Trends in hospital standardized mortality ratios for stroke in Japan between 2012 and 2016: a retrospective observational study
Trends in hospital standardized mortality ratios for stroke in Japan between 2012 and 2016: a retrospective observational study
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DOI：
10.1093/intqhc/mzz091
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发表时间：
2019-11-01
影响因子：
2.6
通讯作者：
Hasegawa, Tomonori
中科院分区：
文献类型：
--
作者：
Amin, Rebeka;Kitazawa, Takefumi;Hasegawa, Tomonori
目的：脑卒中是导致死亡和残疾的主要原因之一，并造成了重大的医疗负担。本研究的目的是确定2012- 2016年日本卒中的医院标准化死亡率（HSMRs）的特征，以描述其趋势。设计：回顾性观察性研究。设置：来自日本行政数据库的数据。参与者：从2012年至2016年的诊断程序组合（DPC）数据库中识别所有因卒中住院的患者。主要结局指标：使用实际住院死亡人数和预期死亡人数计算HSMR。为了获得预期死亡人数，建立了一个logistic回归模型，以获得具有许多解释变量的系数。Logistic模型的预测准确性进行了评估，使用c指数和校准进行了评估，使用Hosmer-Lemeshow test.Results：共63 084例患者入院中风从2012年1月至2016年12月进行了分析。5年来HSMRs呈下降趋势，提示脑卒中相关死亡率有改善趋势。虽然HSMR每年都有变化，但日本不同医院之间也存在很大差异。HSMR小于100的医院比例从2012年的41.0%增加到2016年的59.0%。结论：本研究表明，可以使用DPC数据计算HSMR，并发现日本各医院卒中的HSMR差异很大，使我们能够描绘趋势。通过研究这些趋势，设施，当局和省份可以启动设计，最终导致升级的医疗保健提供系统。
Objective: Stroke is one of the leading causes of death and disability, and imposes a major healthcare burden. The aim of this study was to determine the characteristics of hospital standardized mortality ratios (HSMRs) for stroke in Japan for the year 2012-16 to describe the trend.Design: Retrospective observational study.Setting: Data from the Japanese administrative database.Participants: All hospital admissions for stroke were identified from diagnostic procedures combination (DPC) database from 2012 to 2016.Main Outcome Measures: HSMR was calculated using the actual number of in-hospital deaths and expected deaths. To obtain the expected death number, a logistic regression model was developed to get the coefficient with a number of explanatory variables. Predictive accuracy of the logistic models was assessed using c-index and calibration was evaluated using the Hosmer-Lemeshow test.Results: A total of 63 084 patients admitted for stroke from January 2012 to December 2016 were analyzed. HSMRs showed declining tendency over these 5 years, suggesting stroke-related mortality has been improving. While the HSMRs varied from year to year, a wide variation was also seen among the different hospitals in Japan. The proportion of hospitals with HSMR less than 100 increased from 41.0% in 2012 to 59.0% in 2016.Conclusion: This study demonstrated that HSMR can be calculated using DPC data and found wide variation in HSMR of stroke among hospitals in Japan and enabled us to image the trend. By examining these trends, facilities, authorities and provinces can initiate designs that will ultimately lead to an upgraded healthcare delivery system.