores were not. Quality screens, such as early readmissions, should be critically evaluated before being used administratively

Family medicine · Health care · Kappa · Patient satisfaction · Stratified sampling · Emergency Medicine · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Medicine · Nursing · Patient Satisfaction in Healthcare

• Can Early Re-Admission Rates Accurately Detect Poor-Quality Hospitals

  Timothy P Hofer, Rodney A Hayward•Medical Care•1995

  Añadir item

• Selecting Disease-Outcome Pairs for Monitoring the Quality of Hospital Care

  Nelda P Wray, Carol M Ashton et al.•Medical Care•1995

  Añadir item

• Structured Implicit Review

  Marjorie L Pearson, Jan L Lee et al.•Medical Care•2000

  Añadir item

• Identifying Poor-Quality Hospitals

  Timothy P Hofer, Rodney A Hayward•Medical Care•1996

  Añadir item

• Estimation of Excess Risk of Readmission to Hospital After an Index Inpatient Separation

  Kate J Brameld, Kate Brameld et al.•Medical Care•2003

  Añadir item

• Hospital Readmissions and Quality of Care

  Joel S Weissman, John Z Ayanian et al.•Medical Care•1999

  Añadir item

• A New Casemix Adjustment Index for Hospital Mortality Among Patients With Congestive Heart Failure

  Carisi A Polanczyk, Luís Eduardo Paim Rohde et al.•Medical Care•1998

  Añadir item

• Validation of the Potentially Avoidable Hospital Readmission Rate as a Routine Indicator of the Quality of Hospital Care

  Patricia Halfon, Yves Eggli et al.•Medical Care•2006

  Añadir item

• The Association Between the Quality of Inpatient Care and Early Readmission

  Carol M Ashton, Carol M Ashton Carol M Ashton et al.•Medical Care•1997

  Añadir item

• A conceptual framework for the study of early readmission as an indicator of quality of care

  Open Access•Carol M Ashton, Naomi R Wray et al.•Social Science & Medicine•1996

  Añadir item

• Apache-L

  Laurence F McMahon, Rodney A Hayward et al.•Medical Care•1992

  Añadir item