Hospital quality measures: are process indicators associated with hospital standardized mortality ratios in French acute care hospitals?

Abstract

BackgroundResults of associations between process and mortality indicators, both used for the external assessment of hospital care quality or public reporting, differ strongly across studies. However, most of those studies were conducted in North America or United Kingdom. Providing new evidence based on French data could fuel the international debate on quality of care indicators and help inform French policy-makers. The objective of our study was to explore whether optimal care delivery in French hospitals as assessed by their Hospital Process Indicators (HPIs) is associated with low Hospital Standardized Mortality Ratios (HSMRs).MethodsThe French National Authority for Health (HAS) routinely collects for each hospital located in France, a set of mandatory HPIs. Five HPIs were selected among the process indicators collected by the HAS in 2009. They were measured using random samples of 60 to 80 medical records from inpatients admitted between January 1st, 2009 and December 31, 2009 in respect with some selection criteria. HSMRs were estimated at 30, 60 and 90 days post-admission (dpa) using administrative health data extracted from the national health insurance information system (SNIIR-AM) which covers 77% of the French population. Associations between HPIs and HSMRs were assessed by Poisson regression models corrected for measurement errors with a simulation-extrapolation (SIMEX) method.ResultsMost associations studied were not statistically significant. Only two process indicators were found associated with HSMRs. Completeness and quality of anesthetic records was negatively associated with 30 dpa HSMR (0.72 [0.52–0.99]). Early detection of nutritional disorders was negatively associated with all HSMRs: 30 dpa HSMR (0.71 [0.54–0.95]), 60 dpa HSMR (0.51 [0.39–0.67]) and 90 dpa HSMR (0.52 [0.40–0.68]).ConclusionIn absence of gold standard of quality of care measurement, the limited number of associations suggested to drive in-depth improvements in order to better determine associations between process and mortality indicators. A smart utilization of both process and outcomes indicators is mandatory to capture aspects of the hospital quality of care complexity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2534-3) contains supplementary material, which is available to authorized users.

Analysis of Structure Indicators Influencing 3-h and 6-h Compliance with the Surviving Sepsis Campaign Guidelines in China: A Systematic Review

“…The higher that the predicted mortality rate is, the higher that the proportion of patients admitted to the ICU with severe diseases is. The lower that the standardized mortality ratio is, the higher that the diagnosis and treatment level in the ICU is (8)(9)(10). The combination of the above two indicators can fully re ect the medical level of an ICU.…”

What is the relationship between mortality alerts and other indicators of quality of care? A national cross-sectional study

“…Other studies have also found little evidence of an association between quality process measures and mortality outcomes. 29,30…”

“…Our findings of associations between mortality alerts and other quality measures is supported by further work. 31,32 This study is part of a larger project, which also investigated findings by the English health care regulator into alerting trusts. This found that the majority of alerting trusts carried out audits to explore the higher than expected mortality and that quality of care problems were found in 69% of alerts investigated by the regulator.…”

“…Our statistical approach to investigate the association between mortality alerts and other quality measure outcomes used OLS regression with White-Huber robust standard errors to predict an unbiased estimator. Other authors 30 have used Poisson regression (with a simulation extrapolation method applied to correct for measurement error) to assess the association between health care processes indicators and HSMRs but both approaches are appropriate.…”

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“…Second, while all‐cause mortality is a common indicator of healthcare quality (Diley et al., 2014; Ngantcha et al., 2017), it has been criticized by several scholars for its lack of sensitivity to nursing interventions (Audet et al., 2018; Stalpers et al., 2015), which may also have contributed to the aforementioned inconsistencies. To address this limitation and better elucidate the mechanisms by which nursing contributes to safer patient care, many have called for greater research attention to ‘nursing‐sensitive’ AEs (i.e., AEs that can plausibly be linked to lapses in nursing interventions potentially attributable to suboptimal staffing practices) (Sim et al., 2018; Stalpers et al., 2016).…”