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http://hdl.handle.net/1942/20863
Title: | Community Acquired Pneumonia (CAP) hospitalisations and deaths: is there a quality improvement role for inter-hospital comparisons? | Authors: | Aelvoet, W. Terryn, N. BLOMMAERT, Adriaan MOLENBERGHS, Geert HENS, Niel De Smet, F. Callens, M. Beutels, P. |
Issue Date: | 2016 | Source: | International journal for quality in health care 28(1), p. 22-32 | Abstract: | Objective To assess between-hospital variations in standardized in-hospital mortality ratios of community-acquired pneumonia (CAP), and identify possible leads for quality improvement. Design We used an administrative database to estimate standardized in-hospital mortality ratios for 111 Belgian hospitals, by carrying out a set of hierarchical logistic regression models, intended to disentangle therapeutic attitudes and biases. To facilitate the detection of false-negative/positive results, we added an inconclusive zone to the funnel plots, derived from the results of the study. Data quality was validated by comparison with (i) alternative data from the largest Belgian Sickness Fund, (ii) published German hospital data and (iii) the results of an on-site audit. Setting All Belgian hospital discharge records from 2004 to 2007. Study participants A total of 111 776 adult patients were admitted for CAP. Main outcome measure Risk-adjusted standardized in-hospital mortality ratios. Results Out of the 111 hospitals, we identified five and six outlying hospitals, with standardized mortality ratios of CAP consistently on the extremes of the distribution, as providing possibly better or worse care, respectively, and 18 other hospitals as having possible quality weaknesses/strengths. At the individuals' level of the analysis, adjusted odds ratios showed the paramount importance of old age, comorbidity and mechanical ventilation. The data compared well with the different validation sources. Conclusions Despite the limitations inherent to administrative data, it seemed possible to establish inter-hospital differences in standardized in-hospital mortality ratios of CAP and to identify leads for quality improvement. Monitoring is needed to assess progress in quality. | Keywords: | benchmarking; statistical methods; standardized mortality ratio; funnel plot; health services research | Document URI: | http://hdl.handle.net/1942/20863 | ISSN: | 1353-4505 | e-ISSN: | 1464-3677 | DOI: | 10.1093/intqhc/mzv092 | ISI #: | 000371239300004 | Rights: | © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2017 |
Appears in Collections: | Research publications |
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472.pdf | Peer-reviewed author version | 524.58 kB | Adobe PDF | View/Open |
aelvoet2015.pdf Restricted Access | Published version | 359.13 kB | Adobe PDF | View/Open Request a copy |
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