Measuring Case Mix and Quality of Care

This report describes a series of studies designed to evaluate the validity of the quality-of-care and seriousness-of-illness measures in the Graduate Medical Education dataset. It explores the use of physician evaluations to refine the quality of care measures; uses a series of summary measures to study the relations between the Adverse Patient Occurrence Inventory and the tracer-specific outcome measures, and between process and outcome for each of the tracers; evaluates alternative measures of case mix by examining their ability to predict various measures of resource utilization (length of stay, costs, charges, and relative value units) and of in-hospital events, possibly reflective of quality of care; and compares teaching and non-teaching hospitals in terms of the types of patients treated, reflected by diagnostic mix and seriousness of illness, in terms of quality of care and resource utilization. Overall, the validity studies suggest substantial internal consistency in the dataset. In addition, the results suggest the need for a more in-depth examination of the role of in-hospital events.