USE OF SEVERITY OF ILLNESS TO EVALUATE QUALITY OF CARE

This study compared a severity of illness system (APACHE II) and a 10% random sample of charts in terms of their ability to identify cases w ith quality problems. Using condition-specific data bases of 337 pneum onia, 363 acute myocardial infarction and 266 hip fracture charts, sev erity of illness information was used to separate cases into those wit h a high and a low likelihood of a poor outcome. Cases with low admiss ion severity of illness combined with subsequent death were flagged as potential quality problems. Physician evaluation was used as the gold standard to measure flag performance, Flags were tested against a 10% random sample drawn from within the three condition-specific data bas es, Analyses focused on a combination of sensitivity and positive pred ictive value, The low severity plus death flag performed much better t han a 10% random sample approach, suggesting that outcomes monitoring flags based on severity of illness could play an important role in scr eening cases for potential quality problems. Copyright (C) 1996 Elsevi er Science Ltd.