What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature

摘要: Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality care remains unclear. We undertook a systematic review to ascertain extent which variations in rates were associated differences care. identified studies had been reported more than one hospital. adopted an iterative search strategy using three databases – Medline, HealthSTAR CINAHL from 1966, 1975 1982 respectively. potentially relevant on basis title or abstract. obtained these papers included those met our inclusion criteria. From initial yield 6,456 papers, 36 Several considered process-versus-risk-adjusted relationship. In total we found 51 such relationships widen range clinical conditions variety methods. A positive correlation between better was under half (26/51 51%) but remainder showed no (16/51 31%) paradoxical (9/51 18%). The general notion that hospitals higher have poorer is neither consistent nor reliable.