Variations in the Hospital Standardized Mortality Ratios in Korea

Abstract

Objectives:The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care.Methods:All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities.Results:For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR.Conclusions:We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.

Functional training and timed nutrition intervention in infectious medical patients

“…We found the system easy to use and also very relevant for the population. 47 Compared with historical data, the intervention significantly improved energy and protein intake. The individualized energy and protein supplement recommended to both groups in relation to training, and individual dietetic guidance for patients, thereby proved to be efficient.…”

“…47 Ethical considerations Before inclusion, the patients were given written and oral information about the study. The participants were informed that they could withdraw from participation at any time during the study.…”

Why do patients prefer tertiary hospitals?

“…As such, "consumer value" in uences the behavior of individuals and is de ned more comprehensively than concepts such as opinions, beliefs, attitudes, and interests [13]. Values are constant in the short term, serve as an internal standard for behavioral selection, and play a role in justifying the behavior, accordingly which has an organic relationship with consumers' actual behavior [14,15]. If the value system is similar, the results of the behavior will also be similar; therefore, understanding consumer values can help predict consumer behavior [16].…”

Differences in trends in discharge location in a cohort of hospitalized patients with cancer and non-cancer diagnoses receiving specialist palliative care: A retrospective cohort study

“…In-hospital mortality has been used internationally as a quality indicator of acute care. [12][13][14][15][16][17][18][19][20] Though in-hospital mortality has limitations as an indicator of care quality, it lends itself to being systematically collected over time, and can serve as an entry point to evaluate care quality, 21 in combination with other quantitative and qualitative metrics. 22,23 Multiple studies have evidenced that most patients with and without cancer do not prefer to die in hospital.…”