Severity and Outcome

Severity and Adjusting Outcomes

This discussion focuses on outcome (mortality) data collected by providers, and other data that are in or could be included in the patient's medical or administrative records, that could be used to adjust outcomes. The availability of such data and the integrity of their collection is the Achilles heel of such systems. Unless collection is audited routinely, the data cannot be relied upon. Not only could providers manipulate data, but their ability to provide accurate data depends on their competence, the very attribute the system is supposed to measure. Unless diagnoses were validated, comparisons among providers might be risky. For the near future, at least, validating diagnoses will likely mean examining individual patient records. If such information were available, a provider's cases could be divided into two groups: (1) those meeting criteria, for which mortality rates could be calculated, and (2) those not meeting diagnostic validation criteria, which is not the same as saying the patient did not have the problem. Some adjustment for patient factors would still have to be made, because different providers are likely to treat different percentages of patients with characteristics associated with mortality. Again, such factors are likely to have been drawn from the medical record, and the adequacy of medical records varies. The use of severity scores for adjusting outcomes assumes their validity. Treatment difficulty scores are not useful for adjusting outcomes, because they are predictions of what one is measuring. A valid treatment difficulty score (were it to exist) could be compared to an observed score, at discharge for example, to assess provider performance. The treatment difficulty score represents a prediction of posttreatment outcomes; the observed score represents actual outcome. The approach is another form of population-based quality assessment. Perhaps a valid approach to mortality data could be developed that...