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Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database

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Title: Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database
Authors: Lingsma, HF
Bottle, A
Middleton, S
Kievit, J
Steyerberg, EW
Marang-van de Mheen, PJ
Item Type: Journal Article
Abstract: 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.
Issue Date: 14-Feb-2018
Date of Acceptance: 6-Feb-2018
URI: http://hdl.handle.net/10044/1/57904
DOI: https://dx.doi.org/10.1186/s12913-018-2916-1
ISSN: 1472-6963
Publisher: BioMed Central
Journal / Book Title: BMC Health Services Research
Volume: 18
Copyright Statement: © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Benchmarking
Quality of care
Outcomes
Ordinal models
Composite outcomes
Administrative data
HEART-FAILURE
QUALITY
RATES
SURGERY
CARE
RANKABILITY
RISK
1117 Public Health And Health Services
0807 Library And Information Studies
Health Policy & Services
Publication Status: Published
Article Number: ARTN 116
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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