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Risk-standardized mortality metric to monitor hospital performance for chest pain presentations.
Dawson, Luke P; Andrew, Emily; Nehme, Ziad; Bloom, Jason; Okyere, Daniel; Cox, Shelley; Anderson, David; Stephenson, Michael; Lefkovits, Jeffrey; Taylor, Andrew J; Kaye, David; Smith, Karen; Stub, Dion.
Afiliación
  • Dawson LP; Department of Cardiology, The Alfred Hospital, Melbourne, VIC 3004, Australia.
  • Andrew E; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
  • Nehme Z; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, VIC 3050, Australia.
  • Bloom J; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
  • Okyere D; Centre for Research & Evaluation, Ambulance Victoria, Melbourne, VIC 3130, Australia.
  • Cox S; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
  • Anderson D; Centre for Research & Evaluation, Ambulance Victoria, Melbourne, VIC 3130, Australia.
  • Stephenson M; Department of Paramedicine, Monash University, Melbourne, VIC 3199, Australia.
  • Lefkovits J; Department of Cardiology, The Alfred Hospital, Melbourne, VIC 3004, Australia.
  • Taylor AJ; Heart Failure Research Group, The Baker Institute, Melbourne, VIC 3004, Australia.
  • Kaye D; Centre for Research & Evaluation, Ambulance Victoria, Melbourne, VIC 3130, Australia.
  • Smith K; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
  • Stub D; Centre for Research & Evaluation, Ambulance Victoria, Melbourne, VIC 3130, Australia.
Eur Heart J Qual Care Clin Outcomes ; 9(6): 583-591, 2023 09 12.
Article en En | MEDLINE | ID: mdl-36195327
AIMS: Risk-standardized mortality rates (RSMR) have been used to monitor hospital performance in procedural and disease-based registries, but limitations include the potential to promote risk-averse clinician decisions and a lack of assessment of the whole patient journey. We aimed to determine whether it is feasible to use RSMR at the symptom-level to monitor hospital performance using routinely collected, linked, clinical and administrative data of chest pain presentations. METHODS AND RESULTS: We included 192 978 consecutive adult patients (mean age 62 years; 51% female) with acute chest pain without ST-elevation brought via emergency medical services (EMS) to 53 emergency departments in Victoria, Australia (1/1/2015-30/6/2019). From 32 candidate variables, a risk-adjusted logistic regression model for 30-day mortality (C-statistic 0.899) was developed, with excellent calibration in the full cohort and with optimism-adjusted bootstrap internal validation. Annual 30-day RSMR was calculated by dividing each hospital's observed mortality by the expected mortality rate and multiplying it by the annual mean 30-day mortality rate. Hospital performance according to annual 30-day RSMR was lower for outer regional or remote locations and at hospitals without revascularisation capabilities. Hospital rates of angiography or transfer for patients diagnosed with non-ST elevation myocardial infarction (NSTEMI) correlated with annual 30-day RSMR, but no correlations were observed with other existing key performance indicators. CONCLUSION: Annual hospital 30-day RSMR can be feasibly calculated at the symptom-level using routinely collected, linked clinical, and administrative data. This outcome-based metric appears to provide additional information for monitoring hospital performance in comparison with existing process of care key performance measures.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Dolor en el Pecho / Hospitales Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: Oceania Idioma: En Revista: Eur Heart J Qual Care Clin Outcomes Año: 2023 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Dolor en el Pecho / Hospitales Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: Oceania Idioma: En Revista: Eur Heart J Qual Care Clin Outcomes Año: 2023 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido