Identifying high-impact-opportunity hospitals for improving healthcare quality based on a national population analysis of inter-hospital variation in mortality, readmissions and prolonged length of stay

Figures

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  Figure 1. Hospital variation in in-hospital mortality, 30-day readmissions and prolonged length of stay across 19 Major Diagnostic Categories (MDCs). The median OR represents the odds for a randomly chosen patient in a high-risk hospital compared with a similar patient (ie, with the same fixed effects) in a low-risk hospital. MDCs are ordered by MDC number. Abbreviations: CI, confidence interval; IQR, interquartile range; NE, not estimable; MOR, median OR; pLOS, prolonged length of stay; RSR, risk-standardised rate. aBased on the model including only patient characteristics (model 1). bTotal number of hospitals (number with RSR significantly lower than expected - number with RSR significantly higher than expected), based on model 1. cSignificance of the variation in risk across hospitals (testing whether the random hospital effect differs from zero): *p<0.05, **p<0.01, ***p<0.001 Note: Results are not presented for models in which the random hospital effect was estimated to be zero (indicated as NE).

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  Figure 2. The annual number of observed deaths, readmissions and prolonged length of stay and estimated deaths, readmissions and prolonged length of stay (pLOS) among Major Diagnostic Categories (MDCs) if outcomes in hospitals with risk-standardised outcome rates in the upper quartile would be reduced to the median value. Results are based on the risk-standardised mortality, readmissions and pLOS distribution estimated by the model including only patient characteristics. Numbers at the bottom of the figure represent the annual MDC-specific number of admissions and cases saved in hospitals with risk-adjusted mortality, readmission and pLOS, respectively, in the upper quartile. The percentage of cases saved is calculated relative to the number of risk-adjusted observed deaths, readmissions and pLOS in those hospitals.

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  Figure 3. The combined number of Major Diagnostic Categories (MDCs) categorised within the upper-quartile category for standardised mortality, readmissions and prolonged length of stay between 2016 and 2018 for individual hospitals in Belgium, in descending order.