Using severity-adjusted mortality to compare performance in a veterans affairs hospital and in private-sector hospitals

The objective of this study was to compare hospital mortality in Veterans A ffairs (VA) and private-sector patients. The study included 5016 patients a dmitted to 1 VA hospital. Admission severity of illness was measured using a commercial methodology that was developed in a nationwide database of 850 ,000 patients from 111 private-sector hospitals. The method uses data abstr acted from patients' medical records to predict the risk of death in indivi dual patients, based on the normative database. Analyses compared actual an d predicted mortality rates in VA patients. VA patients had higher (P < .05 ) severity of illness than private-sector patients. The observed mortality rate in VA patients was 4.0% and was similar (P = .09) to the predicted ris k of death (4.4%; 95% confidence interval 4.0-4.9%). In subgroup analyses, actual and predicted mortality rates were similar in medical and surgical p atients and in groups stratified according to severity of illness, except i n the highest severity stratum, in which actual mortality was lower than pr edicted mortality (57% vs 73%; P < .001), We found that in-hospital mortali ty in 1 VA hospital and a nationwide sample of private-sector hospitals wer e similar, after adjusting for severity of illness. Although not directly g eneralizable to other VA hospitals, our findings nonetheless suggest that t he quality of VA and private-sector care may be similar with respect to one important and widely used measure.