Hospital Comparisons Based on Mortality: Revisiting the Choice of Postadmission Timeframe and Evaluating the Contribution of Cause-of-death Data, France, 2009.

TitreHospital Comparisons Based on Mortality: Revisiting the Choice of Postadmission Timeframe and Evaluating the Contribution of Cause-of-death Data, France, 2009.
Publication TypeJournal Article
Year of Publication2015
AuthorsLamarche-Vadel, A, Ngantcha, M, Le Pogam, M-A, Ghosn, W, Grenier, C, Meyer, L, Rey, G
JournalMed Care
Volume53
Issue8
Pagination736-742
Date Published2015 Aug
DOI10.1097/MLR.0000000000000376
ISSN1537-1948
Abstract

BACKGROUND: In-hospital mortality is widely used to judge the quality of hospital care, but is biased by discharge patterns. Fixed-timeframe indicators have thus been recommended. However, the 30-day postadmission indicator may underestimate hospital-wide mortality, as patients dying in hospital >30 days after admission are considered as survivors.

OBJECTIVES: To identify the most relevant timeframes and to assess the contribution of cause-of-death data.

METHODS: The 2009 French hospital discharge database was linked to vital status records and to the causes of death register for 11.5 million hospital stays by beneficiaries of French general health insurance. Correlations and agreements between the 30-day hospital standardized mortality ratio (HSMR) and the in-hospital, 60-, 90-, 180-, and 365-day postadmission HSMRs were estimated.

RESULTS: A total of 7.8%, 1.5%, and 0.5% of patients who died during their hospital stay were considered as survivors by the 30-, 60-, and 90-day HSMRs, respectively. The 30-day HSMR correlated strongly with the 60-day HSMR (Pearson coefficient=0.92), and their agreement on outlier status was excellent (κ coefficient=0.80). The association remained substantial at 90 days, but weakened at 180 days and even more so at 365 days. Regardless of the timeframe, exclusion of deaths likely due to independent causes barely modified the indicators.

CONCLUSIONS: This nationwide study shows that 60- and 90-day HSMRs encompass in-hospital deaths better than the 30-day HSMR, while capturing the same interhospital variations. They should thus be preferred. The contribution of cause-of-death data to hospital-wide indicators seems negligible.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/26125416?dopt=Abstract

Alternate JournalMed Care
Citation Key / SERVAL ID6174
PubMed ID26125416

                         

IUMSP | www.iumsp.ch
Institut universitaire de médecine sociale et préventive
Route de la Corniche 10, 1010 Lausanne - Switzerland
+41 21 314 72 72 | iumsp@chuv.ch

Go to top