Mortality, readmission and length of stay have different relationships using hospital-level versus patient-level data: an example of the ecological fallacy affecting hospital performance indicators
| Autor: | Leti van Bodegom-Vos, Perla J Marang-van de Mheen, Ewout W. Steyerberg, Stefanie N. Hofstede, Dionne S. Kringos |
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| Přispěvatelé: | Public Health, APH - Aging & Later Life, Public and occupational health, APH - Quality of Care, APH - Global Health |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Gerontology Databases Factual continuous quality improvement quality measurement Logistic regression Hospital performance Patient Readmission 03 medical and health sciences 0302 clinical medicine Case mix index medicine Humans Hospital Mortality Registries 030212 general & internal medicine Myocardial infarction Ecological fallacy Stroke Diagnosis-Related Groups Aged Netherlands Quality Indicators Health Care Aged 80 and over 030222 orthopedics business.industry Health Policy Hospital level Length of Stay Middle Aged medicine.disease mortality (standardized Mortality Ratios) Logistic Models Patient level data Female business healthcare quality improvement Demography |
| Zdroj: | BMJ Quality & Safety, 27(6), 474-483 BMJ Quality & Safety, 27(6), 474-483. BMJ Publishing Group BMJ quality & safety, 27(6), 474-483. BMJ Publishing Group |
| ISSN: | 1475-3901 2044-5415 2044-5423 |
| Popis: | BackgroundEcological fallacy refers to an erroneous inference about individuals on the basis of findings for the group to which those individuals belong. Suppose analysis of a large database shows that hospitals with a high proportion of long length of stay (LOS) patients also have higher than average in-hospital mortality. This may prompt efforts to reduce mortality among patients with long LOS. But patients with long LOS may not be the ones at higher risk of death. It may be that hospitals with higher mortality (regardless of LOS) also have more long LOS patients—either because of quality problems on both counts or because of unaccounted differences in case mix. To provide more insight how the ecological fallacy influences the evaluation of hospital performance indicators, we assessed whether hospital-level associations between in-hospital mortality, readmission and long LOS reflect patient-level associations.MethodsPatient admissions from the Dutch National Medical Registration (2007–2012) for specific diseases (stroke, colorectal carcinoma, heart failure, acute myocardial infarction and hip/knee replacements in patients with osteoarthritis) were analysed, as well as all admissions. Logistic regression analysis was used to assess patient-level associations. Pearson correlation coefficients were used to quantify hospital-level associations.ResultsOverall, we observed 2.2% in-hospital mortality, 8.1% readmissions and a mean LOS of 5.9 days among 8 478 884 admissions in 95 hospitals. Of the 10 disease-specific associations tested, 2 were reversed at hospital-level, 3 were consistent and 5 were only significant at either hospital-level or patient-level. A reversed association was found for stroke: patients with long LOS had 58% lower in-hospital mortality (OR 0.42 (95% CI 0.40 to 0.44)), whereas the hospital-level association was reversed (r=0.30, pConclusionsHospital-level associations did not reflect the same patient-level associations in 7 of 10 associations, and were even reversed in 2 associations. Ecological fallacy thus potentially influences interpretation of hospital performance when patient-level associations are not taken into account. |
| Databáze: | OpenAIRE |
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