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Gregory Binns, PhD
President, Lexecon Health Service, Inc Chicago, Ill

JAMA. 1991;265(4):458-459.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor. —

If one takes the data presented by Park et al¹ at face value, very important considerations for quality improvement activities were omitted in the abstract and "Comment" sections, even though these conclusions are readily apparent in the data. A cursory reading will cause readers to miss the crucial implications of this research.

Random binomial variation, a medical record—based severity of illness adjustment, and a detailed process measure of quality could not explain the substantial difference between expected and observed deaths at hospitals with high death rates. There was an unexplained excess over the average hospital after adjustment in the hospitals with high death rates of 37% of inpatient deaths and 5% of deaths 30 days postadmission for patients with congestive heart failure and 14% of inpatient deaths and 9% of deaths 30 days postadmission for patients with acute myocardial infarction. Obviously, something other than the . . . [Full Text PDF of this Article]

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