Abstract
Monitoring of hospital performance is increasingly used in the process of improving the quality of health care. Various approaches to quality assessment and publication of the results are discussed. Therefore, a method acceptable for clinicians in the hospitals is urgently needed. As the case mix of the patients differs considerably across hospitals, any assessment based on outcome measures has to be adjusted for the patients’ risk profiles. We use a method of calculation and presentation that relates the observed complication rate of one centre to the mean rate that would be expected for similar patients in the other centres. We argue that this procedure might especially meet the demands of clinicians in the centres. Data from 44 hospitals in the German Cypher Stent Registry are used to exemplify the proposed procedure.
Results
A large variation in the cumulative incidence of MACE within 6 months (range 0–12.2%) as well as in the prevalence of selected risk factors was observed across hospitals. Using a logistic prediction model, the differences in risk profiles of the patient populations in the centres resulted in a wide range of expected MACE rates (2.55–5.44%). The outcome of seven centres differed significantly from the expectation.
Conclusion
In comparisons of the outcome quality of hospitals, adjustment for the patients’ baseline risk by an appropriate method is indispensable.
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References
Bruckenberger E (2006) Herzbericht 2005 mit Transplantationschirurgie, Hannover
Bundesgeschäftsstelle Qualitätssicherung gGmbH (2006) Qualität sichtbar machen. BQS-Qualitätsreport 2005, Düsseldorf
Iezzoni LI (2003) Getting started and defining terms. In: Iezzoni LI (ed) Risk adjustment for measuring health care outcomes, 3rd edn. Health Administration Press, Chicago, IL, pp 17–32
Zahn R, Hamm CW, Zeymer U, Schneider S, Nienaber CA, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Schobel WA, Sabin G, Senges J (2004) “Real life” use of sirolimus- eluting coronary stents in Germany. Results from the prospective multi-centre German Cypher Registry. Z Kardiol 93:287–294
Zahn R, Hamm CW, Zeymer U, Schneider S, Nienaber CA, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Schobel WA, Sabin G, Senges J (2004) Aktuelle Indikationsstellung und Sicherheit beim Einsatz des koronaren Sirolimus-Stents im klinischen Alltag in Deutschland. Herz 29:181–186
Zahn R, Hamm CW, Schneider S, Zeymer U, Nienaber CA, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Sabin G, Senges J (2005) Incidence and predictors of target vessel revascularization and clinical event rates of the sirolimus-eluting coronary stent (results from the prospective multicenter German Cypher Stent Registry). Am J Cardiol 95:1302–1308
Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. John Wiley & Sons, New York etc.
Goldstein H, Spiegelhalter DJ (1996) League tables and their limitations: statistical issues in comparisons of institutional performance. J Royal Stat Soc A 159:385–443
Marshall EC, Spiegelhalter DJ (1998) Reliability of league tables of in vitro fertilisation clinics: retrospective analysis of live birth rates. BMJ 316:1701–1704
Shwartz M, Ash AS (2003) Evaluating risk-adjustment models empirically. In: Iezzoni LI (ed) Risk adjustment for measuring health care outcomes, 3rd edn. Health Administration Press, Chicago, IL, pp 231–273
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Hochadel, M., Schneider, S., Gottwik, M. et al. Evaluation of hospitals regarding outcomes and baseline risk. Clin Res Cardiol 96, 502–507 (2007). https://doi.org/10.1007/s00392-007-0529-5
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DOI: https://doi.org/10.1007/s00392-007-0529-5