Does lay media ranking of hospitals reflect lower mortality in treating acute myocardial infarction?
Arch Cardiovasc Dis
; 105(10): 489-98, 2012 Oct.
Article
em En
| MEDLINE
| ID: mdl-23062480
ABSTRACT
BACKGROUND:
Ranking of hospitals by lay media has attracted widespread attention but may not accurately reflect quality. Acute myocardial infarction (AMI) mortality is a straightforward measure of clinical outcome frequently used by ranking algorithms.AIMS:
Our aim was to assess whether ranking among top hospitals correlated with lower in-hospital risk-adjusted mortality following admission for AMI.METHODS:
Using a hierarchical regression model and the comprehensive nationwide database of hospital AMI admissions from 2004 to 2007 in France, we analysed crude and risk-adjusted hospital mortality rates in the ranked ('best') hospitals versus non-ranked hospitals. We subsequently restricted the comparison to non-ranked hospitals with matching on-site facilities.RESULTS:
We analysed 192,372 admissions in 439 hospitals, 43 of which were in the ranked group. Patients admitted to the 396 non-ranked hospitals tended to be older with more comorbidities and underwent fewer revascularization procedures than patients admitted to ranked hospitals. Between hospital differences accounted for 10% of differences in mortality. Crude mortality was lower in ranked versus non-ranked hospitals (7.5% vs. 11.9%; P<0.001). The survival advantage associated with admission to ranked hospitals was reduced after adjustment for age and sex (5.7% vs. 6.4%; P=0.087) and comorbidities (4.9% vs. 5.5%; P=0.102).CONCLUSIONS:
Ranked hospitals have similar adjusted AMI mortality rates to those not ranked and patient characteristics rather than hospital differences account for the variation in outcomes.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Avaliação de Processos e Resultados em Cuidados de Saúde
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Mortalidade Hospitalar
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Indicadores de Qualidade em Assistência à Saúde
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Hospitais
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Meios de Comunicação de Massa
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Infarto do Miocárdio
Tipo de estudo:
Etiology_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article