Comparisons of hospitals based on healthcare outcomes are standard practice in developed countries. Risk-adjusted treatment outcome measures are often used as indicators of hospital performance. This statistical tool considers patient characteristics’ differences when comparing resource utilization and treatment outcomes. In Russia, such indicators are not used to compare hospitals’ performance and form their ratings.

OBJECTIVE

To review and analyze methods used abroad to assess the performance of hospitals based on patient health indicators and key indicators of treatment outcomes.

MATERIAL AND METHODS

A systematic search for publications using the protocol developed by the author, comprehensive analysis, and systematization of the information obtained on the indicators used abroad to assess hospitals’ performance were conducted.

RESULTS

Risk adjustment mechanisms are a standard tool in foreign practice used in healthcare financing, quality, and safety assessment of medical care. The methods used for this purpose may include different risk factors and weights, but some aspects overlap. Risk adjustment mechanisms in healthcare financing are used to establish payment levels for inpatient care when applying the clinical and statistical group method system. When using risk-adjustment methods to compare the quality of inpatient care provided, a standardized inpatient mortality rate is calculated as the primary indicator. The risk adjustment methods used abroad differ in some basic criteria: risk factors included in the adjustment mechanism, mortality rates, and statistical methods used. Patient-standardized inpatient mortality rates are usually publicly available.

CONCLUSIONS

Despite the variety of risk-adjustment methods used and shortcomings of such methods, comparison of the hospitals’ performance without any adjustment for patient characteristics can significantly distort the resulting estimates.