A critical review of research on hospital mortality among medical–surgical and acute myocardial infarction patients

Abstract

Research results reporting the relationships of hospital structural characteristics to inpatient mortality for medical–surgical and Acute Myocardial Infarction patients are inconclusive. Hospital characteristics thought to be significantly associated with mortality are: percentage of board‐certified physicians, the hospital's teaching status, and technological resource availability. Yet studies of these characteristics have yielded mixed results. Only Registered Nurse ratios (measures of Registered Nurse hours per patient days or per patient) have been shown to be consistently (and inversely) associated with mortality. However, far fewer studies have examined the impact of this variable and design weaknesses, including the absence of a conceptual framework to guide the selection of a given study's explanatory variables, have hindered those that have. Further, inconsistencies, indeed clear contradictions, in these studies’ findings (with the exception of nurse ratios) necessitate further analysis of both research methods and interpretation of results. Such analyses must occur to promote advances in research design and methodology in studies of inpatient mortality.

Adoption of high technology medical imaging and hospital quality and efficiency: Towards a conceptual framework

“…These elements were obtained from Hearld et al (2008), who comprehensively reviewed the literature to assess how hospital organizational structure and processes affect quality of care. Most determinants reported in this review are also consistent with similar reviews previously published . Largely, frequent structural elements identified by Hearld et al (2008) have also been reported in the literature on adoption.…”

“…One of the most frequently reported outcomes of medical care is mortality (or risk‐adjusted mortality). It has been extensively used to assess and validate the quality of hospital care . Length of stay is also a common outcome of interest and is typically studied in models with similar predictors as for mortality .…”

“…Although not reported in the review by Hearld et al (2008), 3 additional determinants of quality reported in the literature on adoption were also included: financial performance, market competition, and physician supply. Financial performance has been reported in previous reviews of hospital quality, and was considered relevant to this framework because of the high price tag attached to high technology imaging devices . Market competition has been extensively investigated in the literature on adoption and that on health care quality and costs .…”

“…In the literature on quality of hospital care, organizational (or hospital) size is also a commonly studied determinant . However, the causal relationship between hospital size and quality is not yet fully understood.…”

“…For example, the presence of high technology medical imaging in hospitals has been recognized as critical to attract highly qualified physicians and other leading care providers . They in turn play an important role in the quality and efficiency of the care provided to patients because of the direct influence and control physicians and nurses have over the practice environment and patient care . This example, which underlies a potential mechanism by which adoption influences quality and efficiency in hospitals, highlights the need and opportunity to study the value of imaging within a broader conceptual framework or model.…”