e between 1995 and 1998 were found to have significantly lower mortality rates in 1999-2000 and hospitals in the highest mortality quintile between 1995 and 1998 had significantly higher mortality rates in 1999-2000. "The percentage of hospital-level variation in mortality in 1999-2000 that was forecasted by the highest and lowest quintiles based on patient mortality was 34 percent compared with only 1 percent for the highest and lowest quintiles of volume," the researchers add.

"These results suggest that the current ... standard, which is based on only volume and level of care at the NICU, would tend to be an unreliable indicator of quality in our sample of hospitals (e.g., many hospitals with low-patient volume or low-level NICUs would have better patient outcomes and vice versa).

"Our results suggest that direct-quality indicators based on patient mortality are likely to outperform indirect-quality indicators such as patient volume and more lives could potentially be saved if patient referrals were based on the former rather than the latter. The difference in mortality between the best and worst hospitals was more than 5 times larger when ranking hospitals on past-mortality rates compared with ranking hospitals on past volume. Thus, moving patients out of hospitals with high past mortality and into hospitals with lower past mortality will have a larger impact than moving patients from low-volume to high-volume hospitals," they write. (JAMA. 2004;291:202-209. Available post-embargo at http://www.JAMA.com)

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Contact: Warren Robak
310-451-6913
JAMA and Archives Journals
13-Jan-2004

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