International comparison of mortality following AMI using hospital administrative data – the example of Germany and the USA

急性心肌梗死患者的生存关键取决于在配备适当人员和设备的医疗机构进行及时和符合指南的护理。这就是为什么急性心肌梗死后的死亡率被用作国际比较的质量指标，表明护理过程的有效性。根据经合组织卫生保健指标项目，与美国、法国、意大利或斯堪的纳维亚国家相比，德国急性心肌梗死后的年龄和性别标准化30天死亡率更高。这些差异可能表明德国医疗保健系统存在缺陷。例如，有证据表明，在德国，将有急性心肌梗死症状的患者分配到适当的卫生保健机构的管理并不理想。相比之下，德国的医疗保健系统的特点是相对较高的密度的急性护理医院，以及大量的左心导管设施。经合组织的质量指标的医院死亡率是通过使用管理数据，这是在医院护理过程中产生的计算。然而，保健制度、报销规则和其他非质量相关因素的差异可能会损害这些指标的可比性。然而，在国际比较中几乎没有考虑到一个可能的非质量相关因素。值得怀疑的是，在不同国家的行政医院数据中，关注的治疗病例是否以相同的方式作为住院患者采集。例如，在德国医院数据中被计为住院病人的短期护理治疗事件（例如，由于到达后数小时内死亡），在其他卫生保健系统中可能被计为急诊室病例。因此，这些患者将在行政住院医院数据中缺失。这个问题可能会影响急性心肌梗死的死亡率指标，因为这些患者在到达医院后的前24小时内死亡的风险最高。本项目的目的是研究急性心肌梗死后医院死亡率的国际差异是否受到因各自医疗保健系统不同报销模式而导致的治疗病例差异的影响。出于数据可用性的原因，将针对德国和美国的情况分析研究问题。通过这种方式，该项目将首次考虑可能影响急性心肌梗塞后死亡率国际可比性的重要因素。

Survival of patients who experience an acute myocardial infarction crucially depends on timely and guideline-compliant care at a health care facility with appropriate staffing and equipment. This is why mortality following acute myocardial infarction is used as a quality indicator in international comparisons, indicating the effectiveness of processes of care.According to the OECD Health Care Indicators Project the age-and-sex standardized 30-day mortality following acute myocardial infarction is higher in Germany when compared to the US, France, Italy or Scandinavian countries. These differences might indicate shortcomings in the German health care system. For instance, there is some evidence that the allocation of patients with symptoms of acute myocardial infarction to appropriate health care facilities is not optimally managed in Germany. In contrast, the German health care system is characterized by a comparatively high density of acute care hospitals, as well as a high number of left heart catheter facilities.The OECD quality indicators on hospital mortality are calculated by using administrative data which are generated during the processes of hospitals care. However, differences in health care systems, reimbursement rules and other non-quality-related factors might impair the comparability of such indicators. One possible non-quality-related factor has hardly been considered in international comparisons, yet. It is questionable, if treatment cases of interest are captured as inpatients in administrative hospital data in the same way in different countries. For instance, treatment episodes with a short duration of care (e.g. because of death within hours after arrival), which are counted as inpatients in German hospital data, might in other health care systems be counted as emergency ward cases. As a result, these patients would be missing in the administrative inpatient hospital data. This issue might, in particular, affect mortality measures for acute myocardial infarction because in those patients the risk of death is highest within the first 24 hours after arrival in hospital.The aim of this project is to study if international differences of hospital mortality following acute myocardial infarction are influenced by differences in capturing treatment cases due to varying modes of reimbursement in the respective health care systems. For the reason of data availability the research question will be analyzed for the case of Germany and the US. By this means the project will consider important factors which might impair the international comparability of mortality following acute myocardial infarction for the first time.