To the Editor.
—The relative importance of the process of care as compared with the outcome of care, as a measure of quality, has been debated for many years. It has been raised again in an important study about the value of admission characteristics in predicting short-term mortality from acute myocardial infarction (MI) in elderly patients.1 Six years ago, we, in collaboration with 5 professional review organizations, studied this issue for patients with acute MI, congestive heart failure, pneumonia, stroke, and hip fracture, using a nationally representative sample.2 After collecting 57 clinically detailed variables to study sickness at admission or severity of illness for patients hospitalized with acute MI, we were able to explain 22% of the variance in death rates 30 days after admission using only 16 of these variables. We concluded that a small set of clinical variables could explain a substantial amount of variance in
Kahn KL, Brook RH, Keeler E. Predicting Short-term Mortality From Myocardial Infarction. JAMA. 1996;276(13):1033. doi:10.1001/jama.1996.03540130031012