Health care report cards. Validity of case definitions
W. E. Golden, M. A. Cleves and J. Johnston
Arkansas Foundation for Medical Care, Fort Smith, USA.
Administrative databases are increasingly being used to construct health
care report cards. We analyzed information from one of the original report
cards, the Medicare Hospital Information Project. Assessment of mortality
statistics for three clinical entities--coronary artery bypass surgery, hip
reconstruction, and treatment of sepsis--demonstrated widespread outcome
variances that reflected imperfect definitions rather than performance
issues in clinical care. The use of administrative data sets to design
report cards requires clinical expertise to ensure validity of the data.
Designers of report card measures should share preliminary data with
providers to enable feedback in methods and uncover definitional and
validity concerns before widespread dissemination.
