Trends in 1-year survival of people admitted to hospital in Ontario, 1994–2009

Abstract

H ospitals have a special place in most health care systems. Hospital staff care for the people with the most serious illnesses and the most vulnerable. They are frequently the location of many life-defining moments -including birth, surgery, acute medical illness and death -of many people and their families. Hospitals serve as a focus in the training of most physicians. In addition, they consume a considerable proportion of health care expenditures worldwide. 1Given the prominence of hospitals in health care systems, measuring outcomes related to hospital care is important. In particular, the measurement of trends for outcomes of hospital care can help us to infer whether the care provided to hospital patients is improving. Previous such studies have focused on survival trends for specific diseases or patients who received treatment in specific departments.2-12 None of these studies have adjusted for survival trends in the general population, the adjustment for which is important to determine whether changes in survival of patients in hospital merely reflect changes in the overall population. In this study, whether or not patient outcomes have changed over time was determined by examining trends in 1-year survival in all patients admitted to hospital, adjusting for improved survival in the general population. Methods Study design and data sourcesThis study used 2 population-based administrative databases to identify patients admitted to hospital in Ontario during the study period: the Discharge Abstract Database, which records demographic and diagnostic information on all nonpsychiatric admissions to hospital, and the Registered Persons Database, which records the date of death for all residents of Ontario. Study period and populationPopulation life tables for Ontario were used to measure trends in 1-year survival of adults admitted to hospital relative to the general population. At the time of the study, 2009 was the latest year for which life tables were available. To measure Trends in 1-year survival of people admitted to hospital in Ontario,

The risk of death within 5 years of first hospital admission in older adults

“…In that study, adults older than 65 years had an associated 6-to 25-fold increased odds of death compared with adults aged 20-25 years. 4 None of these studies measured the risk of death after a first hospital admission (none of the patients in our study had been admitted in the previous 5 years) in a cohort of older adults. Therefore, the findings from these studies may be heavily influenced by patients with multiple comorbidities and repeated hospital admissions, and do not directly apply to a population of healthier people like those in our study.…”

“…In all groups, we also measured the risk of death stratified by 5-year age intervals. 4 We reported a person's cause of death and grouped it according to a modified form of Becker's leading cause of death. 24 Secondary outcomes, which were intended to generate new hypotheses, included risk of death at 5 years using case-mix grouping to categorize admission diagnoses into those managed as a medical or surgical condition; the total number of emergency department visits, hospital admissions and admissions to the intensive care unit (ICU) for each group during the follow-up period; and risk of death at 5 years in a subset with noncancer diagnoses after their first unplanned hospital admission or visit to the emergency department (see Appendix 1, Table S4, for the complete list of diagnoses).…”

“…We studied a cohort of older adults because the annual risk of death after any hospital admission substantially increases beyond the age of 70 years. 4 Furthermore, conventional comorbidity indices rely on hospital records. Because our study included people without previous hospital admission, we were unable to use these comorbidity indices.…”

The utility of a shortened palliative care screening tool to predict death within 12 months – a prospective observational study in two South African hospitals with a high HIV burden

“…Hospitalisation is an important medical encounter that increases the chance of identifying patients in the last year of life. Previous publications have shown that 12-35% of patients admitted to hospital will die within 12 months of admission [8][9][10][11][12]. Mortality risk assessment models for single diagnoses are often used by hospital specialists but are of limited value since most patients are admitted with advanced, long-term conditions which are multimorbid in nature [13].…”

The utility of a shortened palliative care screening tool to predict death within 12 months – a prospective observational study in two South African hospitals with a high HIV burden

“…Previous publications have shown that 12-35% of patients admitted to hospital will die within 12 months of admission. [8][9][10][11][12] Mortality risk assessment models for single diagnoses are often used by hospital specialists but are of limited value since most patients are admitted with advanced, long-term conditions which are multimorbid in nature. 13 Walsch et al 14 reviewed the four widely used tools in General Practice; three of those, the Gold Standards Framework Prognostic Indicator Guidance (GSF-PIG), 15 the Supportive and Palliative Indicators Tool (SPICT) 16 and the Palliative Necessities CCOMS-ICO (NECPAL) 17 have been tested in hospital populations and have been shown to increase early identification of patients, potentially leading to more proactive care of patients who have palliative care needs.…”