| Titre : | Evaluation of a consumer-oriented Internet health care report card : The risk of quality ratings based on mortality data. (2002) |
| Auteurs : | Harlan-M KRUMHOLZ ; Jersey CHEN ; Martha-J RADFORD ; Saif-S RATHORE ; YONGFEI WANG . (.) ; Qualidigm. Middletown. CT. USA ; Section of Cardiovascular Medicine. Department of Medicine. Yale University School of Medicine. New Haven. CT. USA ; Yale-New Haven Hospital Center for Outcomes Research and Evaluation. New Haven. CT. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 287, n° 10, 2002) |
| Pagination : | 1277-1287 |
| Langues: | Anglais |
| Mots-clés : | Evaluation ; Internet ; Rapport ; Soins ; Pronostic ; Mortalité ; Taux ; Hôpital ; Infarctus ; Myocarde ; Homme ; Appareil circulatoire [pathologie] ; Cardiopathie coronaire ; Myocarde [pathologie] |
| Résumé : | [BDSP. Notice produite par INIST-CNRS dLgR0xNK. Diffusion soumise à autorisation]. Context Health care "report cards" have attracted significant consumer interest, particularly publicly available Internet health care quality rating systems. However, the ability of these ratings to discriminate between hospitals is not known. Objective To determine whether hospital ratings for acute myocardial infarction (AMI) mortality from a prominent Internet hospital rating system accurately discriminate between hospitals'performance based on process of care and outcomes. Design, Setting, and Patients Data from the Cooperative Cardiovascular Project, a retrospective systematic medical record review of 141914 Medicare fee-for-service beneficiaries 65 years or older hospitalized with AMI at 3363 US acute care hospitals during a 4-to 8-month period between January 1994 and February 1996 were compared with ratings obtained from HealthGrades. com (1-star : worse outcomes than predicted, 5-star : better outcomes than predicted) based on 1994-1997 Medicare data. Main Outcome Measures Quality indicators of AMI care, including use of acute reperfusion therapy, aspirin, bêta-blockers, angiotensin-converting enzyme inhibitors ; 30-day mortality. Results Patients treated at higher-rated hospitals were significantly more likely to receive aspirin (admission : 75.4% 5-star vs 66.4% 1-star, P for trend=001 ; discharge : 79.7% 5-star vs 68.0% 1-star, P=001) and bêta-blockers (admission : 54.8% 5-star vs 35.7% 1-star, P=001 ; discharge : 63.3% 5-star vs 52.1% 1-star, P=001), but not angiotensin-converting enzyme inhibitors (59.6% 5-star vs 57.4% 1-star, P=40). Acute reperfusion therapy rates were highest for patients treated at 2-star hospitals (60.6%) and lowest for 5-star hospitals (53.6% 5-star, P=008). Risk-standardized 30-day mortality rates were lower for patients treated at higher-rated than lower-rated hospitals (21.9% 1-star vs 15.9% 5-star, P=001). (...) |
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