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Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database.
Lingsma, Hester F; Bottle, Alex; Middleton, Steve; Kievit, Job; Steyerberg, Ewout W; Marang-van de Mheen, Perla J.
Afiliação
  • Lingsma HF; Department of Public Health, Erasmus Medical Centre, PO box 2040, 3000, CA, Rotterdam, The Netherlands. h.lingsma@erasmusmc.nl.
  • Bottle A; Imperial College, Faculty of Medicine, School of Public Health, South Kensington Campus, London, SW7 2AZ, UK.
  • Middleton S; Dr Foster Intelligence, 3 Dorset Rise, London, EC4Y 8EN, UK.
  • Kievit J; Department of Medical Decision Making, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
  • Steyerberg EW; Department of Public Health, Erasmus Medical Centre, PO box 2040, 3000, CA, Rotterdam, The Netherlands.
  • Marang-van de Mheen PJ; Department of Medical Decision Making, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
BMC Health Serv Res ; 18(1): 116, 2018 02 14.
Article em En | MEDLINE | ID: mdl-29444713
BACKGROUND: Hospital mortality, readmission and length of stay (LOS) are commonly used measures for quality of care. We aimed to disentangle the correlations between these interrelated measures and propose a new way of combining them to evaluate the quality of hospital care. METHODS: We analyzed administrative data from the Global Comparators Project from 26 hospitals on patients discharged between 2007 and 2012. We correlated standardized and risk-adjusted hospital outcomes on mortality, readmission and long LOS. We constructed a composite measure with 5 levels, based on literature review and expert advice, from survival without readmission and normal LOS (best) to mortality (worst outcome). This composite measure was analyzed using ordinal regression, to obtain a standardized outcome measure to compare hospitals. RESULTS: Overall, we observed a 3.1% mortality rate, 7.8% readmission rate (in survivors) and 20.8% long LOS rate among 4,327,105 admissions. Mortality and LOS were correlated at the patient and the hospital level. A patient in the upper quartile LOS had higher odds of mortality (odds ratio = 1.45, 95% confidence interval 1.43-1.47) than those in the lowest quartile. Hospitals with a high standardized mortality had higher proportions of long LOS (r = 0.79, p < 0.01). Readmission rates did not correlate with either mortality or long LOS rates. The interquartile range of the standardized ordinal composite outcome was 74-117. The composite outcome had similar or better reliability in ranking hospitals than individual outcomes. CONCLUSIONS: Correlations between different outcome measures are complex and differ between hospital- and patient-level. The proposed composite measure combines three outcomes in an ordinal fashion for a more comprehensive and reliable view of hospital performance than its component indicators.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Readmissão do Paciente / Avaliação de Resultados em Cuidados de Saúde / Mortalidade Hospitalar / Tempo de Internação Tipo de estudo: Prognostic_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Readmissão do Paciente / Avaliação de Resultados em Cuidados de Saúde / Mortalidade Hospitalar / Tempo de Internação Tipo de estudo: Prognostic_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article