The purpose of this research project Ic,as to compare impatient mortality rates for rural hospitals with mortality rates of urban hospitals of given sizes and ranges of service. Statistical adjustments for risk were m...
详细信息
The purpose of this research project Ic,as to compare impatient mortality rates for rural hospitals with mortality rates of urban hospitals of given sizes and ranges of service. Statistical adjustments for risk were made in the probability of death during hospitalization for 43,000 patients across 166 hospitals by age, gender, principal diagnosis, principal surgical procedure, characteristics of the secondary diagnoses, and whether or not cancer was a secondary diagnosis. Eighty-three small hospitals that had a relatively unspecialized range of services constituted the stimy group. Patients characteristics of this study group were moderately representative, of the national population. A standardized score was calculated for each hospital using a formula based oil the actual hospital death rate and the death rate expected for a given hospital with patients of the same demographic and medicinal characteristics. Patients admitted to hospitals ill nonmetropolitan areas had a mortality rate of 0.41 percent compared with a mortality rate of 0.66 percent in peer hospitals in metropolitan areas. After mortality rates were risk-adjusted and converted to z scores, nonmetropolitan areas had an nz,average z of +0.16, and metropolitan areas had an average z of -0.25, where positive z scores reflect a lower-than-average adjusted mortality rate. The metropolitan-nonmetropolitan (urban-rural) difference ic,ns not statistically significant, but if is meaningful in that rural hospitals tended to have a lower adjusted mortality rate than urban hospitals of the same size and type, indicating that rural hospitals had the same or lower adjusted mortality rates. The possibility of urban hospitals having riskier patients was minimized but could not be definitely ruled out. Taken together with other studies, the data are consistent ,with the view ro that small rural hospitals generally make appropriate transfer decisions for severely ill patients and quality cars for retained patients.
Abstract: Reimbursement changes during the 1980s, particularly Medicare diagnosis‐related group (DRG) reform and the growth of managed care, have squeezed hospital revenues available for cross‐subsidizing care for u...
详细信息
暂无评论