USING ADMINISTRATIVE DATA TO SCREEN HOSPITALS FOR HIGH COMPLICATION RATES

Medicare's Peer Review Organizations (PROs) now are required to work w ith hospitals to improve patient outcomes. Which hospitals should be t argeted? 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 ge nerally were correlated across clinical areas, although correlations w ere lower between medical and surgical case types. Higher relative rat es of complications were associated with larger size, major teaching f acilities, and provision of open heart surgery, as well as with coding more diagnoses per case. Complication rates generally were not relate d significantly to hospital mortality rates as calculated by the Healt h Care Financing Administration. Different hospitals may be chosen for quality review depending on the method used to identify poor outcomes .