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Health Serv Res. 1968 Summer; 3(2): 96–118.
PMCID: PMC1067460

A Proposed Hospital Quality Index

Hospital Death Rates Adjusted for Case Severity


It is proposed that an appropriate measure of the quality of hospital care might be a measure of its outcome—the death rate, corrected to take into account the fact that certain types of hospitals have a larger proportion of seriously ill patients than others. Various indicators of case severity are assessed, under the constraints of simplicity and practicality of data collection and of calculation; and it is shown that the easily determined factor of length of hospital stay, especially when corrected so as to exclude external factors not related to the patient's condition, offers a valuable approach to such an adjustment of the crude death rate. An equation is proposed by which the crude death rate in general hospitals may be adjusted for case severity by the length of stay, corrected in turn by the occupancy rate, to give a more objective measure of hospital performance than the currently used measures based chiefly on evaluation of the hospital's staffing, equipment, and services.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • SHEPS MC. Approaches to the quality of hospital care. Public Health Rep. 1955 Sep;70(9):877–886. [PMC free article] [PubMed]
  • MYERS RS, SLEE VN. Medical statistics tell the story at a glance. Mod Hosp. 1959 Sep;93:72–75. [PubMed]
  • ROEMER MI. Is surgery safer in larger hospitals. Hosp Manage. 1959 Jan;87(1):35–passim. [PubMed]
  • RIDER RV, HARPER PA, KNOBLOCH H, FETTER SE. An evaluation of standards for the hospital care of premature infants. J Am Med Assoc. 1957 Nov 9;165(10):1233–1236. [PubMed]
  • STOCKWELL EG. A critical examination of the relationship between socioeconomic status and mortality. Am J Public Health Nations Health. 1963 Jun;53:956–964. [PubMed]
  • ROEMER MI. Hospital utilization and the supply of physicians. JAMA. 1961 Dec 9;178:989–993. [PubMed]
  • Moses LE, Mosteller F. Institutional differences in Postoperative death rates. Commentary on some of the findings of the National Halothane Study. JAMA. 1968 Feb 12;203(7):492–494. [PubMed]

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