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Nancy E. Gary, MD
Health Care Financing Administration Washington, DC

JAMA. 1991;265(4):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.—

I read with interest the article by Park et al.¹ Using 6-year-old data, the authors from the RAND Corporation showed that death rates for 1126 patients with congestive heart failure and 1150 patients with acute myocardial infarction in targeted hospitals were 5 to 10.9 higher per 100 admissions than in all other hospitals studied.

The report suggests that 56% to 82% of the excess deaths could result from "purely random variation." After review of patients' medical records, the authors concluded that a statistically significant difference in mortality could not be explained by the quality of the process of care.

The Health Care Financing Administration (HCFA), through appropriate state agencies, inspects institutions that have shown for 2 years higher than expected death rates. The purpose of these on-site surveys is to determine compliance with Medicare's conditions of participation, and measures of quality such as infection control processes, . . . [Full Text PDF of this Article]

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