Potential of Electronic Medical Record Data for National Quality Measurement

Bernet, Niklaus S; Thomann, Silvia; Kurpicz-Briki, Mascha; Roos, Leonie; Everink, Irma H. J.; Schols, Jos M. G. A.; Hahn, Sabine

doi:10.3233/shti220320

Cited by 2 publications

(3 citation statements)

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“…In this respect, electronic medical record data could in future provide a suitable data basis for national monitoring of inpatient falls over time, including risk adjustment. 64 However, further research is required.…”

Section: Discussionmentioning

confidence: 99%

Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study

Bernet,

Everink,

Hahn

et al. 2024

BMJ Open

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ObjectivesThis study aimed to investigate whether a significant trend regarding inpatient falls in Swiss acute care hospitals between 2011 and 2019 could be confirmed on a national level, and whether the trend persists after risk adjustment for patient-related fall risk factors.DesignA secondary data analysis was conducted based on annual multicentre cross-sectional studies carried out between 2011 and 2019.SettingAll Swiss acute care hospitals were obliged to participate in the surveys. Except for emergency departments, outpatient wards and recovery rooms, all wards were included.ParticipantsAll inpatients aged 18 or older who had given their informed consent and whose data were complete and available were included.Outcome measureWhether a patient had fallen in the hospital was retrospectively determined on the survey day by asking patients the following question: Have you fallen in this institution in the last 30 days?ResultsBased on data from 110 892 patients from 222 Swiss hospitals, a national inpatient fall rate of 3.7% was determined over the 9 survey years. A significant linear decreasing trend (p=0.004) was observed using the Cochran-Armitage trend test. After adjusting for patient-related fall risk factors in a two-level random intercept logistic regression model, a significant non-linear decreasing trend was found at the national level.ConclusionsA significant decrease in fall rates in Swiss hospitals, indicating an improvement in the quality of care provided, could be confirmed both descriptively and after risk adjustment. However, the non-linear trend, that is, an initial decrease in inpatient falls that flattens out over time, also indicates a possible future increase in fall rates. Monitoring of falls in hospitals should be maintained at the national level. Risk adjustment accounts for the observed increase in patient-related fall risk factors in hospitals, thus promoting a fairer comparison of the quality of care provided over time.

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Section: Discussionmentioning

confidence: 99%

Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study

Bernet,

Everink,

Hahn

et al. 2024

BMJ Open

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“…In order to be able to substantiate or refute the speculations, a more comprehensive application of the risk adjustment model to international data sets from several countries is recommended. A basic prerequisite is that the hospitals and countries included in the international comparison ensure and adhere to a uniform approach to data collection as well as the precise definition and operationalisation of key variables in order to exclude or at least minimise systematic bias in the underlying data [ 3 , 13 , 14 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…First, despite recent developments such as defined core outcome sets [ 12 ], an internationally standardised data collection procedure is often lacking. This results in the absence of uniformly collected data [ 3 , 13 ]; for example, if the information is based on primary data collection in one country or on routine data in another country [ 14 , 15 ]. Second, internationally standardised definitions are frequently not applied [ 3 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing risk-adjusted inpatient fall rates internationally: validation of a risk-adjustment model using multicentre cross-sectional data from hospitals in Switzerland and Austria

Bernet,

Everink,

Hahn

et al. 2024

BMC Health Serv Res

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Background Inpatient falls in hospitals are an acknowledged indicator of quality of care. International comparisons could highlight quality improvement potential and enable cross-national learning. Key to fair cross-national comparison is the availability of a risk adjustment model validated in an international context. This study aimed to 1) ascertain that the variables of the inpatient fall risk adjustment model do not interact with country and thus can be used for risk adjustment, 2) compare the risk of falling in hospitals between Switzerland and Austria after risk adjustment. Methods The data on inpatient falls from Swiss and Austrian acute care hospitals were collected on a single measurement day in 2017, 2018 and 2019 as part of an international multicentre cross-sectional study. Multilevel logistic regression models were used to screen for interaction effects between the patient-related fall risk factors and the countries. The risks of falling in hospital in Switzerland and in Austria were compared after applying the risk-adjustment model. Results Data from 176 hospitals and 43,984 patients revealed an inpatient fall rate of 3.4% in Switzerland and 3.9% in Austria. Two of 15 patient-related fall risk variables showed an interaction effect with country: Patients who had fallen in the last 12 months (OR 1.49, 95% CI 1.10–2.01, p = 0.009) or had taken sedatives/psychotropic medication (OR 1.40, 95% CI 1.05–1.87, p = 0.022) had higher odds of falling in Austrian hospitals. Significantly higher odds of falling were observed in Austrian (OR 1.38, 95% CI 1.13–1.68, p = 0.002) compared to Swiss hospitals after applying the risk-adjustment model. Conclusions Almost all patient-related fall risk factors in the model are suitable for a risk-adjusted cross-country comparison, as they do not interact with the countries. Further model validation with additional countries is warranted, particularly to assess the interaction of risk factors “fall in the last 12 months” and “sedatives/psychotropic medication intake” with country variable. The study underscores the crucial role of an appropriate risk-adjustment model in ensuring fair international comparisons of inpatient falls, as the risk-adjusted, as opposed to the non-risk-adjusted country comparison, indicated significantly higher odds of falling in Austrian compared to Swiss hospitals.

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Potential of Electronic Medical Record Data for National Quality Measurement

Cited by 2 publications

References 4 publications

Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study

Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study

Comparing risk-adjusted inpatient fall rates internationally: validation of a risk-adjustment model using multicentre cross-sectional data from hospitals in Switzerland and Austria

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