Measuring and explaining mortality in Dutch hospitals; The hospital standardized mortality rate between 2003 and 2005
Measuring and explaining mortality in Dutch hospitals; The hospital standardized mortality rate between 2003 and 2005
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DOI：
10.1186/1472-6963-8-73
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发表时间：
2008-04-03
影响因子：
2.8
通讯作者：
Westert, Gert
中科院分区：
文献类型：
--
作者：
Heijink, Richard;Koolman, Xander;Westert, Gert
背景资料：医院标准化死亡率（HSMR）等医院质量指标已越来越多地用于评估和提高医院质量。我们的目的是描述和解释在新的HSMRs的变化为Netherlands.Methods：HSMRs估计使用的数据从完整的人口出院患者在2003年至2005年。我们使用二元逻辑回归来间接标准化病例组合的差异。在总共101家医院中，89家医院仍在我们的解释性分析中。在这项分析中，我们探讨了HSMRs和决定因素之间的关联，可以和不能受到医院的影响。在这项分析中，我们使用了两个层次的分层线性回归模型来解释每年HSMRs.Results的变化：平均HSMR每年下降超过百分之八。在所有年份中，最高HSMR约为最低HSMR的两倍。超过2/3的变异来自医院间变异。年（-），当地的全科医生（-）和医院类型显着相关的HSMR在所有测试models.Conclusion：HSMR分数差异很大，医院之间，而随着时间的推移出现稳定的排名。我们没有发现HSMR不能作为监测和比较医院质量的指标的证据。由于标准化方法是间接的，因此从社会角度来看，比较最相关，但从个人角度来看则不那么相关。我们发现，在学术医院相对较高的HSMRs的证据。这可能是由于（高质量）高风险程序，低质量的护理或不充分的病例组合纠正。
Background: Indicators of hospital quality, such as hospital standardized mortality ratios (HSMR), have been used increasingly to assess and improve hospital quality. Our aim has been to describe and explain variation in new HSMRs for the Netherlands.Methods: HSMRs were estimated using data from the complete population of discharged patients during 2003 to 2005. We used binary logistic regression to indirectly standardize for differences in case-mix. Out of a total of 101 hospitals 89 hospitals remained in our explanatory analysis. In this analysis we explored the association between HSMRs and determinants that can and cannot be influenced by hospitals. For this analysis we used a two-level hierarchical linear regression model to explain variation in yearly HSMRs.Results: The average HSMR decreased yearly with more than eight percent. The highest HSMR was about twice as high as the lowest HSMR in all years. More than 2/3 of the variation stemmed from between-hospital variation. Year (-), local number of general practitioners (-) and hospital type were significantly associated with the HSMR in all tested models.Conclusion: HSMR scores vary substantially between hospitals, while rankings appear stable over time. We find no evidence that the HSMR cannot be used as an indicator to monitor and compare hospital quality. Because the standardization method is indirect, the comparisons are most relevant from a societal perspective but less so from an individual perspective. We find evidence of comparatively higher HSMRs in academic hospitals. This may result from (good quality) high-risk procedures, low quality of care or inadequate case-mix correction.