Abstract:
The incidence of mortality in a specific hospital depends on many risk factors. These
risk factors may be divided roughly into two categories. The intake category, consists
of those risk factors for which the hospital has hardly any influence upon their incidence;
and the care category being those for which the incidence depends partly or completely
on the treatment policy of the hospital. A hospital with a high incidence of risk
factors in the intake category will have a higher mortality rate than a hospital with
a low incidence, even if their care is exactly the same (i. e., if they treat their
infants equally well). Therefore, a fair comparison between one hospital and a reference
cohort, or among several hospitals (using a national registry) should adjust e. g.
correct for those risk factors belonging to the intake category. A practical method
is proposed, based on logistic regression, to effectuate such a “fair” judgment. The
regression technique enables to compare “observed” and “expected” rates in a specific
hospital and to test whether a difference between these rates is statistically significant.
Both clinical and statistical aspects of the method are discussed, as well as the
actual implementation of an automated annual reporting system. The method has been
implemented in the Netherlands as an annual peer review and quality assessment system
in obstetric care.
Keywords
Logistic Regression - Comparison - Prediction - Peer Review - Quality Assessment
