Key result
60- and 90-day hospital standardized mortality ratios misclassified fewer in-hospital deaths as survivors than the 30-day HSMR (1.5% and 0.5% vs 7.8%), while maintaining strong correlation (r=0.92).
Why the study?
Do 60- and 90-day postadmission HSMRs better capture in-hospital deaths compared to 30-day HSMRs?
Observational (n=11,500,000)
Yes
Do 60- and 90-day postadmission HSMRs better capture in-hospital deaths compared to 30-day HSMRs?
Effect estimate: Pearson coefficient 0.92
The 60- and 90-day HSMRs encompass in-hospital deaths better than the 30-day HSMR while capturing the same interhospital variations, suggesting they should be preferred for hospital quality assessment.
60- and 90-day HSMRs may better capture hospital deaths than 30-day measures; leaves open optimal timeframe for quality benchmarking.
BACKGROUND: In-hospital mortality is widely used to judge the quality of hospital care, but is biased by discharge patterns. Fixed-timeframe indicators have thus been recommended. However, the 30-day postadmission indicator may underestimate hospital-wide mortality, as patients dying in hospital >30 days after admission are considered as survivors. OBJECTIVES: To identify the most relevant timeframes and to assess the contribution of cause-of-death data. METHODS: The 2009 French hospital discharge database was linked to vital status records and to the causes of death register for 11.5 million hospital stays by beneficiaries of French general health insurance. Correlations and agreements between the 30-day hospital standardized mortality ratio (HSMR) and the in-hospital, 60-, 90-, 180-, and 365-day postadmission HSMRs were estimated. RESULTS: A total of 7.8%, 1.5%, and 0.5% of patients who died during their hospital stay were considered as survivors by the 30-, 60-, and 90-day HSMRs, respectively. The 30-day HSMR correlated strongly with the 60-day HSMR (Pearson coefficient=0.92), and their agreement on outlier status was excellent (κ coefficient=0.80). The association remained substantial at 90 days, but weakened at 180 days and even more so at 365 days. Regardless of the timeframe, exclusion of deaths likely due to independent causes barely modified the indicators. CONCLUSIONS: This nationwide study shows that 60- and 90-day HSMRs encompass in-hospital deaths better than the 30-day HSMR, while capturing the same interhospital variations. They should thus be preferred. The contribution of cause-of-death data to hospital-wide indicators seems negligible.
No takes yet. Share an insight, caveat, or question.
Lamarche‐Vadel et al. (2015) conducted an observational in Hospital admission (n=11,500,000). 60- and 90-day hospital standardized mortality ratios vs. 30-day hospital standardized mortality ratio was evaluated on Correlation and agreement between 30-day HSMR and longer timeframe HSMRs (Pearson coefficient 0.92). 60- and 90-day hospital standardized mortality ratios misclassified fewer in-hospital deaths as survivors than the 30-day HSMR (1.5% and 0.5% vs 7.8%), while maintaining strong correlation (r=0.92).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: