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

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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.