Statistical uncertainty of mortality rates and rankings for children's hospitals.

Abstract:

OBJECTIVES:Hospitals are being required to report publically their adjusted mortality rates, which are then being used to rank hospitals. Our objectives were to assess the statistical reliability of the determination of a hospital's adjusted mortality rate, of comparisons of that rate with the rates of other hospitals, and of the use of those rates to rank the hospitals. METHODS:A cross-sectional study of 473 383 patients discharged from 42 US children's hospitals in 2008 was performed. Hospital-specific observed/expected (O/E) mortality rate ratios and corresponding hospital rankings, with 95% confidence intervals (CIs), were examined. RESULTS:Hospitals' O/E mortality rate ratios exhibited wide 95% CIs, and no hospital was clearly distinguishable from the other hospitals' aggregated mean mortality performance. Only 2 hospitals' mortality performance fell outside the comparator hospitals' 95% CI. Those hospitals' 95% CIs overlapped with the overall comparator set's 95% CI, which suggests that there were no statistically significant hospital outliers. Fourteen (33.3%) of the 42 hospitals had O/E ratios that were not statistically different from being in the 95% CI of the top 10% of hospitals. Hospital-specific mortality rate rankings displayed even broader 95% CIs; the typical hospital had a 95% CI range that spanned 22 rank-order positions. CONCLUSION:Children's hospital-specific measures of adjusted mortality rate ratios and rankings have substantial amounts of statistical imprecision, which limits the usefulness of such measures for comparisons of quality of care.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Feudtner C,Berry JG,Parry G,Hain P,Morse RB,Slonim AD,Shah SS,Hall M

doi

10.1542/peds.2010-3074

subject

Has Abstract

pub_date

2011-10-01 00:00:00

pages

e966-72

issue

4

eissn

0031-4005

issn

1098-4275

pii

peds.2010-3074

journal_volume

128

pub_type

杂志文章
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    doi:10.1542/peds.2005-2000L

    authors: Boychuk RB,Demesa CJ,Kiyabu KM,Yamamoto F,Yamamoto LG,Sanderson R,Gartner B,Donovan R,Beckham S,Pang C,Fanucchi R,Chong V

    更新日期:2006-04-01 00:00:00

  • Treatment of chronic childhood asthma with beclomethasone dipropionate aerosols: II. Effect on pituitary-adrenal function after substitution for oral corticosteroids.

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    authors: Kershnar H,Klein R,Waldman D,Berger W,Rachelefsky G,Katz R,Siegel S

    更新日期:1978-08-01 00:00:00

  • Fetal and neonatal ventricular arrhythmia.

    abstract::Ventricular arrhythmia in the perinatal period is observed with greater frequency than reported in the literature. Four cases from the authors' experience and an analysis of the literature are presented. Of the total of 45 cases, nine were detected in utero, three persisted beyond the neonatal period, and two resulted...

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    authors: Stevens DC,Schreiner RL,Hurwitz RA,Gresham EL

    更新日期:1979-05-01 00:00:00

  • Cognitive delay and behavior problems prior to school age.

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    更新日期:2014-09-01 00:00:00

  • American Academy of Pediatrics. Committee on Injury and Poison Prevention. Snowmobiling hazards.

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    authors:

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  • Measles outbreak in a pediatric practice: airborne transmission in an office setting.

    abstract::In February 1981, a measles outbreak occurred in a pediatric practice in DeKalb County, GA. The source case, a 12-year-old boy vaccinated against measles at 11 1/2 months of age, was in the office for one hour on the second day of rash, primarily in a single examining room. On examination, he was noted to be coughing ...

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    pub_type: 杂志文章

    doi:

    authors: Bloch AB,Orenstein WA,Ewing WM,Spain WH,Mallison GF,Herrmann KL,Hinman AR

    更新日期:1985-04-01 00:00:00

  • Rumination--a new complication of neonatal intensive care.

    abstract::The infant rumination syndrome has not been previously reported in a neonatal intensive care setting. We recently managed three infants in our newborn intensive care unit who developed rumination following chronic courses in the unit. The events leading to this condition in each infant are described, as well as the su...

