Mortality rates as an indicator of hospital quality.

This study examines the relationship between outlier status based on adjusted mortality rates and theoretical underlying quality of care in hospitals. We use Monte Carlo stimulation to determine, in the absence of case mix variation, if random variation noise could obscure the signal of differences in underlying rates of quality of care problems. Classification of hospitals as "outliers" is done compared with "true" hospital quality, based on underlying rates for quality of care problems in mortality cases. Predictive error rates with respect to "quality" for both "outlier" and "non-outlier" hospitals are substantial under a variety of patient load and cutoff point choices for determining outlier status. Using overall death rates as an indicator of underlying quality of care problems may lead to substantial predictive error rates, even when adjustment for case mix is excellent. Outlier status should only be used as a screening tool and not as the information provided to the public to make informed choices about hospitals.

The relationship between violent trauma and nonemployment in Washington, DC.

The purpose of this study was to determine the association of violent trauma with nonemployment status of victims and whether victims who knew their assailants were associated with a higher nonemployment rate than victims who did not know their assailants. Data were collected for 585 patients between 18 and 65 years of age. Patients were residents of Washington, DC, who presented with violent injuries to the emergency department at DC General Hospital between November 1989 and November 1990. Study participants were divided into two groups: those who knew their assailants (Group 1, n = 329) and those who did not know their assailants (Group 2, n = 256). The overall nonemployment rate for the sample population was 51% versus 29% for residents in the hospital catchment area (comparison population based on census data) (P < .001). Of patients in Group 1, 61% were nonemployed compared with 38% in Group 2 (P < .0001). Of male patients in Group 1, 55% were nonemployed compared with 33% in Group 2 (P < .0001). Of female patients in Group 1, 71% were nonemployed compared with 69% in Group 2 (P < .80). Results indicate that there is a significant association between victimization from violent trauma and nonemployment of the victim. In addition, male victims familiar with their assailants had a higher nonemployment rate than victims who did not know their assailants. We conclude that nonemployment seems to contribute to the violence in this population.

A comparative study of a new skin preparation method for peripheral intravenous lines.

The incidence of peripheral intravenous (IV) catheter infection in relation to skin preparation methods was studied over a 4 month period in 60 patients who had peripheral intravenous infusions in an acute-care setting. Sixty two IV sites were evaluated for redness, inflammation, pain or tenderness, and other signs that might indicate infection or other IV site complications. The hospital protocol for intravenous skin preparation and maintenance was compared with a new method using I.V. Prep. The results indicate a statistically significant difference exists between the two groups when comparing incidence of peripheral IV site complications.

A method to determine a non-economic personal value of life.

This paper presents a method for estimating a non-monetary personal value for death in the context of a decision problem. The method evolved from a case study of a personal decision strategy for choosing whether to receive the swine influenza vaccine, based on the predicted epidemic in the United States in the fall of 1976. Rather than dealing with the decision-maker's assessments of utilities associated with extreme outcomes such as one's own death, the basic approach considers probabilities representing marginal reductions in the probability of death. An application to the swine influenza decision is included.