Variations in the Hospital Standardized Mortality Ratios in Korea
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...
Main Authors: | , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Korean Society for Preventive Medicine
2014-07-01
|
Series: | Journal of Preventive Medicine and Public Health |
Subjects: | |
Online Access: | http://www.jpmph.org/upload/pdf/jpmph-47-4-206.pdf |
id |
doaj-16597a7bdd91488797333178e40eb25c |
---|---|
record_format |
Article |
spelling |
doaj-16597a7bdd91488797333178e40eb25c2020-11-25T00:21:41ZengKorean Society for Preventive MedicineJournal of Preventive Medicine and Public Health1975-83752233-45212014-07-0147420621510.3961/jpmph.2014.47.4.2061788Variations in the Hospital Standardized Mortality Ratios in KoreaEun-Jung Lee0Soo-Hee Hwang1Jung-A Lee2Yoon Kim3 Medical Affairs, Janssen, Seoul, Korea Health Insurance Review & Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Korea Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, KoreaObjectives: 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.http://www.jpmph.org/upload/pdf/jpmph-47-4-206.pdfQuality of health careOutcome assessmentHospital mortality |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eun-Jung Lee Soo-Hee Hwang Jung-A Lee Yoon Kim |
spellingShingle |
Eun-Jung Lee Soo-Hee Hwang Jung-A Lee Yoon Kim Variations in the Hospital Standardized Mortality Ratios in Korea Journal of Preventive Medicine and Public Health Quality of health care Outcome assessment Hospital mortality |
author_facet |
Eun-Jung Lee Soo-Hee Hwang Jung-A Lee Yoon Kim |
author_sort |
Eun-Jung Lee |
title |
Variations in the Hospital Standardized Mortality Ratios in Korea |
title_short |
Variations in the Hospital Standardized Mortality Ratios in Korea |
title_full |
Variations in the Hospital Standardized Mortality Ratios in Korea |
title_fullStr |
Variations in the Hospital Standardized Mortality Ratios in Korea |
title_full_unstemmed |
Variations in the Hospital Standardized Mortality Ratios in Korea |
title_sort |
variations in the hospital standardized mortality ratios in korea |
publisher |
Korean Society for Preventive Medicine |
series |
Journal of Preventive Medicine and Public Health |
issn |
1975-8375 2233-4521 |
publishDate |
2014-07-01 |
description |
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. |
topic |
Quality of health care Outcome assessment Hospital mortality |
url |
http://www.jpmph.org/upload/pdf/jpmph-47-4-206.pdf |
work_keys_str_mv |
AT eunjunglee variationsinthehospitalstandardizedmortalityratiosinkorea AT sooheehwang variationsinthehospitalstandardizedmortalityratiosinkorea AT jungalee variationsinthehospitalstandardizedmortalityratiosinkorea AT yoonkim variationsinthehospitalstandardizedmortalityratiosinkorea |
_version_ |
1725361471002509312 |