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To the Editor: The results of the study by Drs Werner and Bradlow¹ regarding mortality differences between hospitals should not have been a surprise, given the existing interquartile differences in performance. Of the hospital performance measures used, 2 are unlikely to directly influence mortality at 30 days or 1 year (assessment of left ventricular function and oxygenation assessment). In addition, the timing of antibiotics has no trial evidence for estimating the size of the mortality benefit, and pneumococcal vaccination has trial evidence supporting that there is no overall mortality benefit. For the remaining measures, in randomized trials in which the difference in performance that is being compared is generally 100% in the intervention group vs 0% in the placebo group, the size of the absolute mortality benefit for these interventions is best estimated at 1% to 6%.^2-4

The small interquartile differences in performance between hospitals found by Werner and Bradlow . . . [Full Text of this Article]

Paul Shekelle, MD, PhD
paul.shekelle@va.gov
Greater Los Angeles VA Healthcare System
Los Angeles, Calif

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