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    doi:

    authors: Sheagren TG,Mangurten HH,Brea F,Lutostanski S

    更新日期:1980-10-01 00:00:00

  • Preventing neonatal group B streptococcal disease: cost-effectiveness in a health maintenance organization and the impact of delayed hospital discharge for newborns who received intrapartum antibiotics.

    abstract:OBJECTIVES:To estimate the cost and health benefits of implementing a risk factor-based prevention strategy for early-onset neonatal group B streptococcal (GBS) disease, using baseline assumptions and costs from a health maintenance organization. With the risk factor-based strategy, intrapartum antibiotics (IPAs) would...

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    pub_type: 杂志文章

    doi:10.1542/peds.103.4.703

    authors: Mohle-Boetani JC,Lieu TA,Ray GT,Escobar G

    更新日期:1999-04-01 00:00:00

  • Preschool vision screening in pediatric practice: a study from the Pediatric Research in Office Settings (PROS) Network. American Academy of Pediatrics.

    abstract::In this cross-sectional study, the vision-screening process is described for 8417 children aged 3 to 5 seen for health supervision in a group of 102 pediatric practices in 23 states and Puerto Rico. Three hundred forty children who failed screening (63% of those who failed) were followed up 2 months after initial scre...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Wasserman RC,Croft CA,Brotherton SE

    更新日期:1992-05-01 00:00:00

  • Do obese inner-city children with asthma have more symptoms than nonobese children with asthma?

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    authors: Belamarich PF,Luder E,Kattan M,Mitchell H,Islam S,Lynn H,Crain EF

    更新日期:2000-12-01 00:00:00

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    authors: Jimenez N,Symons RG,Wang J,Ebel BH,Vavilala MS,Buchwald D,Temkin N,Jaffe KM,Rivara FP

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    journal_title:Pediatrics

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    authors: Bach V,Bouferrache B,Kremp O,Maingourd Y,Libert JP

    更新日期:1994-05-01 00:00:00

  • Cognitive function and brain structure in females with a history of adolescent-onset anorexia nervosa.

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    pub_type: 临床试验,杂志文章,随机对照试验

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    authors: Gunn AJ,Gunn TR,Rabone DL,Breier BH,Blum WF,Gluckman PD

    更新日期:1996-08-01 00:00:00

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  • Ensuring Timely Connection to Early Intervention for Young Children With Developmental Delays.

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  • Practices of unregulated tanning facilities in Missouri: implications for statewide legislation.

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    pub_type: 杂志文章,随机对照试验

    doi:10.1542/peds.2012-1781

    authors: Balaraman B,Biesbroeck LK,Lickerman SH,Cornelius LA,Jeffe DB

    更新日期:2013-03-01 00:00:00

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    journal_title:Pediatrics

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    authors: Kaufmann WE,Kidd SA,Andrews HF,Budimirovic DB,Esler A,Haas-Givler B,Stackhouse T,Riley C,Peacock G,Sherman SL,Brown WT,Berry-Kravis E

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  • Stature and weight status of children in an urban kindergarten population.

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    journal_title:Pediatrics

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    authors: Kumanyika SK,Huffman SL,Bradshaw ME,Waller H,Ross A,Serdula M,Paige D

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  • Herpes simplex virus central nervous system relapse during treatment of infantile spasms with corticotropin.

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    doi:10.1542/peds.101.4.704

    authors: Keller C,Reynolds A,Lee B,Garcia-Prats J

    更新日期:1998-04-01 00:00:00

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    authors: Meng HC,Stahlman MT,Otten A,Dolanski EA,Caldwell MD,O'Neill JA

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    authors: Lodha A,Entz R,Synnes A,Creighton D,Yusuf K,Lapointe A,Yang J,Shah PS,investigators of the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-up Network (CNFUN).

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