THE RELATIONSHIP BETWEEN CHOICE OF OUTCOME MEASURE AND HOSPITAL RANK IN GENERAL SURGICAL-PROCEDURES - IMPLICATIONS FOR QUALITY ASSESSMENT

Objective: Institutional complication rates are often used to assess h ospital quality of care, particularly for conditions and procedures wh ere mortality rates are not useful because deaths are rare, The object ive of this study was to assess the correlation among hospital quality assessment rankings based on adjusted mortality, complication and fai lure-to-rescue rates, Design: This study used a clinically detailed ad ministrative data set to compare severity and case-mix adjusted hospit al outcome rankings for three different measures of quality of care: i n-hospital death, complication and failure-to-rescue (in-hospital deat h following a complication), Setting and Patients: Analysis of 74 647 patients who underwent general surgical procedures included in the 199 1 and 1992 MedisGroups National Comparative Data Base, Measurements: A djusted outcomes of death, complication and failure to rescue based on multivariable logistic regression models, Results: For 142 hospitals, the correlation between hospital rankings based on the death rate and those ranked by the complication rate was only 0.208 (P=0.013), A sim ilarly low correlation was present between the complication and failur e rate rankings, r=-0.090 (P=0.287). A higher correlation was observed between the death and failure rate rankings, r=0.90 (P<0.001). Conclu sions: For general surgical procedures, hospital rank using the compli cation rate is poorly correlated with rankings using the death or fail ure rate, Complication rates should be used with great caution and sho uld not be used in isolation when assessing hospital quality of care, (C) 1997 Elsevier Science Ltd.