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Letters |15 December 1996

In Defense of Farr and Nightingale

Lisa I. Iezzoni, MD

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Author, Article, and Disclosure Information
  • Beth Israel Deaconess Medical Center, Boston, MA 02215.
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IN RESPONSE:
I thank Drs. Vandenbroucke and Vandenbroucke-Grauls for their provocative letter. It underscores why I wrote the article, calling it “a cautionary tale.” Faced with varying methodologic options, perhaps all legitimate within their own contexts, it becomes critically important to open black boxes and look inside-to understand what was done and its implications. Otherwise, misconceptions can arise.
Context is critical. Drs. Vandenbroucke and Vandenbroucke-Grauls adopt a classic epidemiologic perspective, in which exposure per unit of time is the fundamental quantity that informs inferences. In that context, their assertions are reasonable. My comments were framed within the current enthusiasm for publishing “report cards” on hospitals. In this setting, “mortality rates” purportedly shed insight into hospital quality-the belief of Nightingale and Farr. The exposure of interest is an entire “care package” (for example, coronary artery bypass graft surgery) provided during a hospitalization. The public is more interested in outcomes at the end of that care than in deaths per unit of time in the hospital.
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Iezzoni LI. In Defense of Farr and Nightingale. Ann Intern Med. ;125:1014. doi: 10.7326/0003-4819-125-12-199612150-00032

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Published: Ann Intern Med. 1996;125(12):1014.

DOI: 10.7326/0003-4819-125-12-199612150-00032

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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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