To the Editor. —
A ranking of New York hospitals by cardiac surgery mortality rates, adjusted for preoperative risk, appeared in the New York Times (December 5, 1990:B10) in response to the study of "Adult Open Heart Surgery in New York State"1 published in JAMA. Ranking was based on rate of deaths related to heart surgery and adjusted for preoperative condition. Results from the first 6 months of 1990 were compared with the same period in 1989. Several substantive arguments were offered by staff at involved institutions, such as alterations in patient care and case mix, to explain both favorable and unfavorable trends.I believe that a more accurate argument is based on a common and often unrecognized phenomenon: regression to the mean. This is the tendency of outlying values to be more toward the average on repeat measurement. If this principle were operating in this data set, hospitals with
Mosca L. Coronary Artery Surgery in New York State. JAMA. 1991;265(16):2068. doi:10.1001/jama.1991.03460160040025
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